Quality assessment of weekend discharge: a systematic review and meta-analysis.

PURPOSE: Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. DATA SOURCES: PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. STUDY SELECTION: Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. DATA EXTRACTION: Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. RESULTS OF DATA SYNTHESIS: There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. CONCLUSION: In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.

Initial Emergency Department Visit and Follow-Up Care for Concussions among Children with Medicaid.

OBJECTIVE: To describe the rates and patterns of initial emergency department (ED) encounters and follow-up care for concussions among Medicaid-insured children before and after the 2013 enactment of Ohio concussion law. STUDY DESIGN: Using a time-series design, this study analyzed concussion claim data obtained from Partners for Kids, a pediatric accountable-care organization in Ohio. A total of 12 512 concussions and 48 238 associated claims for services between January 1, 2008, and June 30, 2017, with an initial ED encounter among Medicaid-insured children (ages 0-18 years) were analyzed. The effect of the law on the odds of follow-up care were assessed using generalized estimating equations models, adjusted for sex, age group, and residence location. RESULTS: Of the total 12 512 concussions, 63.9% occurred in male patients, 70.1% in patients ages 10-18 years, and 65.2% in patients from urban areas. The rate of initial ED encounters for concussions increased from 2008 to 2014 (2.8 to 4.9 per 10 000 members), followed by a decrease in 2016 (4.2 per 10 000 members). A significant increase in follow-up care after the initial ED encounter was observed from pre-law to post-law (OR 1.73, 95% CI 1.61, 1.86). A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law. CONCLUSIONS: The Ohio concussion law may have influenced the patterns of initial ED visit and follow-up care for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types.

A guide to community mental health law for district nurses: the right to aftercare.

District nurses frequently provide physical care and treatment to patients in their own homes and care homes who have previously been detained under the Mental Health Act 1983 for the treatment of a mental illness. Such patients are commonly subject to community provisions of the Mental Health Act 1983 and it is important that districts nurses are aware of the implications of these provisions on the patients care and support. In this article the author considers a detained mental health patient's right to aftercare under the Mental Health Act 1983, section 117.

The right to aftercare: identifying the responsible bodies.

In the second article on the right to aftercare under the Mental Health Act 1983 , section 117, Richard Griffith considers the identification of the body responsible and whether patients can be charged for their aftercare.

The right to aftercare: best endeavours.

In this two-part article Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers a detained mental health patient's right to aftercare under the Mental Health Act 1983, section 117.

Parenting in recovery program: participant responses and case examples.

Approximately 80% of children served by child welfare agencies have parents who abuse or are dependent on alcohol or illicit drugs. Despite the devastating effects on children from living in substance abusing families, child protective service practitioners have limited options available to assist these families. The Parenting in Recovery program was created to address the needs of substance-abusing mothers involved in child welfare. This manuscript describes this program and perceptions of participants concerning its effectiveness.

["Help Conference", a new social assistance for integration according to § 53 SGB XII--a two-year analysis]. / Hilfekonferenzen, das neue Verfahren zur Eingliederungshilfe psychisch Kranker nach dem SGB XII--eine Zweijahresuntersuchung.

OBJECTIVE: To deal with applications for social assistance for integration according to § 53 SGB XII, in the district of Hannover a so called "Help Conference" was introduced. Since implementation of "Help Conferences", the number of applications has increased by about 1,100% over the past five years. We analysed whether a change from the institutional help system to more individual "help" has already been realised. METHODS: "Help Conferences" recorded between 2005 and 2006 were evaluated in regard to demographic and medical data. 78 of 202 protocols (40%) had been filled in completely and thus could be included in our evaluation. RESULTS: 37 patients (47%) had F2 spectrum diagnoses according to ICD-10. More than one third of our patients (31 patients=40%) were male patients with a diagnosis of addiction, whereas in this study female patients were rarely affected by addiction (5 patients=6%). The first application was filed by the hospital social service in most cases. Applications submitted by the patients themselves were an exception. 46 applications (59%) were follow-ups, submitted by the institution responsible for the patient. CONCLUSIONS: The new system is focused on the individual interests of patients and implicates an improved and more predictable aftercare in patients with psychiatric diseases.

The Philippines' new postabortion care policy.

