Sample records for program hospital inpatient

  1. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

  2. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

  3. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

  4. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

  5. 77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

  6. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and... (United States)


    ... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

  7. 76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction (United States)


    ... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...

  8. 77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... identify outlier cases for both inpatient operating and inpatient capital related payments, which is... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 412... Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality...

  9. 78 FR 64953 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services... (United States)


    ... adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment... notice and comment is unnecessary because the formulae used to calculate the inpatient hospital...

  10. 76 FR 67567 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services... (United States)


    ... adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment... notice and comment is unnecessary because the formulae used to calculate the inpatient hospital...

  11. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Readmission 5. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Reverse... hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are..., (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee, (410) 786-8691 and...

  12. 78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Connective Tissue) a. Reverse Shoulder Procedures b. Total Ankle Replacement Procedures 6. MDC 15 (Newborns... specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric... Issues. James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee...

  13. 76 FR 34633 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for... (United States)


    ..., 413, and 476 [CMS-1518-CN] RIN 0938-AQ24 Medicare Program; Proposed Changes to the Hospital Inpatient...-9644 of May 5, 2011 (76 FR 25788), there were a number of technical and typographical errors that are...) endorsement number for the CMS quality measure, Percent of Residents With Pressure Ulcers That Are New or...

  14. 76 FR 41178 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for... (United States)


    ... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...

  15. 77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Estimated Net Savings for Current HACs g. Previously Considered Candidate HACs--RTI Analysis of Frequency of... Program 1. Background 2. Budget Neutrality Offset Amount for FY 2013 L. Hospital Routine Services... Program a. Administrative Requirements (1) Requirements Regarding QualityNet Account and Administrator for...

  16. 77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Considered HAC Candidate: Iatrogenic Pneumothorax With Venous Catheterization 3. Present on Admission (POA.... History of Measures Adopted for the Hospital IQR Program b. Maintenance of Technical Specifications for...-Associated Infection (HAI) Measures (A) Proposed Central Line Associated Blood Stream Infections ((CLABSI...

  17. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

  18. 76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ...-Associated Secondary Diagnoses for Current HACs h. RTI Analysis of Estimated Net Savings for Current HACs i.... Changes to the Demonstration Program Made by the Affordable Care Act 3. FY 2012 Budget Neutrality Adjustment a. Component of the FY 2012 Budget Neutrality Adjustment that Accounts for Estimated Demonstration...

  19. Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals. (United States)

    Rushakoff, Robert J; Sullivan, Mary M; Seley, Jane Jeffrie; Sadhu, Archana; O'Malley, Cheryl W; Manchester, Carol; Peterson, Eric; Rogers, Kendall M


    establishing an inpatient glycemic control program is challenging, requires years of work, significant education and coordination of medical, nursing, dietary, and pharmacy staff, and support from administration and Performance Improvement departments. We undertook a 2 year quality improvement project assisting 10 medical centers (academic and community) across the US to implement inpatient glycemic control programs. the project was comprised of 3 interventions. (1) One day site visit with a faculty team (MD and CDE) to meet with key personnel, identify deficiencies and barriers to change, set site specific goals and develop strategies and timelines for performance improvement. (2) Three webinar follow-up sessions. (3) Web site for educational resources. Updates, challenges, and accomplishments for each site were reviewed at the time of each webinar and progress measured at the completion of the project with an evaluation questionnaire. as a result of our intervention, institutions revised and simplified formularies and insulin order sets (with CHO counting options); implemented glucometrics and CDE monitoring of inpatient glucoses (assisting providers with orders); added new protocols for DKA and perinatal treatment; and implemented nursing, physician and patient education initiatives. Changes were institution specific, fitting the local needs and cultures. As to the extent to which Institution׳s goals were satisfied: 2 reported "completely", 4 "mostly," 3 "partially," and 1 "marginally". Institutions continue to move toward fulfilling their goals. an individualized, structured, performance improvement approach with expert faculty mentors can help facilitate change in an institution dedicated to implementing an inpatient glycemic control program. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. 76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program (United States)


    ... program based on conditions for coverage. This new program will necessarily be a fluid model, subject to... rewarding better value, outcomes, and innovations instead of merely volume. Use of Measures: , after a 30-day preview period. An interactive Web tool, this Web site assists...

  1. Institutional blood glucose monitoring system for hospitalized patients: an integral component of the inpatient glucose control program. (United States)

    Boaz, Mona; Landau, Zohar; Matas, Zipora; Wainstein, Julio


    The ability to measure patient blood glucose levels at bedside in hospitalized patients and to transmit those values to a central database enables and facilitates glucose control and follow-up and is an integral component in the care of the hospitalized diabetic patient. The goal of this study was to evaluate the performance of an institutional glucometer employed in the framework of the Program for the Treatment of the Hospitalized Diabetic Patient (PTHDP) at E. Wolfson Medical Center, Holon, Israel. As part of the program to facilitate glucose control in hospitalized diabetic patients, an institutional glucometer was employed that permits uploading of data from stands located in each inpatient department and downloading of that data to a central hospital-wide database. Blood glucose values from hospitalized diabetic patients were collected from August 2007 to October 2008. The inpatient glucose control program was introduced gradually beginning January 2008. During the follow-up period, more than 150,000 blood glucose measures were taken. Mean glucose was 195.7 +/- 99.12 mg/dl during the follow-up period. Blood glucose values declined from 206 +/- 105 prior to PTHDP (August 2007-December 2007) to 186 +/- 92 after its inception (January 2008-October 2008). The decline was associated significantly with time (r = 0.11, p < 0.0001). The prevalence of blood glucose values lower than 60 mg/dl was 1.48% [95% confidence interval (CI) 0.36%] prior to vs 1.55% (95% CI 0.37%) following implementation of the PTHDP. Concomitantly, a significant increase in the proportion of blood glucose values between 80 and 200 mg/dl was observed, from 55.5% prior to program initiation vs 61.6% after program initiation (p < 0.0001). The present study was designed to observe changes in institution-wide glucose values following implementation of the PTHDP. Information was extracted from the glucometer system itself. Because the aforementioned study was not a clinical trial, we cannot rule out

  2. Evaluation of an inpatient psychiatric hospital physician education program and adherence to American Diabetes Association practice recommendations. (United States)

    Koffarnus, Robin L; Mican, Lisa M; Lopez, Debra A; Barner, Jamie C


    This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital. This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample. Included subjects were admitted and discharged from an inpatient psychiatric institution within 90 days prior to (pre-intervention) and following (post-intervention) the physician education program. The medical staff was presented an educational program intervention, consisting of a 30 minute overview of the ADA 2010 Standards of Care recommendations and distribution of laminated treatment reminders. Electronic grouped order sets for patients with diabetes were also created and implemented. The primary outcome was change (pre-intervention to post-intervention) in frequency of hemoglobin A1c documentation on admission following the intervention. Secondary outcomes included the change in frequency of documentation of fasting plasma glucose, serum creatinine, urine creatinine/microalbumin ratio (UMA), fasting lipid profile (FLP), and change in days on sliding scale insulin. Regarding change in frequency of documentation of A1c values on admission, chi-square analysis revealed a significant increase from pre-intervention to post-intervention period of 30% (n = 18) to 61.7% (n = 37), respectively (p = 0.0005). Documentation of FLP also significantly increased [73.3% vs. 91.7% (p = 0.0082)]. There were no significant differences in the documentation of fasting plasma glucose, serum creatinine, and UMA or days treated with sliding scale insulin. The physician education program was successful in increasing the assessment of A1c values and lipid profiles for patients with diabetes mellitus in a psychiatric

  3. 78 FR 16632 - Medicare Program; Part B Inpatient Billing in Hospitals (United States)


    ... other devices used for reduction of fractures and dislocations. Prosthetic devices (other than dental... rehabilitation facilities (IRFs), CAHs, children's hospitals, cancer hospitals, and Maryland waiver hospitals. We...

  4. Inpatient Suicide in a Chinese Psychiatric Hospital (United States)

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian


    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

  5. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule. (United States)


    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  6. 75 FR 23851 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for... (United States)


    ... Diagnoses for Current HACs g. Preliminary RTI Analysis of Estimated Net Savings for Current HACs h... MIEA-TRHCA a. Reclassification Average Hourly Wage Comparison Criteria b. Budget Neutrality Adjustment....--Proposed Rural Floor Budget Neutrality Factors for Acute Care Hospitals--FY 2011 Table 4D-2.--Urban Areas...

  7. Implementation of inpatient models of pharmacogenetics programs. (United States)

    Cavallari, Larisa H; Lee, Craig R; Duarte, Julio D; Nutescu, Edith A; Weitzel, Kristin W; Stouffer, George A; Johnson, Julie A


    The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results. With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care. Copyright © 2016 by the American Society of Health

  8. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  9. CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients. (United States)

    Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M


    Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each

  10. Qualities of Inpatient Hospital Rooms: Patients' Perspectives. (United States)

    Devlin, Ann Sloan; Andrade, Cláudia Campos; Carvalho, Diana


    The aim of this qualitative study was to investigate what design features of hospital rooms are valued by inpatients. Little research has explored how patients evaluate the physical environment of their hospital rooms. Most responses are captured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which includes only two questions about the physical environment. Two hundred thirty-six orthopedic patients (78 in the United States and 158 in Portugal) listed three features of their hospital room that influenced their level of satisfaction with their hospital stay, indicating whether the feature was positive or negative. The comments were more positive (71.4%) than negative (28.6%). Using the framework of supportive design from Ulrich, over half the comments (64.31%) could be categorized in one of the three dimensions: 33.2% (positive distraction), 22.4% (perceived control), and 6.0% (social support). This total includes Internet (2.7%), which could be categorized as either social support or positive distraction. Comments called "other aspects" focused on overall environmental appraisals, cleanliness, and functionality and maintenance. The majority of comments could be accommodated by Ulrich's theory, but it is noteworthy that other aspects emerge from patients' comments and affect their experience. Cross-cultural differences pointed to the greater role of light and sun for Portuguese patients and health status whiteboard for U.S. Qualitative research can add significantly to our understanding of the healthcare experience and may inform design decisions. © The Author(s) 2015.

  11. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

  12. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period. (United States)


    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

  13. Characterizing hospital inpatients: the importance of demographics and attitudes. (United States)

    Danko, W D; Janakiramanan, B; Stanley, T J


    To compete effectively, hospital administrators must understand inpatients who are involved in hospital-choice decisions more clearly. To this end, a methodology is presented to measure and assess the importance of inpatients' personal attributes in predicting hospital selection. Empirical results show that demographic characteristics are poor--but attitudes are useful--segmentation variables that delineate differences between two particular hospitals' inpatients. More generally, the survey method and statistical procedures outlined are applicable (with slight modification) to markets with a greater number of competitors.

  14. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  15. Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review. (United States)

    Kelly, Michelle M; Coller, Ryan J; Hoonakker, Peter Lt


    Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. Growing evidence supports portal use in ambulatory settings; however, only recently have portals been used with hospitalized patients. Our objective was to review the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care. Literature was reviewed from 2006 to 2017 in PubMed, Web of Science, CINALPlus, Cochrane, and Scopus to identify English language studies evaluating patient portals, engagement, and inpatient care. Data were analyzed considering the following 3 themes: inpatient portal design, use and usability, and impact. Of 731 studies, 17 were included, 9 of which were published after 2015. Most studies were qualitative with small samples focusing on inpatient portal design; 1 nonrandomized trial was identified. Studies described hospitalized patients' and caregivers' information needs and design recommendations. Most patient and caregiver participants in included studies were interested in using an inpatient portal, used it when offered, and found it easy to use and/or useful. Evidence supporting the role of inpatient portals in improving patient and caregiver engagement, knowledge, communication, and care quality and safety is limited. Included studies indicated providers had concerns about using inpatient portals; however, the extent to which these concerns have been realized remains unclear. Inpatient portal research is emerging. Further investigation is needed to optimally design inpatient portals to maximize potential benefits for hospitalized patients and caregivers while minimizing unintended consequences for healthcare teams. © 2017 Society of Hospital Medicine.

  16. 42 CFR 412.79 - Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent... (United States)


    ... OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient... § 412.73(c)(14) through (c)(16). (e) DRG adjustment. The applicable hospital-specific cost per discharge...

  17. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database


    Vin?Raviv, Neomi; Akinyemiju, Tomi; Meng, Qingrui; Sakhuja, Swati; Hayward, Reid


    Abstract The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD?9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failur...

  18. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  19. Hospital billing for blood processing and transfusion for inpatient stays. (United States)

    McCue, Michael J; Nayar, Preethy


    Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.

  20. The management of constipation in hospital inpatients. (United States)

    Greenfield, Simon M


    This article reviews the causes of constipation in hospital and how it can be prevented with simple measures. A review of laxatives available on hospital words is provided for the reader and recommendations are made.

  1. Data Mining Application in Customer Relationship Management for Hospital Inpatients


    Lee, Eun Whan


    Objectives This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. Methods A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services us...

  2. Financial protection mechanisms for inpatients at selected Philippine hospitals. (United States)

    Caballes, Alvin B; Söllner, Walter; Nañagas, Juan


    The study was undertaken to determine, from the patient's perspective, the comparative effectiveness of locally established financial protection mechanisms particularly for indigent and severely-ill hospitalized patients. Data was obtained from a survey conducted in 2010 in Philippine provinces which were part of the Health Systems Development Project and involved 449 patients from selected private and public hospitals. Direct medical expenses incurred during the confinement period, whether already paid for prior to or only billed upon discharge, were initially considered. Expenses were found to be generally larger for the more severely ill and lower for the poor. Hospital-provided discounts and social health insurance (PhilHealth) reimbursements were the financial protection mechanisms evaluated in this study. In average terms, only up to 46% of inpatient expenses were potentially covered by the combined financial support. Depending on the hospital type, 28-42% of submitted PhilHealth claims were invalidated. Multiple linear regression analysis was utilized to determine the relationship of the same set of patients' demographic characteristics, socioeconomic status, severity of illness, and hospital assignments with selected expense categories and financial protection measures. Pre-discharge expenditures were significantly higher in public hospitals. The very ill also faced significantly larger expenses, including those for final hospital charges. Hospital-derived discounts provided significantly more support for indigent as well as very sick patients. The amounts for verified PhilHealth claims were significantly greater for the moderately-ill and, incongruously, the financially better-off patients. Sponsored Program members, supposed indigents enjoying fully-subsidized PhilHealth enrollment, qualified for higher mean reimbursements. However, there was a weak correlation between such patients and those identified as poor by the hospital social service staff. Thus

  3. Heat-related inpatient hospitalizations and emergency room visits among California residents, May-September, 2000-2010. (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of heat-related inpatient hospitalizations and ED visits among California residents for the years...