In 2000, a Philippine policy clarifying the legality of medical treatment for women with postabortion complications was introduced to address unsafe abortion as a leading cause of maternal death, and reports of discrimination and abuse by healthcare providers against women who had abortions illegally. Despite its initial success as a pilot program, the policy's implementation and expansion were not prioritized. The incidence of unsafe abortion has increased over the years and, in 2009, the right to postabortion care was codified in national law, yet the mistreatment and abuse of women has continued in violation of medical ethics and the law. In 2016, following the demands of advocates and recommendations from national and international human rights bodies, the government introduced a new policy to strengthen the national framework for postabortion care, clarifying the legal and ethical duties of health service providers and offering women formal avenues for redress against abuse. The new policy offers useful guidance for countries that are contemplating new ways to strengthen the quality of postabortion care services in accordance with recognized standards of medical ethics and human rights.

The Philippines rolls back advancements in the postabortion care policy.

In 2018, the Philippines announced a postabortion care policy that rolls back crucial safeguards aimed at protecting women who seek medical treatment for postabortion complications from discrimination and abuse. It replaces another policy that was introduced in 2016, following years of advocacy by national and international advocates who were concerned about the mistreatment of women seeking postabortion care due to discriminatory practices in the health system and abortion stigma. The new policy is narrower in scope than the previous policy and reinforces abortion stigma by emphasizing the legal prohibition on abortion, failing to clarify that women seeking postabortion care need not be reported to the authorities, and not recognizing the availability of complaint mechanisms for women who are mistreated. These and other crucial gaps put the new policy at risk of being in violation of ethical standards of medical care and guarantees of human rights.

Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery.

OBJECTIVE: To examine the impact of the Short Stay Transfer Policy (SSTP) on practice patterns. DATA SOURCES: This study uses data from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review (MEDPAR) file, Home Health Standard Analytical File, 1999 Provider of Service file, and data from the 2000 United States Census. STUDY DESIGN: An interrupted time-series analysis was used to examine the length of stay (LOS) and probability of "early" discharge to post acute care (PAC). DATA COLLECTION: Separate 100 percent samples of all fee-for-service Medicare recipients undergoing either elective joint replacement (JR) surgery or surgical management of hip fracture (FX) between January 1, 1996 and December 31, 2000 were selected. PRINCIPAL FINDINGS: Prior to implementation of the SSTP. LOS had been falling by 0.37 and 0.30 days per year for JR and FX patients respectively. After implementation of the SSTP, there was an immediate increase in LOS by 0.20 and 0.17 days, respectively. Thereafter, LOS remained flat. The proportion of patients discharged "early" to PAC had been rising by 4.4 and 2.6 percentage points per year for JR and FX patients respectively, to a peak of 28.8 percent and 20.4 percent early PAC utilization in September 1998. Immediately after implementation of the SSTP, there was a 4.3 and 3.0 percentage point drop in utilization of "early" PAC. Thereafter utilization of early PAC increased at a much slower rate (for JR) or remained flat (for FX). There was significant regional variation in the magnitude of response to the policy. CONCLUSION: Implementation of the SSTP reduced the financial incentive to discharge patients early to PAC. This was accomplished primarily through longer LOS without meaningful change in PAC utilization. With the recent expansion of the SSTP to 29 DRGs (representing 34 percent of all discharges), these findings have important implications regarding patient care.

The regulatory environment and rural hospital long-term care strategies from 1997 to 2003.

CONTEXT: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). PURPOSE: This article has 2 goals: (1) to provide a summary of the many legislative acts and provisions influencing rural hospital LTC strategies during the 1997-2003 period and (2) to track changes in the LTC strategies of a national sample of rural hospitals through this 7-year period. METHODS: A 3-wave panel of rural hospital discharge planners in 540 nonfederal community-general hospitals were interviewed in 1997, 2000, and 2003. Questions focused on hospital structure, discharge planning process, and reports of internal and external organizational arrangements for providing LTC services to hospitalized patients, and changes in LTC strategy since the previous interview. Descriptive statistics are presented on LTC strategies in place in 1997 and dropped or added in 2000 and 2003. FINDINGS AND CONCLUSIONS: The general shape of the regulatory environment confronting rural hospitals and their LTC strategies during the recent past can be described as complicated, rapidly changing, and at times contradictory in intended effects. There has been a large volume of strategy change during this 7-year period, without the emergence of any identifiable pattern or LTC strategy profile, other than swing-bed participation combined with home health agency ownership.

The treatment of personality-disordered offenders in Germany.

Offenders with mental illness challenge forensic systems throughout the world. Those with personality disorders present additional challenges. In this article, the authors describe relevant German legislation and the consequent forensic treatment of personality-disordered offenders in the German psychiatric and correctional systems, with a focus on the German state of Hessen. The development of laws and regulations are addressed, as are the parallels and distinctions between forensic hospitals and correctional settings. Current treatment approaches and programs are described. Research initiatives and future directions for the system, and comparisons with the system in the United States conclude the article.