  4. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals. (United States)


    ... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

  5. The effects of hospital competition on inpatient quality of care. (United States)

    Mutter, Ryan L; Wong, Herbert S; Goldfarb, Marsha G


    Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However, the effect is not unidirectional: some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain.

  6. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

  7. Hospital Readmissions Reduction Program (United States)

    U.S. Department of Health & Human Services — In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions. Excess readmissions are measured...

  8. 42 CFR 412.78 - Determination of the hospital-specific rate for inpatient operating costs for sole community... (United States)


    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating... determined using the methodology set forth in §§ 412.73(c)(15) and 412.73(c)(16). (f) DRG adjustment. The...

  9. 42 CFR 412.77 - Determination of the hospital-specific rate for inpatient operating costs for sole community... (United States)


    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating... update factor is determined using the methodology set forth in § 412.73(c)(12) through (c)(16). (f) DRG...

  10. Mortality among inpatients of a psychiatric hospital: Indian perspective. (United States)

    Shinde, Shireesh Shatwaji; Nagarajaiah; Narayanaswamy, Janardhanan C; Viswanath, Biju; Kumar, Naveen C; Gangadhar, B N; Math, Suresh Bada


    The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. The medical records of those psychiatric inpatients (n = 333) who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008) constituted the study population. During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6%) of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%), married (n = 172, 56.8%) and from urban areas (n = 191, 63%). About, 54% of the subjects had short inpatient stay (history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%), followed by respiratory system disorders (n = 45, 14.9%), nervous system disorders (n = 30, 9.9%) and infections (n = 31, 10.1%). In 21 (7%), cause of death was suicide. Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality.




  12. Pediatric inpatient hospital resource use for congenital heart defects. (United States)

    Simeone, Regina M; Oster, Matthew E; Cassell, Cynthia H; Armour, Brian S; Gray, Darryl T; Honein, Margaret A


    Congenital heart defects (CHDs) occur in approximately 8 per 1000 live births. Improvements in detection and treatment have increased survival. Few national estimates of the healthcare costs for infants, children and adolescents with CHDs are available. We estimated hospital costs for hospitalizations using pediatric (0-20 years) hospital discharge data from the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for hospitalizations with CHD diagnoses. Estimates were up-weighted to be nationally representative. Mean costs were compared by demographic factors and presence of critical CHDs (CCHDs). Up-weighting of the KID generated an estimated 4,461,615 pediatric hospitalizations nationwide, excluding normal newborn births. The 163,980 (3.7%) pediatric hospitalizations with CHDs accounted for approximately $5.6 billion in hospital costs, representing 15.1% of costs for all pediatric hospitalizations in 2009. Approximately 17% of CHD hospitalizations had a CCHD, but it varied by age: approximately 14% of hospitalizations of infants, 30% of hospitalizations of patients aged 1 to 10 years, and 25% of hospitalizations of patients aged 11 to 20 years. Mean costs of CHD hospitalizations were higher in infancy ($36,601) than at older ages and were higher for hospitalizations with a CCHD diagnosis ($52,899). Hospitalizations with CCHDs accounted for 26.7% of all costs for CHD hospitalizations, with hypoplastic left heart syndrome, coarctation of the aorta, and tetralogy of Fallot having the highest total costs. Hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with CCHD diagnoses accounted for 27% of CHD hospital costs. © 2014 Wiley Periodicals, Inc.

  13. Assessment and evaluation efficacy of a clinical pharmacist-led inpatient warfarin knowledge education program and follow-up at a Chinese tertiary referral teaching hospital

    Directory of Open Access Journals (Sweden)

    Guy-Armel Bounda


    Conclusion: Chinese patients on warfarin therapy should benefit from periodic educational efforts reinforcing key medication safety information. Patient education is not a once-off procedure. A complete patient education program run by a clinical pharmacist in a Cardio-thoracic ward can considerably improve and enhance to reduce the hospital stays and significantly enlighten the role of the patient education in adherence to therapy.

  14. Hospitalized women's willingness to pay for an inpatient screening mammogram. (United States)

    Khaliq, Waseem; Harris, Ché Matthew; Landis, Regina; Bridges, John F P; Wright, Scott M


    Lower rates for breast cancer screening persist among low income and uninsured women. Although Medicare and many other insurance plans would pay for screening mammograms done during hospital stays, breast cancer screening has not been part of usual hospital care. This study explores the mean amount of money that hospitalized women were willing to contribute towards the cost of a screening mammogram. Of the 193 enrolled patients, 72% were willing to pay a mean of $83.41 (95% CI, $71.51-$95.31) in advance towards inpatient screening mammogram costs. The study's findings suggest that hospitalized women value the prospect of screening mammography during the hospitalization. It may be wise policy to offer mammograms to nonadherent hospitalized women, especially those who are at high risk for developing breast cancer. © 2014 Annals of Family Medicine, Inc.

  15. Postoperative pneumonia-prevention program for the inpatient surgical ward. (United States)

    Wren, Sherry M; Martin, Molinda; Yoon, Jung K; Bech, Fritz


    Postoperative pneumonia can lead to increased morbidity, length of hospital stay, and costs. Pneumonia-prevention programs have been successfully implemented in ICU settings, but no program exists for surgical ward patients. A pilot prevention program was designed and implemented based on literature review. The program consisted of education of physicians and ward staff and a standardized postoperative electronic order set consisting of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. Quarterly staff meetings discussed the results of and compliance with the program. The intervention commenced in April 2007. Baseline incidence of inpatient ward pneumonia was calculated from the National Surgical Quality Improvement Program database for fiscal year (FY) 2006 and FY 2007. Postintervention incidence was calculated in the same manner from FY 2007 through FY 2008. Any patient who contracted pneumonia in the ICU was excluded from analysis. There was a significant decrease in ward pneumonia incidence from 0.78% in the preintervention group compared with 0.18% in the postintervention group (p = 0.006), representing an 81% decrease in incidence from 2006 to 2008. The pneumonia-prevention program was very successful in diminishing postoperative pneumonia on the surgical ward. There was a highly statistically significant 4-fold decrease in pneumonia incidence after program implementation. The interventions were not costly but did require ongoing communication and cooperation between physician and nursing leadership to achieve compliance with the measures. This program has great potential for dissemination to hospital surgical wards and could decrease inpatient postoperative pneumonias. Published by Elsevier Inc.

  16. 5 CFR 890.905 - Limits on inpatient hospital and physician charges. (United States)


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905 Limits on inpatient...

  17. Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation. (United States)

    Daras, Laura Coots; Ingber, Melvin J; Carichner, Jessica; Barch, Daniel; Deutsch, Anne; Smith, Laura M; Levitt, Alan; Andress, Joel


    To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Observational design. Inpatient rehabilitation facilities. Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Not applicable. The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. Published by Elsevier Inc.

  18. Perceived coercion in inpatients with Anorexia nervosa: Associations with illness severity and hospital course. (United States)

    Schreyer, Colleen C; Coughlin, Janelle W; Makhzoumi, Saniha H; Redgrave, Graham W; Hansen, Jennifer L; Guarda, Angela S


    The use of coercion in the treatment for anorexia nervosa (AN) is controversial and the limited studies to date have focused on involuntary treatment. However, coercive pressure for treatment that does not include legal measures is common in voluntarily admitted patients with AN. Empirical data examining the effect of non-legal forms of coerced care on hospital outcomes are needed. Participants (N = 202) with AN, Avoidant/Restrictive Food Intake Disorder (ARFID), or subthreshold AN admitted to a hospital-based behavioral specialty program completed questionnaires assessing illness severity and perceived coercion around the admissions process. Hospital course variables included inpatient length of stay, successful transition to a step-down partial hospitalization program, and achievement of target weight prior to program discharge. Higher perceived coercion at admission was associated with increased drive for thinness and body dissatisfaction, but not with admission BMI. Perceived coercion was not related to inpatient length of stay, rate of weight gain, or achievement of target weight although it was predictive of premature drop-out prior to transition to an integrated partial hospitalization program. These results, from an adequately powered sample, demonstrate that perceived coercion at admission to a hospital-based behavioral treatment program was not associated with rate of inpatient weight gain or achieving weight restoration, suggesting that coercive pressure to enter treatment does not necessarily undermine formation of a therapeutic alliance or clinical progress. Future studies should examine perceived coercion and long-term outcomes, patient views on coercive pressures, and the effect of different forms of leveraged treatment. © 2015 Wiley Periodicals, Inc.

  19. The effect of an interactive follow-up program on ostomy adjustment of inpatients after their discharge from surgical wards of the hospitals affiliated to Isfahan University of Medical Sciences. (United States)

    Hamidi, Yaser; Moeini, Mahin; Yousefi, Hojatollah


    Ostomy patients suffer from many physical and mental problems, which can be solved to a large extent with the help of education and follow-up programs. These follow-ups can be done in person or on the telephone by the nurses, or even, by sending a text message that is an easier way for the patients to adapt to their condition. This study aimed to investigate the effect of an interactive follow-up program on the adjustment of ostomy inpatients after being discharged. This study is a clinical trial, conducted on 64 ostomy patients who were discharged from the surgical wards of the hospital affiliated to Isfahan University of Medical Sciences. Subjects in the experimental group participated in a 6-week follow-up program via text message. The information about the patients were collected by Olbrisch Ostomy Adjustment Scale. The obtained results have suggested that 34.4% of the patients in the experimental group and 28.1% of the patients in the control group were female. Before the intervention, comparing the mean score of ostomy adjustment and its dimensions in the two groups showed no significant difference (P > 0.05). However, a significant difference was observed between the two groups immediately after the intervention (P  0.05). The findings of this study suggested that using SMS can be considered as a proper tool or method for following up the ostomy patients.

  20. Reliability of hospital cost profiles in inpatient surgery. (United States)

    Grenda, Tyler R; Krell, Robert W; Dimick, Justin B


    With increased policy emphasis on shifting risk from payers to providers through mechanisms such as bundled payments and accountable care organizations, hospitals are increasingly in need of metrics to understand their costs relative to peers. However, it is unclear whether Medicare payments for surgery can reliably compare hospital costs. We used national Medicare data to assess patients undergoing colectomy, pancreatectomy, and open incisional hernia repair from 2009 to 2010 (n = 339,882 patients). We first calculated risk-adjusted hospital total episode payments for each procedure. We then used hierarchical modeling techniques to estimate the reliability of total episode payments for each procedure and explored the impact of hospital caseload on payment reliability. Finally, we quantified the number of hospitals meeting published reliability benchmarks. Mean risk-adjusted total episode payments ranged from $13,262 (standard deviation [SD] $14,523) for incisional hernia repair to $25,055 (SD $22,549) for pancreatectomy. The reliability of hospital episode payments varied widely across procedures and depended on sample size. For example, mean episode payment reliability for colectomy (mean caseload, 157) was 0.80 (SD 0.18), whereas for pancreatectomy (mean caseload, 13) the mean reliability was 0.45 (SD 0.27). Many hospitals met published reliability benchmarks for each procedure. For example, 90% of hospitals met reliability benchmarks for colectomy, 40% for pancreatectomy, and 66% for incisional hernia repair. Episode payments for inpatient surgery are a reliable measure of hospital costs for commonly performed procedures, but are less reliable for lower volume operations. These findings suggest that hospital cost profiles based on Medicare claims data may be used to benchmark efficiency, especially for more common procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

    Directory of Open Access Journals (Sweden)

    Shahyar Michael Gharacholou


    Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.

  2. The association of cannabis use on inpatient psychiatric hospital outcomes. (United States)

    Rylander, Melanie; Winston, Helena R; Medlin, Haley; Hull, Madelyne; Nussbaum, Abraham


    The associations between cannabis use and psychosis are well documented in numerous studies. There is a need to evaluate the impact of cannabis use on inpatient psychiatric utilization and outcomes. To evaluate the impact of cannabis use on psychiatric hospital outcomes. This study was conducted between April 20, 2015 and October 20, 2015. All patients (n = 120) admitted to Denver Health with psychotic symptoms were administered a urine toxicology screening testing for the presence of 11-nor-9-carboxy-Δ 9 -tetrahydrocannabinol (THC-COOH, the active metabolite of cannabis). Patients with positive tests were compared to those with negative tests on several measures, including length of stay, presence or lack of 30-day readmission, Brief Psychotic Rating Scale (BPRS) score, and use of antipsychotics and/or sedatives/anxiolytics. There were 120 patients. Twenty nine were women and 91 were men. Patients testing positive for THC-COOH had a shorter length of stay compared to patients testing negative for THC-COOH, after adjusting for age, prior psychiatric admissions, history of a psychotic-spectrum disorder, and comorbid additional substance use (p = 0.02). There were no differences in 30-day readmissions, 30-day post-discharge presentation to the Denver Health psychiatric emergency department, BPRS scores, and medication administration. Patients presenting with psychotic symptoms and cannabis use require shorter inpatient psychiatric hospitalizations. This study is the first to quantify this observation and highlights the need for future clinical decision-making tools that would ideally correlate cannabis use with the degree of potential need for expensive and scarce mental health resources, such as psychiatric hospitalization.

  3. Data mining application in customer relationship management for hospital inpatients. (United States)

    Lee, Eun Whan


    This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM.

  4. Data Mining Application in Customer Relationship Management for Hospital Inpatients (United States)


    Objectives This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. Methods A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. Results Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. Conclusions To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM. PMID:23115740

  5. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States. (United States)

    Sills, Marion R; Hall, Matthew; Fieldston, Evan S; Hain, Paul D; Simon, Harold K; Brogan, Thomas V; Fagbuyi, Daniel B; Mundorff, Michael B; Shah, Samir S


    Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.

  6. Estimating inpatient hospital prices from state administrative data and hospital financial reports. (United States)

    Levit, Katharine R; Friedman, Bernard; Wong, Herbert S


    To develop a tool for estimating hospital-specific inpatient prices for major payers. AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers--an important asset as the payer mix changes with the implementation of the Affordable Care Act. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  7. The Relationship between Inpatient Expectations of Staff Responsiveness and Empathy with Inpatient Satisfaction at Wangaya District Hospital Denpasar

    Directory of Open Access Journals (Sweden)

    Dwidyaniti Wira


    Full Text Available Background and purpose: The evaluation of quality of service within inpatient and outpatient services is very critical to be done. This research aimed to explore the relationship between inpatient expectations of the quality of nursing service and inpatient satisfaction, in the third-class ward Wangaya District General Hospital, Denpasar.Methods: This research was a quantitative study using cross-sectional design. A sample of 111 was selected by simple random sampling. The data was analysed by using univariate, bivariate, and multivariate analysis with logistic regression.Results: The analysis indicated that the level of actual satisfaction compared to inpatient expectations was as low as 45%. Perception of responsiveness with OR=2.404 (95%CI: 1.076–5.373 and perception of empathy with OR=2.594 (95%CI: 1.165-5.779 had a significant relationship with inpatient satisfaction.Conclusion: The study concluded that the patient satisfaction rate is moderate and found to have significant correlation with perceptions of responsiveness and empathy.Keywords: inpatient expectations, nursing service provision, inpatient satisfaction

  8. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  9. 42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of... (United States)


    ... payment system for inpatient hospital services of psychiatric facilities. 412.404 Section 412.404 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... must meet the conditions of this section to receive payment under the prospective payment system...

  10. A qualitative study on nurses' reactions to inpatient suicide in a general hospital

    Directory of Open Access Journals (Sweden)

    Shujie Wang


    Conclusions: Nurses who experienced inpatient suicide became stressed. Effective interventions must be implemented to improve the coping mechanisms of nurses against the negative consequences of inpatient suicide. The findings of this study will allow administrators to gain insight into the impacts of inpatient suicides on nurses in general hospitals. Such information can be used to develop effective strategies and provide individual support and ongoing education. Consequently, nurses will acquire suicide prevention skills and help patients achieve swift recovery.

  11. Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives (United States)

    Wong, Matthew; Katzman, Debra K.; Akseer, Nadia; Steinegger, Cathleen; Hancock-Howard, Rebecca L.; Coyte, Peter C.


    Background Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs. Methods We used micro-costing methods for this cohort study involving all adolescent patients (age 12–18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs. Results We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs. PMID:26389097

  12. Feeling safe during an inpatient hospitalization: a concept analysis. (United States)

    Mollon, Deene


    This paper aims to explore the critical attributes of the concept feeling safe. The safe delivery of care is a high priority; however; it is not really known what it means to the patient to 'feel safe' during an inpatient hospitalization. This analysis explores the topic of safety from the patient's perspective. Concept analysis. The data bases of CINAHL, Medline, PsychInfo and Google Scholar for the years 1995-2012 were searched using the terms safe and feeling safe. The eight-step concept analysis method of Walker and Avant was used to analyse the concept of feeling safe. Uses and defining attributes, as well as identified antecedents, consequences and empirical referents, are presented. Case examples are provided to assist in the understanding of defining attributes. Feeling safe is defined as an emotional state where perceptions of care contribute to a sense of security and freedom from harm. Four attributes were identified: trust, cared for, presence and knowledge. Relationship, environment and suffering are the antecedents of feeling safe, while control, hope and relaxed or calm are the consequences. Empirical referents and early development of a theory of feeling safe are explored. This analysis begins the work of synthesizing qualitative research already completed around the concept of feeling safe by defining the key attributes of the concept. Support for the importance of developing patient-centred models of care and creating positive environments where patients receive high-quality care and feel safe is provided. © 2014 John Wiley & Sons Ltd.

  13. Implementing and Evaluating a Multicomponent Inpatient Diabetes Management Program: Putting Research into Practice (United States)

    Munoz, Miguel; Pronovost, Peter; Dintzis, Joanne; Kemmerer, Theresa; Wang, Nae-Yuh; Chang, Yi-Ting; Efird, Leigh; Berenholtz, Sean M.; Golden, Sherita Hill


    Background Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. Conceptual Model Components The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staff while incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. Outcomes Overall the average patient-day–weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. Conclusion Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives. PMID:22649859

  14. Constructing Episodes of Inpatient Care: How to Define Hospital Transfer in Hospital Administrative Health Data? (United States)

    Peng, Mingkai; Li, Bing; Southern, Danielle A; Eastwood, Cathy A; Quan, Hude


    Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Alberta, Canada. Transfer cases were defined by transfer institution code and were used as the reference standard. Four time gaps between 2 hospitalizations (6, 9, 12, and 24 h) and 2 day gaps between hospitalizations [same day (up to 24 h), ≤1 d (up to 48 h)] were used to identify transfer cases. We compared the sensitivity and positive predictive value (PPV) of 6 definitions across different categories of sex, age, and location of residence. Readmission rates within 30 days were compared after episodes of care were defined at the different time gaps. Among the 6 definitions, sensitivity ranged from 93.3% to 98.7% and PPV ranged from 86.4% to 96%. The time gap of 9 hours had the optimal balance of sensitivity and PPV. The time gaps of same day (up to 24 h) and 9 hours had comparable 30-day readmission rates as the transfer indicator after defining episode of care. We recommend the use of a time gap of 9 hours between 2 hospitalizations to define hospital transfer in inpatient databases. When admission or discharge time is not available in the database, a time gap of same day (up to 24 h) can be used to define hospital transfer.

  15. Inpatient Obstetric Care at Irwin Army Community Hospital: A Study to Determine the Most Efficient Organization

    National Research Council Canada - National Science Library

    Bergeron, Timothy


    This study attempts to compare, analyze, and recommend the most efficient model with which to deliver inpatient obstetrics and gynecological services to the served population of Irwin Army Community Hospital...

  16. Department of Defense TRICARE Inpatient Satisfaction Survey (TRISS) Data– military hospitals (United States)

    U.S. Department of Health & Human Services — This file contains U.S. military hospital data from the TRICARE Inpatient Satisfaction Survey (TRISS) administered by the Department of Defense (DoD). TRISS data do...

  17. Satisfaction Level Of Inpatient in an University Hospital

    Directory of Open Access Journals (Sweden)

    Serap Ejder Apay


    Full Text Available AIM: Quality concept is becoming increasingly more important in all sectors. Patient satisfaction is one of the basic steps in the quality of the health care system. The aim of this study was to determine the satisfaction of the patients receiving inpatient treatment. METHODS: This is a descriptive study, and it was conducted on 473 patients between the dates 03 March and 30 June 2008. A questionnarie form was applied to by means of face-to-face survey technique. A Visual Analog Patient Satisfaction Scale (VAPSS was used to evaluate the satisfaction state. RESULTS: It was found out that VAPSS score average of the patients was 7.2±2.2 in women; it was 7.4±2.2 in 50 and 65 age group; it was 7.1±2.2 in those who one graduate of primary school, it was 7.1±2.4 in those who dont have social security, and it was 7.1±2.3 in people who live in the towns. When we compare VAPSS points according to the clinics they stayed at, the average score of surgery clinic was 7.5±2.1 (p<0.001, score average of people who stayed in the hospital for 11–20 days was 7.3±2.1 (p<0.05, and the difference between the two was found statistically significant (p< 0.001, p< 0.05 . CONCLUSION: This study indicated that level of satisfaction of the patients different depending on the clinic they stayed at. [TAF Prev Med Bull 2009; 8(3.000: 239-244

  18. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients (United States)

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert


    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  19. Child and Adolescent Inpatient Unit in General Hospital “Tzaneio”

    Directory of Open Access Journals (Sweden)

    E. Tseva


    Full Text Available The Child and Adolescent Psychiatry Inpatient Service offers comprehensive diagnostic evaluation and treatment of children and adolescents (typical age ranges from 3-16 years old with a variety of emotional and behavioral problems including mood disorders, anxiety disorders, psychotic disorders, severe disruptive behavior, and suicide attempts. Treatment Team. The inpatient treatment team includes psychiatrists, psychologists, registered nurses, special education teacher, social worker, speech and occupational therapists. In addition, pediatricians from a full range of medical subspecialties are available for consultations. The multi-disciplinary staff emphasizes a family-oriented approach and parents and care-givers are encouraged to be active participants in the treatment team throughout a child’s stay. Treatment Program. The program offers developmentally appropriate therapeutic activities in a closely supervised environment. Extensive opportunities for observation, assessment, and intervention are possible in this intensive setting. Specialized assessments including neuropsychological testing, speech and language testing, and occupational therapy assessments are all available. Treatment plans typically include a combination of individual psychotherapy, behavior management, family counseling and medications. Staff members develop an individualized treatment plan emphasizing safety for each patient during the hospital stay. The plan is closely coordinated with families, outpatient providers, and resource programs to coordinate aftercare plans and facilitate a smooth transition to home.

  20. Development of a recovery education program for inpatient mental health providers. (United States)

    Chen, Shu-Ping; Krupa, Terry; Lysaght, Rosemary; McCay, Elizabeth; Piat, Myra


    Mental health system transformation toward a recovery-orientation has created a demand for education to equip providers with recovery competencies. This report describes the development of a recovery education program designed specifically for inpatient providers. Part 1 of the education is a self-learning program introducing recovery concepts and a recovery competency framework; Part 2 is a group-learning program focusing on real-life dilemmas and applying the Appreciative Inquiry approach to address these clinical dilemmas. A pilot study with a pretest/posttest design was used to evaluate the program. Participants included 26 inpatient multidisciplinary providers from 3 hospitals. The results showed participants' improvement on recovery knowledge (z = -2.55, p = .011) after the self-learning program. Evaluations of the group-learning program were high (4.21 out of 5). These results support continued efforts to refine the program. Inpatient providers could use this program to lead interprofessional practice in promoting recovery. (c) 2014 APA, all rights reserved.

  1. Adverse events in surgical inpatients: A comparative analysis of public hospitals in Victoria


    Katharina Hauck; Xueyan Zhao; Terri Jackson


    We compare adverse event rates for surgical inpatients across 36 public hospitals in the state of Victoria, Australia, conditioning on differences in patient complexity across hospitals. We estimate separate models for elective and emergency patients which stay at least one night in hospitals, using fixed effects complementary log-log models to estimate AEs as a function of patient and episode characteristics, and hospital effects. We use 4 years of patient level administrative hospital data ...

  2. Inpatient violence in a Dutch forensic psychiatric hospital

    NARCIS (Netherlands)

    Nienke Verstegen; Vivienne de Vogel; Michiel de Vries Robbé; Martijn Helmerhorst


    Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be

  3. 75 FR 70013 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal... (United States)


    ... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...

  4. Factors affecting time of access of in-patient care at Webuye District hospital, Kenya

    Directory of Open Access Journals (Sweden)

    Maxwell M. Lodenyo


    Conclusion: Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors, having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.

  5. Hospital and Health Insurance Markets Concentration and Inpatient Hospital Transaction Prices in the U.S. Health Care Market. (United States)

    Dauda, Seidu


    To examine the effects of hospital and insurer markets concentration on transaction prices for inpatient hospital services. Measures of hospital and insurer markets concentration derived from American Hospital Association and HealthLeaders-InterStudy data are linked to 2005-2008 inpatient administrative data from Truven Health MarketScan Databases. Uses a reduced-form price equation, controlling for cost and demand shifters and accounting for possible endogeneity of market concentration using instrumental variables (IV) technique. The findings suggest that greater hospital concentration raises prices, whereas greater insurer concentration depresses prices. A hypothetical merger between two of five equally sized hospitals is estimated to increase hospital prices by about 9 percent (p costs. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  6. Health literacy and English language comprehension among elderly inpatients at an urban safety-net hospital. (United States)

    Cordasco, Kristina M; Asch, Steven M; Franco, Idalid; Mangione, Carol M


    To evaluate the relationship between health literacy and age in chronically-ill inpatients at a safety-net hospital. We recruited 399 English- and Spanish-speaking inpatients being evaluated or treated for Congestive Heart Failure or Coronary Artery Disease at a large, urban safety-net teaching hospital in Southern California. Participants were interviewed to ascertain education, English comprehension, and in-home language use. Health literacy was assessed using The Test of Functional Health Literacy in Adults (TOFHLA). We compared by age (aged 65 or more, 51 to 64 years of age, and less than age 50) levels of health literacy, educational attainment, English comprehension, and language use. Prevalence of inadequate health literacy significantly increased with increasing age (87.2% in > or = 65, 48.9% for 51-64, and 26.3% in immigration status. Additionally, older patients were more likely to have never learned to read (34.9% in > or = 65, 6.5% for 51-64, and 1.5% in or = 65, 9.0% for 51-64, and 0.8% in or = 65, 43.5% for 51-64, and 35.8% in language at home (82.3% in > or = 65, 70.2% for 51-64, and 62.2% in < or = 50, p=0.015). To prepare to meet the chronic disease needs of a growing older patient population, and ameliorate the negative health effects of associated low literacy, safety-net hospital leaders and providers need to prioritize the development and implementation of low-literacy educational materials, programs, and services.

  7. Hospital Outpatient PPS Partial Hospitalization Program LDS (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  8. Inpatient Hospitalization Costs: A Comparative Study of Micronesians, Native Hawaiians, Japanese, and Whites in Hawai‘i

    Directory of Open Access Journals (Sweden)

    Megan Hagiwara


    Full Text Available Considerable interest exists in health care costs for the growing Micronesian population in the United States (US due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai‘i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations, we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI. We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically. Costs were estimated using standard cost-to-charge metrics overall and within nine major disease categories determined by All Patient Refined Diagnosis Related Groups. Micronesians had higher unadjusted hospitalization costs overall and specifically within several disease categories (including infectious and heart diseases. Higher SOI in Micronesians explained some, but not all, of these higher costs. The total cost of the 3486 Micronesian hospitalizations in the three-year study period was $58.1 million and 75% was covered by Medicaid; 23% of Native Hawaiian, 3% of Japanese, and 15% of white hospitalizations costs were covered by Medicaid. These findings may be of particular interests to hospitals, Medicaid programs, and policy makers.

  9. The association between rehabilitation programs and metabolic syndrome in chronic inpatients with schizophrenia. (United States)

    Lin, Yi-Chun; Lai, Chien-Liang; Chan, Hung-Yu


    The correlation between different rehabilitation programs and the prevalence of metabolic syndrome in people with schizophrenia is unclear. We tested the association in chronic inpatients with schizophrenia of a psychiatric hospital in Taiwan. Patients with schizophrenia and age from 20 to 65 years old were included. The criteria of metabolic syndrome were according to the adapted Adult Treatment Protocol for Asians. According to different types of rehabilitations, patients were divided into work group, occupational therapy group and daily activities group. A total of 359 chronic inpatients with schizophrenia were recruited. Participants had a mean age of 45.9 years and the prevalence of metabolic syndrome was 37.3%. There was a significantly higher prevalence of metabolic syndrome in the work group than in the daily activity group (adjusted odds ratio (aOR) = 1.91, 95% CI = 1.019-3.564, p metabolic syndrome included old age, female gender, low psychotic symptoms severity and clozapine user. This study identified a high prevalence of metabolic syndrome in chronic inpatients with schizophrenia especially in patients with good occupational function. Further investigation of the relationship between the occupational function and metabolic syndrome is necessary for chronic inpatients with schizophrenia. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Intriguing model significantly reduces boarding of psychiatric patients, need for inpatient hospitalization. (United States)


    As new approaches to the care of psychiatric emergencies emerge, one solution is gaining particular traction. Under the Alameda model, which has been put into practice in Alameda County, CA, patients who are brought to regional EDs with emergency psychiatric issues are quickly transferred to a designated emergency psychiatric facility as soon as they are medically stabilized. This alleviates boarding problems in area EDs while also quickly connecting patients with specialized care. With data in hand on the model's effectiveness, developers believe the approach could alleviate boarding problems in other communities as well. The model is funded by through a billing code established by California's Medicaid program for crisis stabilization services. Currently, only 22% of the patients brought to the emergency psychiatric facility ultimately need to be hospitalized; the other 78% are able to go home or to an alternative situation. In a 30-day study of the model, involving five community hospitals in Alameda County, CA, researchers found that ED boarding times were as much as 80% lower than comparable ED averages, and that patients were stabilized at least 75% of the time, significantly reducing the need for inpatient hospitalization.

  11. 76 FR 59256 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal... (United States)


    ...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...

  12. Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial. (United States)

    Mor, V; Stalker, M Z; Gralla, R; Scher, H I; Cimma, C; Park, D; Flaherty, A M; Kiss, M; Nelson, P; Laliberte, L


    A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

  13. Asthma and myocardial infarction inpatient hospitalization and emergency room visit counts and rates by county, year and month of admission, age group, race/ethnicity and gender of California residents, 2000-2009. (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of asthma (ICD9-CM 493.0-493.9) and myocardial infarction (ICD9-CM 410) inpatient hospitalizations...


    Directory of Open Access Journals (Sweden)

    Kumboyono Kumboyono


    Full Text Available Introduction: Patient acceptance to diet in fl uences patient intake during the hospitalization. Patient acceptance on meals provided by the hospital can be seen from the left over. Whilst factors which in fl uences patient motivation to finish their meals including addtional food, taste, and adaptation level to the hospital, the aim of this research was to identify factors that related to patient acceptance on meals provided by the hospital in class three ward dr. Soepraoen Hospital, Malang. Method: Descriptive analitic was used as research design with cross-sectional approach. As many as 51 samples were chosen with purposive sampling. Data was analyzed with chi square with 95%signi fi cance. Results: The results showed a signi fi cant relation between additional food and the leftover (p-Value = 0,018. There is signi fi cant relation on the taste and the leftover (p-Value = 0.032 and adaptation level and leftover (p-Value = 0.026. Discussion: It can be concluded that additional food, taste, and adaptation level to the hospital have signi fi cant relation with hospitalized patient acceptance on their diet. It is suggested that nurse pay more attention on these factors to fulfi ll patient nutrition needs during hospitalization.

  15. 42 CFR 412.75 - Determination of the hospital-specific rate for inpatient operating costs based on a Federal... (United States)


    ... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating Costs § 412.75 Determination of the... methodology set forth in §§ 412.73(c)(15) and 412.73(c)(16). (e) DRG adjustment. The applicable hospital...

  16. Utilization of inpatient care from private hospitals: trends emerging from Kerala, India. (United States)

    Dilip, T R


    There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

  17. Hospital heavies. Venture capital bulks up companies that outsource medicine's newest specialty: inpatient-only care. (United States)

    Huff, C

    They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.

  18. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

    Directory of Open Access Journals (Sweden)

    Latha KS


    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  19. Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

    Directory of Open Access Journals (Sweden)

    Langalibalele H. Mabuza


    Full Text Available Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity. Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods: This was a qualitative arm of a larger study, titled ‘Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa’, conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152 who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity.Data were analysed thematically. Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be ‘too busy’, aloof, non-communicators and sometimes uncertain about patients’ conditions. Some inpatients had unquestioning trust in healthcare practitioners,whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion: The reasons for not seeking clarity were based on patients’ experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.

  20. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge. (United States)

    Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena


    Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital. (United States)

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian


    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. 30-Day Hospital Readmission Following Otolaryngology Surgery: Analysis of a State Inpatient Database (United States)

    Graboyes, Evan M.; Kallogjeri, Dorina; Saeed, Mohammed J.; Olsen, Margaret A.; Nussenbaum, Brian


    Objectives For patients undergoing inpatient otolaryngologic surgery, determine patient and hospital-level risk factors associated with 30-day readmission. Study Design Retrospective cohort study Methods We analyzed the State Inpatient Database (SID) from California for patients who underwent otolaryngologic surgery between 2008 and 2010. Readmission rates, readmission diagnoses, and patient- and hospital-level risk factors for 30-day readmission were determined. Hierarchical logistic regression modeling was performed to identify procedure-, patient-, and hospital-level risk factors for 30-day readmission. Results The 30-day readmission rate following an inpatient otolaryngology procedure was 8.1%. The most common readmission diagnoses were nutrition, metabolic or electrolyte problems (44% of readmissions) and surgical complications (10% of readmissions). New complications after discharge were the major drivers of readmission. Variables associated with 30-day readmission in hierarchical logistic regression modeling were: type of otolaryngologic procedure, Medicare or Medicaid health insurance, chronic anemia, chronic lung disease, chronic renal failure, index admission via the emergency department, in-hospital complication during the index admission, and discharge destination other than home. Conclusions Approximately one out of twelve patients undergoing otolaryngologic surgery had a 30-day readmission. Readmissions occur across a variety of types of procedures and hospitals. Most of the variability was driven by patient-specific factors, not structural hospital characteristics. PMID:27098654

  3. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid


    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  4. Participation in and Satisfaction With an Exercise Program for Inpatient Mental Health Consumers. (United States)

    Stanton, Robert; Donohue, Trish; Garnon, Michelle; Happell, Brenda


    This study examines attendance at, and satisfaction with, a group exercise program in an inpatient mental health setting. Thirty-two inpatients completed discharge surveys to evaluate group activities. Data were analyzed for participation and satisfaction. More inpatients (n = 16, 50%) rated exercise as "excellent" compared with all other activities. Nonattendance rates were lowest for cognitive behavioral therapy (n = 2, 6.3%), highest for the relaxation group (n = 6, 18.8%), and 12.5% (n = 4) for the group exercise program. Group exercise programs delivered by highly trained personnel are well attended and achieve high satisfaction ratings by inpatient mental health consumers. © 2015 Wiley Periodicals, Inc.

  5. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care. (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B


    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Casemix funding for acute hospital inpatient services in Australia. (United States)

    Duckett, S J


    Casemix funding was introduced first in Victoria in 1993-94, and since then most States have moved towards either casemix funding or using casemix to inform the budget setting process. The five States implementing casemix have adopted some common funding elements: all use AN-DRG-3; all have introduced capping, msot commonly at the hospital level; and all ensure accuracy of diagnosis and procedure coding through coding audits. Two funding models have been developed. The fixed and variable model involves a fixed grant for hospital overhead costs and a payment for each patient treated, covering only variable costs. The integrated model provides an integrated payment to hospitals for each patient treated, covering both the fixed and variable costs. There are different weight setting processes and base prices between the States, which result in marked differences in the price paid for the same type of case treated in similar hospitals. Learning across State boundaries should be encouraged, with knowledge of what is effective and what is ineffective in casemix funding arrangements being used to develop Australian best practice in this area.

  7. Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification. (United States)

    Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L


    The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

  8. Inpatient migration patterns in persons with spinal cord injury: A registry study with hospital discharge data

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    Elias Ronca


    Full Text Available This study investigated and compared patient migration patterns of persons with spinal cord injury, the general population and persons with morbid obesity, rheumatic conditions and bowel disease, for secondary health conditions, across administrative boundaries in Switzerland. The effects of patient characteristics and health conditions on visiting hospitals outside the residential canton were examined using complete, nationwide, inpatient health records for the years 2010 and 2011. Patients with spinal cord injury were more likely to obtain treatment outside their residential canton as compared to all other conditions. Facilitators of patient migration in persons with spinal cord injury and the general hospital population were private or accidental health insurances covering costs. Barriers of patient migration in persons with spinal cord injury were old age, severe multimorbidity, financial coverage by basic health insurance, and minority language region. Keywords: Spinal cord injury, Patient migration, Health services accessibility, Health care utilization, Inpatient hospital care

  9. Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg

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    Laila Paruk


    Full Text Available Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year. Methods: A retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment, length of stay and follow-up of a group of inpatients during 2010 with a diagnosis of BPD, based on DSM-IV-TR diagnostic criteria, allocated on discharge. Results: Considering evidence retrospectively, the quality of the BPD diagnosis allocated appeared adequate. Statistical analysis revealed findings mainly in keeping with other reports, for example, that patients with BPD are above-average users of resources who make significantly more use of emergency services and that they generally do not adhere well to their scheduled outpatient follow-up arrangements. The longer average length of inpatient stay of this group with BPD, however, exceeded the typically brief period generally recommended for acute inpatient containment and emergency intervention. Conclusion: Implementation of targeted prevention and early intervention strategies, based on systematised programmes such as dialectical behavioural therapy and mentalisation based therapy, may be useful in addressing these problems experienced with integrating the in- and outpatient management of BPD. Keywords: Borderline personality; inpatient; acute

  10. Performance of freestanding inpatient rehabilitation hospitals before and after the rehabilitation prospective payment system. (United States)

    Thompson, Jon M; McCue, Michael J


    Inpatient rehabilitation hospitals provide important services to patients to restore physical and cognitive functioning. Historically, these hospitals have been reimbursed by Medicare under a cost-based system; but in 2002, Medicare implemented a rehabilitation prospective payment system (PPS). Despite the implementation of a PPS for rehabilitation, there is limited published research that addresses the operating and financial performance of these hospitals. We examined operating and financial performance in the pre- and post-PPS periods for for-profit and nonprofit freestanding inpatient rehabilitation hospitals to test for pre- and post-PPS differences within the ownership groups. We identified freestanding inpatient rehabilitation hospitals from the Centers for Medicare and Medicaid Services Health Care Cost Report Information System database for the first two fiscal years under PPS. We excluded facilities that had fiscal years less than 270 days, facilities with missing data, and government facilities. We computed average values for performance variables for the facilities in the two consecutive fiscal years post-PPS. For the pre-PPS period, we collected data on these same facilities and, once facilities with missing data and fiscal years less than 270 days were excluded, computed average values for the two consecutive fiscal years pre-PPS. Our final sample of 140 inpatient rehabilitation facilities was composed of 44 nonprofit hospitals and 96 for-profit hospitals both pre- and post-PPS. We utilized a pairwise comparison test (t-test comparison) to measure the significance of differences on each performance variable between pre- and post-PPS periods within each ownership group. Findings show that both nonprofit and for-profit freestanding inpatient rehabilitation hospitals reduced length of stay, increased discharges, and increased profitability. Within the for-profit ownership group, the percentage of Medicare discharges increased and operating expense per

  11. Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995. (United States)

    Pottick, K J; McAlpine, D D; Andelman, R B


    The authors examine patterns in utilization of psychiatric inpatient services by children and adolescents in general hospitals during 1988-1995. National Hospital Discharge Survey data were used to describe utilization patterns for children and adolescents with primary psychiatric diagnoses in general hospitals from 1988 to 1995. During the study period, there was a 36% increase in hospital discharges and a 44% decline in mean length of stay, resulting in a 23% decline in the number of bed-days, from more than 3 million to about 2.5 million. The number of nonpsychotic major depressive disorders increased significantly. Discharges from public hospitals have declined, and those from proprietary hospitals have risen. Concurrently, the role of private insurance declined and the role of Medicaid increased. During the period of study, the mean and median length of stay declined most for children and adolescents who were hospitalized in private facilities and those covered by private insurance. Across the United States, the mean length of stay declined significantly; this decline was almost 60% in the West. Discharges also declined in the West, in contrast to the Midwest and the South, where they significantly increased. Increased numbers of discharges and decreased length of stay may reflect evolving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existing Medicaid policy could have a profound impact on the availability of inpatient resources.

  12. Inpatient antibiotic consumption in a regional secondary hospital in New Zealand. (United States)

    Hopkins, C J


    Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking. © 2014 The Author; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  13. How can the impact of PACS on inpatient length of hospital stay be established? (United States)

    Bryan, Stirling; Muris, Nicole; Keen, Justin; Weatherburn, Gwyneth C.; Buxton, Martin J.


    Many have argued that the introduction of a large-scale PACS system into a hospital will bring about reductions in the length of inpatient hospital stays. There is currently no convicting empirical evidence to support such claims. As part of the independent evaluation exercise being undertaken alongside the Hammersmith Hospital PACS implementation, an assessment is being made of the impact of PACS on length of stay for selected patient groups. This paper reports the general research methods being employed to undertake this assessment and provides some baseline results from the analysis of total hip replacement patients and total knee replacement patients treated prior to the introduction of PACS.

  14. Hospital Readmission Following Discharge From Inpatient Rehabilitation for Older Adults With Debility (United States)

    Karmarkar, Amol M.; Graham, James E.; Tan, Alai; Raji, Mukaila; Granger, Carl V.; Ottenbacher, Kenneth J.


    Background Debility accounts for 10% of inpatient rehabilitation cases among Medicare beneficiaries. Debility has the highest 30-day readmission rate among 6 impairment groups most commonly admitted to inpatient rehabilitation. Objective The purpose of this study was to examine rates, temporal distribution, and factors associated with hospital readmission for patients with debility up to 90 days following discharge from inpatient rehabilitation. Design A retrospective cohort study was conducted using records for 45,424 Medicare fee-for-service beneficiaries with debility discharged to community from 1,199 facilities during 2006–2009. Methods Cox proportional hazard regression models were used to estimate hazard ratios for readmission. Schoenfeld residuals were examined to identify covariate-time interactions. Factor-time interactions were included in the full model for Functional Independence Measure (FIM) discharge motor functional status, comorbidity tier, and chronic pulmonary disease. Most prevalent reasons for readmission were summarized by Medicare severity diagnosis related groups. Results Hospital readmission rates for patients with debility were 19% for 30 days and 34% for 90 days. The highest readmission count occurred on day 3 after discharge, and 56% of readmissions occurred within 30 days. A higher FIM discharge motor rating was associated with lower hazard for readmissions prior to 60 days (30-day hazard ratio=0.987; 95% confidence interval=0.986, 0.989). Comorbidities with hazard ratios >1.0 included comorbidity tier and 11 Elixhauser conditions, 3 of which (heart failure, renal failure, and chronic pulmonary disease) were among the most prevalent reasons for readmission. Limitations Analysis of Medicare data permitted only use of variables reported for administrative purposes. Comorbidity data were analyzed only for inpatient diagnoses. Conclusions One-third of patients were readmitted to acute hospitals within 90 days following rehabilitation for

  15. Drug use by elderly inpatients of a philanthropic hospital

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    Rômulo Moreira dos Santos


    Full Text Available The high incidence of chronic diseases in the elderly leads to increased intermittent drug therapies. The presence of concomitant diseases and prescriptions made out by various health professionals facilitate the practice of polypharmacy, the emergence of iatrogenic diseases, and therapeutic regimens that are inconvenient for patients. The present study was carried out among elderly patients hospitalized at the Hospital Care Foundation of Paraiba, Campina Grande, with the objectives of studying the consumption of drugs by these patients, noting the possible adverse drug reactions (ADR, drug interactions and the presence of high-risk drugs prescribed to this age group. The study had a descriptive and cross-sectional quantitative design and involved a sample of 65 patients accompanied by the Pharmacovigilance Centre of the hospital, from August 2009 to July 2010. Over 90% of the patients were on polypharmacy, and the possible ADR found were related to the gastrointestinal tract where the most frequent interactions were with cardiovascular drugs. Within the context of pharmacoepidemiology, pharmacists can contribute by improving the quality of life of patients and preventing unnecessary expense with erroneous and poorly evaluated treatments.A elevada incidência de doenças crônicas na terceira idade induz ao aumento de terapias medicamentosas intermitentes. A presença de patologias concomitantes e prescrições elaboradas por diversos profissionais de saúde facilitam a prática da polifarmácia, surgimento de doenças iatrogênicas e esquemas terapêuticos pouco cômodos para o paciente. O estudo foi realizado junto aos pacientes idosos internados no Hospital da Fundação Assistencial da Paraíba (FAP, Campina Grande, com objetivo de estudar o consumo de medicamentos por estes pacientes, observando as possíveis reações adversas a medicamentos (RAM, interações medicamentosas apresentadas e a presença de medicamentos de alto risco

  16. Inpatient child mortality by travel time to hospital in a rural area of Tanzania. (United States)

    Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M; Todd, Jim; Reyburn, Hugh


    To investigate the association, if any, between child mortality and distance to the nearest hospital. The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. © 2014 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  17. Nurses' experiences of inpatients suicide in a general hospital*

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    Mirriam Matandela


    Full Text Available When suicide occurs, it is regarded as an adverse event. Often, little attention is given to the nurses who cared for the patients prior to the adverse event. Instead the affected nurses are expected to write statements and incident reports about the adverse event. The aim was to explore the experiences of nurses who cared for patients who successfully committed suicide whilst admitted at a specific general hospital in Gauteng Province, South Africa. A qualitative exploratory research was conducted. Data were collected through in-depth interviews with a purposive sample of six nurses and content analysis was done. Nurses experienced feelings of shock; blame and condemnation; inadequacy and feared reprisal. This study suggests a basis for development of support strategies to assist the nurses to deal with their emotions following experience of adverse events.

  18. Prevalence of antibacterial resistant bacterial contaminants from mobile phones of hospital inpatients. (United States)

    Vinod Kumar, B; Hobani, Yahya Hasan; Abdulhaq, Ahmed; Jerah, Ahmed Ali; Hakami, Othman M; Eltigani, Magdeldin; Bidwai, Anil K


    Mobile phones contaminated with bacteria may act as fomites. Antibiotic resistant bacterial contamination of mobile phones of inpatients was studied. One hundred and six samples were collected from mobile phones of patients admitted in various hospitals in Jazan province of Saudi Arabia. Eighty-nine (83.9%) out of 106 mobile phones were found to be contaminated with bacteria. Fifty-two (49.0%) coagulase-negative Staphylococcus, 12 (11.3%) Staphylococcus aureus, 7 (6.6%) Enterobacter cloacae, 3 (2.83%) Pseudomonas stutzeri, 3 (2.83%) Sphingomonas paucimobilis, 2 (1.8%) Enterococcus faecalis and 10 (9.4%) aerobic spore bearers were isolated. All the isolated bacteria were found to be resistant to various antibiotics. Hence, regular disinfection of mobile phones of hospital inpatients is advised.

  19. Analysis of Drugs Interaction among Pediatric Inpatients at Hospital in Palu

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    Akhmed G. Sjahadat


    Full Text Available We performed drug interaction analyses in the pediatric inpatient unit at one of hospitals in Palu. In this study, those analysesstudy are important to prevent childhood morbidity, mortality and to improve patient’s safety. By using a cross-sectional descriptive study, we collected retrospective data from January until December 2012. We included patients at age of 0- 18 years old who were hospitalized during 2012 and received two or more drugs from a prescription sheet. In particular, we excluded pediatric inpatients in emergency and intensive care units who received topical medications (e.g., ointment, creams, eye drops, ear drops, and nasal drops. Each drug was analyzed by using Drug.Com software. In total, we minor interactions (44.78%. We found several drug interactions in the combination of rifampicin-isoniazid, dexamethasone-ibuprofen, acetaminophen-isoniazid, gentamicin-cefotaxime-ceftriaxone and diazepam- dexamethasone.

  20. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone.

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    Matthew Clark

    Full Text Available BACKGROUND: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. METHODS AND FINDINGS: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607 lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. CONCLUSIONS: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.

  1. Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital. (United States)

    Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K


    Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

  2. Perceptions of the Inpatient Training Experience: A Nationwide Survey of Gastroenterology Program Directors and Fellows. (United States)

    Kumar, Navin L; Perencevich, Molly L; Trier, Jerry S


    Inpatient training is a key component of gastroenterology (GI) fellowship programs nationwide, yet little is known about perceptions of the inpatient training experience. To compare the content, objectives and quality of the inpatient training experience as perceived by program directors (PD) and fellows in US ACGME-accredited GI fellowship programs. We conducted a nationwide, online-based survey of GI PDs and fellows at the conclusion of the 2016 academic year. We queried participants about (1) the current models of inpatient training, (2) the content, objectives, and quality of the inpatient training experience, and (3) the frequency and quality of educational activities on the inpatient service. We analyzed five-point Likert items and rank assessments as continuous variables by an independent t test and compared proportions using the Chi-square test. Survey response rate was 48.4% (75/155) for PDs and a total of 194 fellows completed the survey, with both groups reporting the general GI consult team (>90%) as the primary model of inpatient training. PDs and fellows agreed on the ranking of all queried responsibilities of the inpatient fellow to develop during the inpatient service. However, fellows indicated that attendings spent less time teaching and provided less formal feedback than that perceived by PDs (p < 0.0001). PDs rated the overall quality of the inpatient training experience (p < 0.0001) and education on the wards (p = 0.0003) as better than overall ratings by fellows. Although GI fellows and PDs agree on the importance of specific fellow responsibilities on the inpatient service, fellows report experiencing less teaching and feedback from attendings than that perceived by PDs. Committing more time to education and assessment may improve fellows' perceptions of the inpatient training experience.

  3. Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan. (United States)

    Asahi, Yoshinao; Omichi, Shiro; Ono, Takahiro


    Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  4. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital.

    LENUS (Irish Health Repository)

    Forde, Dónall


    BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to

  5. 76 FR 32085 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate... (United States)


    ..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...

  6. The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.

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    Sara Garfield

    Full Text Available Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing.We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically.Paper or electronic medication records were shown to patients in only 4 (2% of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.Patients appear to have more access to paper-based records than

  7. The epidemiology of assault-related hospital in-patient admissions and ED attendances.

    LENUS (Irish Health Repository)

    O'Farrell, A


    The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292\\/16079 (14%) of in-patient cases and 242\\/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

  8. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – by Facility (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  9. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – by State (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  10. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – National (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  11. Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

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    Simoens Steven R


    Full Text Available Abstract Background Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway and the differences in the treatment of depressive episodes. Methods A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43. The websites of the hospitals were searched for information on their approach to treating depressive episodes. Results A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment, discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes. Conclusion This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.

  12. Exploring differences in inpatient drug purchasing cost between two pediatric hospitals. (United States)

    Nydert, Per; Poole, Robert


    In this study, the hospital cost of purchasing drugs at two children's hospitals is explored with respect to high-cost drugs and drug classes and discussed with regard to differences in hospital setting, drug price, or number of treatments. The purchasing costs of drugs at the two hospitals were retrieved and analyzed. All information was connected to the Anatomic Therapeutic Chemical code and compared in a Microsoft Access database. The 6-month drug purchasing costs at Astrid Lindgren Children's Hospital (ALCH), Stockholm, Sweden, and Lucile Packard Children's Hospital at Stanford (LPCH), Palo Alto, California, are similar and result in a cost per patient day of US $149 and US $136, respectively. The hospital setting and choice of drug products are factors that influence the drug cost in product-specific ways. Several problems are highlighted when only drug costs are compared between hospitals. For example, the comparison does not take into account the amount of waste, risk of adverse drug events, local dosing strategies, disease prevalence, and national drug-pricing models. The difference in cost per inpatient day at ALCH may indicate that cost could be redistributed in Sweden to support pediatric pharmacy services. Also, when introducing new therapies seen at the comparison hospital, it may be possible to extrapolate the estimated increase in cost.

  13. Perceptions of Yoga Therapy Embedded in Two Inpatient Rehabilitation Hospitals: Agency Perspectives

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    Marieke Van Puymbroeck


    Full Text Available Inpatient medical rehabilitation has maintained a typical medical-model focus and structure for many years. However, as integrative therapies, such as yoga therapy, emerge as treatments which can enhance the physical and mental health of its participants, it is important to determine if they can be easily implemented into the traditional rehabilitation structure and milieu. Therefore, the purpose of this study was to examine the perceptions of key agency personnel on the feasibility and utility of yoga therapy implemented in inpatient rehabilitation. This study reports the results of focus groups and an individual interview with key stakeholders (administrators and rehabilitation therapists from two rehabilitation hospitals following the implementation of yoga therapy. Results focused on several key themes: feasibility from the therapist and administrator perspectives, challenges to implementation, and utility and benefit. Overall, the implementation and integration of yoga therapy were positive; however, some programmatic and policy and organizational considerations remain. Implications for practice and future research are provided.

  14. An analysis of the recording of tobacco use among inpatients in Irish hospitals.

    LENUS (Irish Health Repository)

    Sheridan, A


    Smoking is the largest avoidable cause of premature mortality in the world. Hospital admission is an opportunity to identify and help smokers quit. This study aimed to determine the level of recording of tobacco use (current and past) in Irish hospitals. Information on inpatient discharges with a tobacco use diagnosis was extracted from HIPE. In 2011, a quarter (n=84, 679) of discharges had a recording of tobacco use, which were more common among males (29% (n=50,161) male v. 20% (n=30,162) female), among medical patients (29% (n=54,375) medical v. 20% (n=30,162) other) and was highest among those aged 55-59 years (30.6%; n=7,885). SLAN 2007 reported that 48% of adults had smoked at some point in their lives. This study would suggest an under- reporting of tobacco use among hospital inpatients. Efforts should be made to record smoking status at hospital admission, and to improve the quality of the HIPE coding of tobacco use.

  15. Profile and pattern of crack consumption among inpatients in a Brazilian psychiatric hospital. (United States)

    da Cunha, Silvia Mendes; Araujo, Renata Brasil; Bizarro, Lisiane


    Crack cocaine use is associated with polydrug abuse, and inpatients dependent on crack exhibit profiles of serious consumption patterns. Use of alcohol and tobacco and other drugs is a risk factor for experimentation of additional drugs, including crack cocaine. The present study describes the characteristics and crack consumption patterns among inpatients in treatment during 2011 and 2012 at the Hospital Psiquiátrico São Pedro (Porto Alegre, Brazil). An additional objective was to identify the sequence of alcohol and tobacco consumption prior to crack use. The participants were 53 male inpatients addicted to crack with a mean age of 27.5±7.3 years. A sociodemographic questionnaire; the Alcohol, Smoking and Substance Involvement Screening Test and the Mini Mental State Examination were all administered to participants. Inclusion criteria were crack cocaine dependency (based on the 10th edition of the International Classification of Diseases [ICD-10]) and being abstinent for 7 days. Patients with cognitive difficulties who were unable to understand and/or respond to the questionnaires were excluded from the sample. The participants were young male adults with low educational level and low incomes and were polydrug users. The majority had made more than one attempt to quit. Use of legal drugs in early adolescence, prior to crack use, was identified. The profiles of the inpatients addicted to crack treated at this hospital indicate a serious usage pattern among those who seek specialized support. Crack use is frequent and is associated with use of other drugs and with difficulty sustaining abstinence. The pattern of progression from alcohol and tobacco use to crack cocaine dependency demands the attention of those responsible for prevention policies.

  16. Inpatient dermatology: Characteristics of patients and admissions in a tertiary level hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Arpita Sen


    Full Text Available Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27% were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33% and infective disorders (73 patients, 19.47%. Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2% improved after hospitalization; while 29 (7.73% patients died from their illness. About 133 patients (35.64% required referral services during their stay, while 8 patients (2.13% were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

  17. Alcohol, cognitive impairment and the hard to discharge acute hospital inpatients.

    LENUS (Irish Health Repository)

    Popoola, A


    AIM: To examine the role of alcohol and alcohol-related cognitive impairment in the clinical presentation of adults in-patients less than 65 years who are \\'hard to discharge\\' in a general hospital. METHOD: Retrospective medical file review of inpatients in CUH referred to the discharge coordinator between March and September 2006. RESULTS: Of 46 patients identified, the case notes of 44 (25 male; age was 52.2 +\\/- 7.7 years) were reviewed. The average length of stay in the hospital was 84.0 +\\/- 72.3 days and mean lost bed days was 15.9 +\\/- 36.6 days. The number of patients documented to have an overt alcohol problem was 15 (34.1%). Patients with alcohol problems were more likely to have cognitive impairment than those without an alcohol problem [12 (80%) and 9 (31%) P = 0.004]. Patients with alcohol problems had a shorter length of stay (81.5 vs. 85.3 days; t = 0.161, df = 42, P = 0.87), fewer lost bed days (8.2 vs. 19.2 days; Mann-Whitney U = 179, P = 0.34) and no mortality (0 vs. 6) compared with hard to discharge patients without alcohol problem. CONCLUSION: Alcohol problems and alcohol-related cognitive impairment are hugely over-represented in acute hospital in-patients who are hard to discharge. Despite these problems, this group appears to have reduced morbidity, less lost bed days and a better outcome than other categories of hard to discharge patients. There is a need to resource acute hospitals to address alcohol-related morbidity in general and Wernicke-Korsakoff Syndrome in particular.

  18. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    International Nuclear Information System (INIS)

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore


    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  19. Prevalence of nasal carriage and diversity of Staphylococcus aureus among inpatients and hospital staff at Korle Bu Teaching Hospital, Ghana

    DEFF Research Database (Denmark)

    Egyir, Beverly; Guardabassi, Luca; Nielsen, Søren Saxmose


    %) was more common than for other agents (resistant S. aureus carriage was observed among IP compared with HS (P = 0.01). High genetic diversity was shown by spa typing, with 55 spa types found among 105 isolates; the predominant spa types were t355 (10%) and t084 (10......There is a paucity of data on Staphylococcus aureus epidemiology in Africa. Prevalence of nasal carriage and genetic diversity of S. aureus were determined among hospital staff (HS) and inpatients (IP) at the largest hospital in Ghana. In total, 632 nasal swabs were obtained from 452 IP and 180 HS...... in the Child Health Department (CHD) and Surgical Department (SD). S. aureus carriage prevalences were 13.9% in IP and 23.3% in HS. The chance of being a carrier was higher in HS (P = 0.005) and IP staying ≤7 days in hospital (P = 0.007). Resistance to penicillin (93%), tetracycline (28%) and fusidic acid (12...

  20. Defining pediatric inpatient cardiology care delivery models: A survey of pediatric cardiology programs in the USA and Canada. (United States)

    Mott, Antonio R; Neish, Steven R; Challman, Melissa; Feltes, Timothy F


    The treatment of children with cardiac disease is one of the most prevalent and costly pediatric inpatient conditions. The design of inpatient medical services for children admitted to and discharged from noncritical cardiology care units, however, is undefined. North American Pediatric Cardiology Programs were surveyed to define noncritical cardiac care unit models in current practice. An online survey that explored institutional and functional domains for noncritical cardiac care unit was crafted. All questions were multi-choice with comment boxes for further explanation. The survey was distributed by email four times over a 5-month period. Most programs (n = 45, 60%) exist in free-standing children's hospitals. Most programs cohort cardiac patients on noncritical cardiac care units that are restricted to cardiac patients in 39 (54%) programs or restricted to cardiac and other subspecialty patients in 23 (32%) programs. The most common frontline providers are categorical pediatric residents (n = 58, 81%) and nurse practitioners (n = 48, 67%). However, nurse practitioners are autonomous providers in only 21 (29%) programs. Only 33% of programs use a postoperative fast-track protocol. When transitioning care to referring physicians, most programs (n = 53, 72%) use facsimile to deliver pertinent patient information. Twenty-two programs (31%) use email to transition care, and eighteen (25%) programs use verbal communication. Most programs exist in free-standing children's hospitals in which the noncritical cardiac care units are in some form restricted to cardiac patients. While nurse practitioners are used on most noncritical cardiac care units, they rarely function as autonomous providers. The majority of programs in this survey do not incorporate any postoperative fast-track protocols in their practice. Given the current era of focused handoffs within hospital systems, relatively few programs utilize verbal handoffs to the referring pediatric

  1. Depression and Associated Factors among Adult Inpatients at Public Hospitals of Harari Regional State, Eastern Ethiopia

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    Haile Tilahun


    Full Text Available Introduction. Globally, depression is one of the three leading causes of disease and it will be the second leading cause of world disability by 2030. The prevalence of depression in Sub-Saharan Africa ranges from 15 to 30%. In Ethiopia, depression was found to be the seventh leading cause of disease burden and its prevalence has been increased in hospital compared to community setting because hospital environment itself is stressful. Yet, no study was done in Eastern Ethiopia, where substance use like Khat is very rampant. Objective. To assess depression and associated factors among adult inpatients at public hospitals of Harari Regional State, Eastern Ethiopia, from February 01 to 28, 2017. Methodology. Hospital based cross-sectional study design was employed on 492 admitted adult patients in Harari region hospitals. Consecutive sampling method was used to include study population. The data were collected by interviewee and analyzed by SPSS version 20.0. Bivariate and multivariate logistic regression analyses were employed. p value of 0.05 or less was considered to be statistically significant. Result. A total of 489 patients were interviewed with response rate of 99.4%. Having duration of 1-2 weeks in the hospital [AOR = 2.02, 95% CI: (1.28, 3.19], being diagnosed with chronic morbidity [AOR = 4.06, 95% CI: (2.23, 7.40], being users of psychoactive drugs [AOR = 2.24, 95% CI: (1.18, 4.24], and having been admitted to surgical ward [AOR = 0.50, 95% CI: (0.31, 0.81] were significantly associated with depression. Conclusion and Recommendation. Prevalence of depression among admitted inpatients was high. Therefore, increasing the awareness of benefits of early diagnosis of patients to prevent major form of depression and strengthening the clinical set-up and establishing good referral linkage with mental health institutions was considered to be cost-effective method to reduce its prevalence.

  2. Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mohammad Ashraf Wani


    Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96. This includes expenditure incurred both by the hospital and the patient (out of pocket. Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

  3. Adolescent inpatient activity 1999-2010: analysis of English Hospital Episode Statistics data. (United States)

    Hargreaves, Dougal S; Viner, Russell M


    To investigate patterns and trends of adolescent (10-19 years) inpatient activity in England by sex, disease category, and admitting speciality. 9 632 844 Finished Consultant Episodes (FCEs) from English patients aged 1-19 between 1999/2000 and 2010/2011 (Hospital Episode Statistics data). Age trends by sex and major International Classification of Disease 10 (ICD10) chapter; differences in activity rates by age and sex; inpatient activity trends over the past decade, disaggregated by sex, admitting speciality and ICD10 chapter. Adolescent female patients account for more activity than girls aged 1-9 (139.4 vs 107.2 FCEs/1000). Female inpatient activity increases significantly between age 10 (70.9 FCEs/1000) and 19 (281.7 FCES/1000, of which non-obstetric care accounts for 155.9 FCEs/1000). Male activity increases much less during adolescence, with lower overall rates among adolescents than younger children (93.7 vs 142.9 FCEs/1000). Between 1999 and 2010, total adolescent inpatient activity increased faster among adolescents (10-19 years) (+14.2%) than younger children (1-9 years) (+11.0%). Adolescent FCEs/1000 increased by 12.8%, including higher rates admitted under Paediatrics (+47.5%) and Paediatric Surgery (+23.2%). Adolescents were admitted across a range of specialities. These data challenge the belief that adolescents are a healthy group who rarely use inpatient services. In England, use of inpatient services is higher among female patients aged 10-19 years than those aged 1-9 years, while adolescent activity has increased faster than for younger children over the past 11 years. Improving service quality for adolescents will require engagement of the many different teams that care for them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  4. Prevalence of probiotic use among inpatients: A descriptive study of 145 U.S. hospitals. (United States)

    Yi, Sarah H; Jernigan, John A; McDonald, L Clifford


    To inform clinical guidance, public health efforts, and research directions, probiotic use in U.S. health care needs to be better understood. This work aimed to assess the prevalence of inpatient probiotic use in a sample of U.S. hospitals. Probiotic use among patients discharged in 2012 was estimated using the MarketScan Hospital Drug Database. In addition, the annual trend in probiotic use (2006-2012) was assessed among a subset of hospitals. Among 145 hospitals with 1,976,167 discharges in 2012, probiotics were used in 51,723 (2.6%) of hospitalizations occurring in 139 (96%) hospitals. Patients receiving probiotics were 9 times more likely to receive antimicrobials (P probiotic formulations were Saccharomyces boulardii (32% of patients receiving probiotics), Lactobacillus acidophilus and Lactobacillus bulgaricus (30%), L acidophilus (28%), and Lactobacillus rhamnosus (11%). Probiotic use increased from 1.0% of 1,090,373 discharges in 2006 to 2.9% of 1,006,051 discharges in 2012 (P probiotics as part of their care despite inadequate evidence to support their use in this population. Additional research is needed to guide probiotic use in the hospital setting. Published by Elsevier Inc.

  5. A mobility program for an inpatient acute care medical unit. (United States)

    Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie


    For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

  6. The community impact of consolidating long-term inpatient care at a single state hospital. (United States)

    Wolff, N


    A community impact model was used to estimate how consolidation of all long-term inpatient care at one state mental hospital affected the town in which the hospital was located. Qualitative and quantitative methods were used to measure objective and subjective impacts of the hospital's expanded role. Objective impacts included employment, retail sales, and use of local services such as police, welfare, and education. Subjective impacts included residents' perceptions of safety. Data were obtained from hospital records, service providers, merchants, residents, and persons living on the streets or in shelters. Overall, the policy had a positive net impact on the community, estimated at roughly $4 million during the 18 months after implementation. Nearly $1 million was a direct payment from the state in lieu of taxes for the property occupied by the hospital. The hospital's payments to businesses in the town increased 10 percent. The number of hospital employees increased by 61 percent, to 1,336. The number of local residents working in the hospital grew from 200 to 320, and the proportion of the hospital's annual payroll paid to local residents increased from 14 to 24 percent. Local service use did not increase, and no change was noted in the crime rate. More patients were discharged to other towns than were admitted from the host town. Eighty percent of the residents surveyed said the town had either improved or had not changed. The benefits brought by the consolidation are likely to be sustained in the long run if the state continues the current rate of payments to the community and the hospital continues its policy of discharging patients to the town where they resided before hospitalization.

  7. Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury. (United States)

    Hammond, Flora M; Horn, Susan D; Smout, Randall J; Beaulieu, Cynthia L; Barrett, Ryan S; Ryser, David K; Sommerfeld, Teri


    To assess the incidence of, causes for, and factors associated with readmission to an acute care hospital (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Prospective observational cohort. Inpatient rehabilitation. Individuals with TBI admitted consecutively for inpatient rehabilitation (N=2130). Not applicable. RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location. A total of 183 participants (9%) experienced RTAC for a total of 210 episodes. Of 183 participants, 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. The mean time from rehabilitation admission to first RTAC was 22±22 days. The mean duration in acute care during RTAC was 7±8 days. Eighty-four participants (46%) had ≥1 RTAC episodes for medical reasons, 102 (56%) had ≥1 RTAC episodes for surgical reasons, and 6 (3%) participants had RTAC episodes for unknown reasons. Most common surgical RTAC reasons were neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurological (23%), and cardiac (12%). Any RTAC was predicted as more likely for patients with older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission. RTAC was less likely for patients with higher admission FIM motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home. Approximately 9% of patients with TBI experienced RTAC episodes during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation for RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting. Copyright

  8. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital. (United States)

    Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee


    The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

  9. Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey. (United States)

    Seo, Yong Gon; Jang, Mi Ja; Park, Won Hah; Hong, Kyung Pyo; Sung, Jidong


    Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period.

  10. Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning. (United States)

    Jen, Howard C; Shew, Stephen B; Atkinson, James B; Rosenthal, J Thomas; Hiatt, Jonathan R


    To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital. Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity. Large metropolitan university teaching hospital. Hospital census figures and patient outcomes. Census was reduced by 36% from 537 at baseline to 345 on move day, a rate of 18 patients/d (P emergency operations was unchanged. Hospital admissions were decreased by 42%, and the adjusted discharges per occupied bed were increased by 8% (both P capacity to absorb new patients was limited. During a period in which southern California population grew by 8.5%, acute care beds fell by 3.3%, while Los Angeles County emergency departments experienced a 13% diversion rate due to overcrowding. Local or regional disasters of any size can overwhelm the system's ability to respond. Our strategy produced a surge capacity of 36% without interruption of emergency department and trauma services but required 3 to 4 days for implementation, making it applicable to disasters and mass casualty events with longer lead times. These principles may aid in disaster preparedness and planning.

  11. LEAP: A randomized-controlled trial of a lay-educator inpatient asthma education program. (United States)

    Rice, Jessica L; Matlack, Kristen M; Simmons, Marsha D; Steinfeld, Jonathan; Laws, Margaret A; Dovey, Mark E; Cohen, Robyn T


    To evaluate the impact of LEAP, a volunteer-based, inpatient asthma education program for families of inner-city children with asthma. 711 children ages 2-17 years admitted with status asthmaticus were randomized to receive usual care or usual care plus a supplemental education intervention. Both groups completed a baseline interview. Trained volunteer lay educators conducted individualized bedside education with the intervention group. Primary outcome was attendance at a post-hospitalization follow-up visit 7-10 days after discharge. Secondary outcomes included parent-reported asthma management behaviors, symptoms, and self-efficacy scores from a one month follow-up interview. Post-hospitalization asthma clinic attendance was poor (38%), with no difference between groups. Families randomized to the intervention group were more likely to report use of a controller (OR 2.4, 95% CI 1.3-4.2, peducation by trained lay volunteers was associated with improved asthma management behaviors. This novel volunteer-based program could have widespread implications as a sustainable model for asthma education. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland. (United States)

    Mehra, Tarun; Moos, Rudolf M; Seifert, Burkhardt; Bopp, Matthias; Senn, Oliver; Simmen, Hans-Peter; Neuhaus, Valentin; Ciritsis, Bernhard


    The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals

  13. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care. (United States)

    Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao


    Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The

  14. Perfectionism Group Treatment for Eating Disorders in an Inpatient, Partial Hospitalization, and Outpatient Setting. (United States)

    Levinson, Cheri A; Brosof, Leigh C; Vanzhula, Irina A; Bumberry, Laura; Zerwas, Stephanie; Bulik, Cynthia M


    Perfectionism is elevated in individuals with eating disorders and is posited to be a risk factor, maintaining factor, and treatment barrier. However, there has been little literature testing the feasibility and effectiveness of perfectionism interventions in individuals specifically with eating disorders in an open group format. In the current study, we tested the feasibility of (a) a short cognitive behavioural therapy for perfectionism intervention delivered in an inpatient, partial hospitalization, and outpatient for eating disorders setting (combined N = 28; inpatient n = 15; partial hospital n = 9; outpatient n = 4), as well as (b) a training for disseminating the treatment in these settings (N = 9). Overall, we found that it was feasible to implement a perfectionism group in each treatment setting, with both an open and closed group format. This research adds additional support for the implementation of perfectionism group treatment for eating disorders and provides information on the feasibility of implementing such interventions across multiple settings. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  15. The pain experience of inpatients in a teaching hospital: revisiting a strategic priority. (United States)

    Jabusch, Kimberly M; Lewthwaite, Barbara J; Mandzuk, Lynda L; Schnell-Hoehn, Karen N; Wheeler, Barbara J


    For hospital executives and clinicians to improve pain management, organizations must examine the current pain experience of in-patients beyond simply measuring patient satisfaction. The aim of this study was to quantify the prevalence of pain among adult in-patients and the degree of interference pain had on daily activities. A descriptive, cross-sectional study was undertaken in a 530 bed tertiary care, teaching hospital in central Canada. A convenience sample (N = 88) of adult medical-surgical patients completed the Short Form-Brief Pain Inventory survey. Pain prevalence was 70.4%. The mean pain severity score was 3.76 (standard deviation, SD = 2.88) and mean pain interference score on daily activities was 4.56 (SD = 3.93). The most frequently identified site of pain was the lower extremities (n = 15, 28%). Women had higher mean scores on pain "right now" compared to men (p < 0.05). The sample majority (n = 81) indicated hospital staff asked about the presence of pain. Seventy-nine percent (n = 57) reported hospital staff "always" did everything they could to help manage pain. Eighty-four percent (n = 61) selected "always" or "usually" to describe their ability to be involved in deciding pain treatments. The mean pain relief score from treatments was 61% (SD = 34.79). Significant positive correlations were found between pain intensity ratings and pain interference on all daily activities (p < 0.001). Pain prevalence remains high with a significant relationship between pain and activities of daily living. The study provides baseline data to direct future initiatives at improving pain management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Data linkage of inpatient hospitalization and workers' claims data sets to characterize occupational falls. (United States)

    Bunn, Terry L; Slavova, Svetla; Bathke, Arne


    The identification of industry, occupation, and associated injury costs for worker falls in Kentucky have not been fully examined. The purpose of this study was to determine the associations between industry and occupation and 1) hospitalization length of stay; 2) hospitalization charges; and 3) workers' claims costs in workers suffering falls, using linked inpatient hospitalization discharge and workers' claims data sets. Hospitalization cases were selected with ICD-9-CM external cause of injury codes for falls and payer code of workers' claims for years 2000-2004. Selection criteria for workers'claims cases were International Association of Industrial Accident Boards and Commissions Electronic Data Interchange Nature (IAIABCEDIN) injuries coded as falls and/or slips. Common data variables between the two data sets such as date of birth, gender, date of injury, and hospital admission date were used to perform probabilistic data linkage using LinkSolv software. Statistical analysis was performed with non-parametric tests. Construction falls were the most prevalent for male workers and incurred the highest hospitalization and workers' compensation costs, whereas most female worker falls occurred in the services industry. The largest percentage of male worker falls was from one level to another, while the largest percentage of females experienced a fall, slip, or trip (not otherwise classified). When male construction worker falls were further analyzed, laborers and helpers had longer hospital stays as well as higher total charges when the worker fell from one level to another. Data linkage of hospitalization and workers' claims falls data provides additional information on industry, occupation, and costs that are not available when examining either data set alone.

  17. Weekend hospitalization and additional risk of death: an analysis of inpatient data. (United States)

    Freemantle, N; Richardson, M; Wood, J; Ray, D; Khosla, S; Shahian, D; Roche, W R; Stephens, I; Keogh, B; Pagano, D


    To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk. Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death. National Health Service Hospitals in England. 30 day mortality (in or out of hospital). There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set. Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day.

  18. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience. (United States)

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore


    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  19. Effect of lean process improvement techniques on a university hospital inpatient pharmacy. (United States)

    Hintzen, Barbara L; Knoer, Scott J; Van Dyke, Christie J; Milavitz, Brian S


    The effect of lean process improvement on an inpatient university hospital pharmacy was evaluated. The University of Minnesota Medical Center (UMMC), Fairview, implemented lean techniques in its inpatient pharmacy to improve workflow, reduce waste, and achieve substantial cost savings. The sterile products area (SPA) and the inventory area were prospectively identified as locations for improvement due to their potential to realize cost savings. Process-improvement goals for the SPA included the reduction of missing doses, errors, and patient-specific waste by 30%, 50%, and 30%, respectively, and the reallocation of two technician full-time equivalents (FTEs). Reductions in pharmaceutical inventory and returns due to outdating were also anticipated. Work-flow in the SPA was improved through the creation of accountability, standard work, and movement toward one-piece flow. Increasing the number of i.v. batches decreased pharmaceutical waste by 40%. Through SPA environment improvements and enhanced workload sharing, two FTE technicians from the SPA were redistributed within the department. SPA waste reduction yielded an annual saving of $275,500. Quality and safety were also improved, as measured by reductions in missing doses, expired products, and production errors. In the inventory area, visual control was improved through the use of a double-bin system, the number of outdated drugs decreased by 20%, and medication inventory was reduced by $50,000. Lean methodology was successfully implemented in the SPA and inventory area at the UMMC, Fairview, inpatient pharmacy. Benefits of this process included an estimated annual cost saving of $289,256 due to waste reduction, improvements in workflow, and decreased staffing requirements.

  20. Renewed growth in hospital inpatient cost since 1998: variation across metropolitan areas and leading clinical conditions. (United States)

    Friedman, Bernard S; Wong, Herbert S; Steiner, Claudia A


    To use disaggregated data about metropolitan statistical areas (MSAs) and clinical conditions to better describe the variation in cost increases and explore some of the hypothesized influences. The study uses the state inpatient databases from the Healthcare Cost and Utilization Project, containing all discharges from hospitals in 172 MSAs in 1998 and 2001. The discharge summary information was combined with standardized hospital accounting files, surveys of managed care plans, MSA demographics, and state data pertaining to caps on medical malpractice awards. The analysis used descriptive comparisons and multivariate regressions of admission rate and cost per case in 9 leading disease categories across the MSAs. The increase in hospital input prices and changes in severity of illness were controlled. Metropolitan statistical areas with higher HMO market penetration continued to show lower admission rates, no less so in 2001 than in 1998. A cap on malpractice awards appeared to restrain admissions, but the net effect on hospital cost per adult eroded for those states with the most experience with award caps. Higher admission rates and increase in cost were found in several disease categories.

  1. Use of in-patient hospital beds by people living in residential care. (United States)

    Finucane, P; Wundke, R; Whitehead, C; Williamson, L; Baggoley, C


    There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate. To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge. Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff. 153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence. People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation

  2. Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity. (United States)

    Wakeman, Sarah E; Metlay, Joshua P; Chang, Yuchiao; Herman, Grace E; Rigotti, Nancy A


    Alcohol and drug use results in substantial morbidity, mortality, and cost. Individuals with alcohol and drug use disorders are overrepresented in general medical settings. Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment. To determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge. Prospective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital. Three hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder. Addiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment. Addiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge. Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization. Among 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 0.24 vs. 0.08, p drug decreased by 0.05 vs. 0.02, p = 0.003.) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+12.7 days vs. +5.6, p drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0.018, 0.018, and 0.02, respectively). In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline

  3. Supporting management of medical equipment for inpatient service in public hospitals: a case study. (United States)

    Figueroa, Rosa L; Vallejos, Guido E


    This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.

  4. An Integrative Literature Review of Patient Turnover in Inpatient Hospital Settings. (United States)

    Park, Shin Hye; Weaver, Lindsay; Mejia-Johnson, Lydia; Vukas, Rachel; Zimmerman, Julie


    High patient turnover can result in fragmentation of nursing care. It can also increase nursing workload and thus impede the ability of nurses to provide safe and high-quality care. We reviewed 20 studies that examined patient turnover in relation to nursing workload, staffing, and patient outcomes as well as interventions in inpatient hospital settings. The studies consistently addressed the importance of accounting for patient turnover when estimating nurse staffing needs. They also showed that patient turnover varied by time, day, and unit type. Researchers found that higher patient turnover was associated with adverse events; however, further research on this topic is needed because evidence on the effect of patient turnover on patient outcomes is not yet strong and conclusive. We suggest that researchers and administrators need to pay more attention to patterns and levels of patient turnover and implement managerial strategies to reduce nursing workload and improve patient outcomes. © The Author(s) 2015.

  5. Building a novel inpatient diabetes management mentor program: a blueprint for success. (United States)

    Modic, Mary Beth; Sauvey, Rebecca; Canfield, Christina; Kukla, Aniko; Kaser, Nancy; Modic, Joselyn; Yager, Christina


    The intent of this project was to create a formalized educational program for bedside nurses responsible for inpatient diabetes management. Bedside nurses are recruited to serve as diabetes management mentors. The mentors receive advanced education concerning teaching and learning principles, the AADE7™ Self-Care Behaviors, and diabetes management strategies. They teach their peers, advocate for patients, and facilitate referrals for outpatient Diabetes Self-Management Education (DSME) programs. The focus of these ongoing educational activities is to foster the development of diabetes management mentors and to create teaching tools that mentors can use with peers to address practice gaps or skill deficiencies. The diabetes management mentor is integral in enhancing the care of patients with diabetes in the hospital. The empowerment of bedside nurses as mentors for their peers and their patients is an invaluable asset that helps nurses take ownership of their practice. This role could be applied to other complex disease entities, helping nurses to develop specific management skills to improve patient outcomes and enhance patient satisfaction.

  6. Incidence of cutaneous adverse drug reactions among medical inpatients of Sultanah Aminah Hospital Johor Bahru. (United States)

    Latha, S; Choon, S E


    Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia. To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients. A prospective study was conducted among medical inpatients from July to December 2014. A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction. The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.

  7. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review. (United States)

    Brusco, Natasha K; Paratz, Jennifer


    Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide

  8. Prevalence of vision loss among hospital in-patients; a risk factor for falls? (United States)

    Leat, Susan J; Zecevic, Aleksandra A; Keeling, Alexis; Hileeto, Denise; Labreche, Tammy; Brymer, Christopher


    Despite poor vision being a risk factor for falls, current hospital policies and practices often do not include a vision assessment at patient admission or in the hospital's incident reporting system when a fall occurs. Our purpose was to document the prevalence of vision loss in hospital general medicine units to increase awareness of poor vision as a potential risk factor for falls that occur within the hospital, and inform future preventative practice. This cross-sectional study took place in medicine units of an acute care hospital. Participants were adult in-patients. Visual acuity (VA), contrast sensitivity and stereoacuity were measured, and patients were screened for field loss, extinction and neglect. 115 participants took part (average age 67 ± 17, 48% female). Overall, 89% had a visual impairment defined as being outside the age-norms for one or more vision measure, 62% had low vision, and 36% had vision loss equivalent to legal blindness [VA equal to or poorer than 1.0 logMAR (6/60, 20/200) or ≥10x below age-norms]. There was a considerable discrepancy between the prevalence of low vision and the percentage of patients who reported an ocular diagnosis that would result in visual loss (30%). Ten patients fell during the study period, and of these 100% had visual impairment, 90% had low vision and 60% had vision loss equivalent to legal blindness, which compares to 58%, 22% and 9% for non-fallers. Similar high prevalences were found in those whose reason for admission to the hospital was a fall (92%, 63% and 33% respectively). Vision loss has a high prevalence among patients in hospital medicine units, and is higher still among those who fall. Since vision loss may be a contributing factor to falls that occur in hospitals, implementing an assessment of vision at hospital admission would be useful to alert staff to those patients who are at risk for falls due to poor vision, so that preventative measures can be applied. © 2017 The Authors Ophthalmic

  9. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations. (United States)

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P


    To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

  10. 42 CFR 440.10 - Inpatient hospital services, other than services in an institution for mental diseases. (United States)


    ... an institution for mental diseases. 440.10 Section 440.10 Public Health CENTERS FOR MEDICARE... for mental diseases. (a) Inpatient hospital services means services that— (1) Are ordinarily furnished... and treatment of patients with disorders other than mental diseases; (ii) Is licensed or formally...

  11. Pulmonary Embolism Inpatients Treated With Rivaroxaban Had Shorter Hospital Stays and Lower Costs Compared With Warfarin. (United States)

    Margolis, Jay M; Deitelzweig, Steven; Kline, Jeffrey; Tran, Oth; Smith, David M; Crivera, Concetta; Bookhart, Brahim; Schein, Jeff


    Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin. Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching. Hospital LOS, treatment patterns, and hospitalization costs were evaluated. Matched cohorts included 751 rivaroxaban-treated patients and 751 warfarin-treated patients. Adjusted mean LOS was 3.77 days for rivaroxaban patients (95% CI, 3.66-3.87 days) and 5.48 days for warfarin patients (95% CI, 5.33-5.63 days; P < .001). Mean (SD) LOS was shorter for patients taking rivaroxaban whether admission was for provoked PE (rivaroxaban: 5.2 [5.1] days; warfarin: 7.0 [6.5] days; P < .001) or unprovoked PE (rivaroxaban: 3.4 [2.3] days; warfarin: 5.1 [2.7] days; P < .001). Mean (SD) days from first dose to discharge were 2.5 (1.7) (rivaroxaban) and 4.0 (2.9) (warfarin) when initiated with parenteral anticoagulants (P < .001) and 2.7 (1.7) (rivaroxaban) and 4.0 (2.2) (warfarin) without parenteral anticoagulants (P < .001). The rivaroxaban cohort incurred significantly lower unadjusted mean (SD) hospitalization costs (rivaroxaban: $8473 [$9105]; warfarin: $10,291 [$9185]; P < .001), confirmed by covariate adjustment with generalized linear modeling estimating predicted mean hospitalization costs of $8266 for rivaroxaban patients (95% CI, $7851-$8681) and $10,511 for warfarin patients (95% CI, $10,031-$10,992; P < .001). patients with PE treated with rivaroxaban incurred significantly lower hospitalization costs by $2245 per admission compared with patients treated with warfarin, which was attributable to cost offsets from 1.71 fewer days of

  12. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system. (United States)


    ... facility prospective payment system. 412.432 Section 412.432 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient...

  13. Preventing dehydration-related hospitalizations: a mixed-methods study of parents, inpatient attendings, and primary care physicians. (United States)

    Shanley, Leticia; Mittal, Vineeta; Flores, Glenn


    The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.

  14. Prescribing errors during hospital inpatient care: factors influencing identification by pharmacists. (United States)

    Tully, Mary P; Buchan, Iain E


    To investigate the prevalence of prescribing errors identified by pharmacists in hospital inpatients and the factors influencing error identification rates by pharmacists throughout hospital admission. 880-bed university teaching hospital in North-west England. Data about prescribing errors identified by pharmacists (median: 9 (range 4-17) collecting data per day) when conducting routine work were prospectively recorded on 38 randomly selected days over 18 months. Proportion of new medication orders in which an error was identified; predictors of error identification rate, adjusted for workload and seniority of pharmacist, day of week, type of ward or stage of patient admission. 33,012 new medication orders were reviewed for 5,199 patients; 3,455 errors (in 10.5% of orders) were identified for 2,040 patients (39.2%; median 1, range 1-12). Most were problem orders (1,456, 42.1%) or potentially significant errors (1,748, 50.6%); 197 (5.7%) were potentially serious; 1.6% (n = 54) were potentially severe or fatal. Errors were 41% (CI: 28-56%) more likely to be identified at patient's admission than at other times, independent of confounders. Workload was the strongest predictor of error identification rates, with 40% (33-46%) less errors identified on the busiest days than at other times. Errors identified fell by 1.9% (1.5-2.3%) for every additional chart checked, independent of confounders. Pharmacists routinely identify errors but increasing workload may reduce identification rates. Where resources are limited, they may be better spent on identifying and addressing errors immediately after admission to hospital.


    Ross, Joseph S.; Arling, Greg; Ofner, Susan; Roumie, Christianne L.; Keyhani, Salomeh; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.


    Background Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration (VHA). We examined the correlation between stroke care quality at hospital discharge and within 6 months post-discharge. Methods Cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 VHA medical centers and 2380 veterans with post-discharge follow-up within 6 months, in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation for atrial fibrillation, and tobacco cessation counseling, along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented post-discharge care quality: achievement of blood pressure, low-density lipoprotein (LDL), international normalized ratio (INR), and glycosylated hemoglobin target levels, and delivery of appropriate treatment for post-stroke depression, along with a composite measure of achieved outcomes. Results Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized post-discharge rates of achieving goal were 56% for blood pressure, 36% for LDL, 41% for INR, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite six-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the LDL goal (r=0.31; p=0.007) and depression management (r=0.27; p=0.03) goal, but was not correlated with blood pressure, INR, or glycosylated hemoglobin goals, nor with the composite measure of achieved post-discharge outcomes (p-values >0.15). Conclusions Hospital discharge care quality was not consistently correlated with ambulatory care quality. PMID:21719771

  16. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. (United States)

    Guyomard, Veronique; Fulcher, Robert A; Redmayne, Oliver; Metcalf, Anthony K; Potter, John F; Myint, Phyo K


    To examine the effect of dysphasia and dysphagia on stroke outcome. Retrospective database study. Norfolk, United Kingdom. Two thousand nine hundred eighty-three men and women with stroke admitted to the hospital between 1997 and 2001. Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria. Two thousand nine hundred eighty-three patients (1,330 (44.6%) male), median age 78 (range 17-105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8-2.7) and 1.4 (95% CI=1.2-1.6) for dysphasia; 12.5 (95% CI=8.9-17.3) and 3.9 (95% CI=3.3-4.6) for dysphagia, 5.5 (95% CI=3.7-8.2), 1.9 (95% CI=1.6-2.3) for either, and 13.8 (95% CI=9.4-20.4) and 3.7 (95% CI=3.1-4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively. Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity

  17. Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke: a hospital database study over six seasonal years in Norfolk, UK. (United States)

    Myint, Phyo K; Vowler, Sarah L; Woodhouse, Peter R; Redmayne, Oliver; Fulcher, Robert A


    Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke. We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay. There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million. Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future. (c) 2007 S. Karger AG, Basel.

  18. Time-Series Approaches for Forecasting the Number of Hospital Daily Discharged Inpatients. (United States)

    Ting Zhu; Li Luo; Xinli Zhang; Yingkang Shi; Wenwu Shen


    For hospitals where decisions regarding acceptable rates of elective admissions are made in advance based on expected available bed capacity and emergency requests, accurate predictions of inpatient bed capacity are especially useful for capacity reservation purposes. As given, the remaining unoccupied beds at the end of each day, bed capacity of the next day can be obtained by examining the forecasts of the number of discharged patients during the next day. The features of fluctuations in daily discharges like trend, seasonal cycles, special-day effects, and autocorrelation complicate decision optimizing, while time-series models can capture these features well. This research compares three models: a model combining seasonal regression and ARIMA, a multiplicative seasonal ARIMA (MSARIMA) model, and a combinatorial model based on MSARIMA and weighted Markov Chain models in generating forecasts of daily discharges. The models are applied to three years of discharge data of an entire hospital. Several performance measures like the direction of the symmetry value, normalized mean squared error, and mean absolute percentage error are utilized to capture the under- and overprediction in model selection. The findings indicate that daily discharges can be forecast by using the proposed models. A number of important practical implications are discussed, such as the use of accurate forecasts in discharge planning, admission scheduling, and capacity reservation.

  19. Religious attitudes and spiritual health among elderly inpatient adults in Shahrekord hospitals

    Directory of Open Access Journals (Sweden)

    Raziye Sadat hosseiny


    Full Text Available Background and Objectives: Human is a multidimensional creature and spiritual domain is the central dimension which has an undeniable effect on gaining health. The most important part of nursing care with family based approach is to help people in achieving optimal level of health. On the other hand, religious attitudes and spiritual health is an important domain of life in ageing period. Therefore, this study was conducted to assess the religious attitudes and spiritual health among elderly inpatients in Shahrekord hospitals. Methods: This descriptive correlational study was conducted in 1392 in Shahrekord hospitals. A total of 308 geriatric patients who were admitted to a surgical ward, were recruited through random sampling. Two sets of questionnaires regarding religious and spiritual health were used as the instruments. After collecting the data, descriptive (frequency, mean, variance, standard deviation and analytical (independent t test, Pearson correlation statistics were used by SPSS statistical software. Results: The results showed that 68.8% of patients possessed large religious attitude with an average of 140.68 ±30.14. Spiritual health in 51.3 percent of samples was described to be low while the obtained average score was 86.18 ± 16.61. However, Pearson test showed that there is a positive significant correlation between religious attitudes and spiritual health (r =0.83, P =0.05. Conclusions: The present study revealed that there is a significant relationship between religious attitudes and spiritual health and people with high religious attitudes have high spiritual health.

  20. Factors Influencing the Total Inpatient Pharmacy Cost at a Tertiary Hospital in Malaysia: A Retrospective Study (United States)

    Ali Jadoo, Saad Ahmed


    The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III (B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC (B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC. PMID:29436248

  1. 78 FR 26879 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal... (United States)


    ... Prospective Payment System for Federal Fiscal Year 2014; Proposed Rule #0;#0;Federal Register / Vol. 78, No... Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 AGENCY... IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data...

  2. [Inpatient psychotherapy]. (United States)

    Spitzer, C; Rullkötter, N; Dally, A


    In German-speaking countries inpatient psychotherapy plays a major role in the mental healthcare system. Due to its characteristic features, i. e. multiprofessionalism, multimodality and method integration, the inpatient approach represents a unique and independent type of psychotherapy. In order to be helpful, the manifold verbal and non-verbal methods need to be embedded into an overall treatment plan. Additionally, the therapeutic milieu of the hospital represents an important effective factor and its organization requires a more active construction. The indications for inpatient psychotherapy are not only based on the mental disorder but also on illness, setting and healthcare system-related criteria. In integrative concepts, the multiprofessional team is a key component with many functions. The effectiveness of psychotherapeutic hospital treatment has been proven by meta-analysis studies; however, 20-30% of patients do not benefit from inpatient psychotherapy and almost 13% drop-out prematurely.

  3. Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings. (United States)

    Broyles, Lauren M; Gordon, Adam J; Rodriguez, Keri L; Hanusa, Barbara H; Kengor, Caroline; Kraemer, Kevin L


    Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

  4. Reported beverage consumed and alcohol-related diseases among male hospital inpatients with problem drinking. (United States)

    Coder, Beate; Freyer-Adam, Jennis; Lau, Katharina; Riedel, Jeannette; Rumpf, Hans-Jürgen; Meyer, Christian; John, Ulrich; Hapke, Ulfert


    The aim of this study was to examine if problem drinkers have varying risks of having alcohol-related diseases according to their reported beverage consumed. In a cross-sectional study all consecutive inpatients aged 18- 64 years from four general hospitals of one catchment area were systematically screened for alcohol use. A total of 1011 men with problem drinking were used for this study. Routine treatment diagnoses for all participants were provided by hospital physicians and were classified into three categories according to their alcohol-attributable fractions (AAF; AAF = 0; AAF spirits drinkers, 26.0% mixed beer and spirits drinkers and 6.9% individuals drinking wine exclusively or in combination with one or two other beverages (mixed wine drinkers). Compared to spirits drinkers and controlling for possible confounders (i.e. alcohol-associated characteristics, demographic variables), multinomial regressions revealed that beer drinkers, mixed beer and spirits drinkers, and mixed wine drinkers had lower odds of having diseases with AAF = 1 than spirits drinkers (e.g. for AAF = 1: beer versus spirits drinkers: OR = 0.42, CI: 0.25-0.72). Beer drinkers and mixed wine drinkers also had lower odds of having diseases with AAF spirits drinkers (e.g. mixed wine versus spirits drinkers: OR = 0.36, CI: 0.18-0.72). These data suggest an association between the reported beverage consumed and alcohol-related diseases. Among hospitalized problem drinkers, spirits drinkers had the greatest risk of having diseases with AAF < 1 and with AAF = 1.

  5. Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital

    Directory of Open Access Journals (Sweden)

    Christoffel Grobler


    Full Text Available About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way. Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor. When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.

  6. Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial. (United States)

    Gassaway, Julie; Jones, Michael L; Sweatman, W Mark; Hong, Minna; Anziano, Peter; DeVault, Karen


    To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. Randomized controlled trial. Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes

  7. Effect of an educational Inpatient Diabetes Management Program on medical resident knowledge and measures of glycemic control: a randomized controlled trial. (United States)

    Desimone, Marisa E; Blank, Gary E; Virji, Mohamed; Donihi, Amy; DiNardo, Monica; Simak, Deborah M; Buranosky, Raquel; Korytkowski, Mary T


    To investigate the effectiveness of an Inpatient Diabetes Management Program (IDMP) on physician knowledge and inpatient glycemic control. Residents assigned to General Internal Medicine inpatient services were randomized to receive the IDMP (IDMP group) or usual education only (non-IDMP group). Both groups received an overview of inpatient diabetes management in conjunction with reminders of existing order sets on the hospital Web site. The IDMP group received print copies of the program and access to an electronic version for a personal digital assistant (PDA). A Diabetes Knowledge Test (DKT) was administered at baseline and at the end of the 1-month rotation. The frequency of hyperglycemia among patients under surveillance by each group was compared by using capillary blood glucose values and a dispersion index of glycemic variability. IDMP users completed a questionnaire related to the program. Twenty-two residents participated (11 in the IDMP group and 11 in the non-IDMP group). Overall Diabetes Knowledge Test scores improved in both groups (IDMP: 69% ± 1.7% versus 83% ± 2.1%, P = .003; non-IDMP: 76% ± 1.2% versus 84% ± 1.4%, P = .02). The percentage of correct responses for management of corticosteroid-associated hyperglycemia (P = .004) and preoperative glycemic management (P = .006) improved in only the IDMP group. The frequency of hyperglycemia (blood glucose level >180 mg/dL) and the dispersion index (5.3 ± 7.6 versus 3.7 ± 5.6; P = .2) were similar between the 2 groups. An IDMP was effective at improving physician knowledge for managing hyperglycemia in hospitalized patients treated with corticosteroids or in preparation for surgical procedures. Educational programs directed at improving overall health care provider knowledge for inpatient glycemic management may be beneficial; however, improvements in knowledge do not necessarily result in improved glycemic outcomes.

  8. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Louíse Viecili Hoffmeister


    Full Text Available OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units.METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis.RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands.CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  9. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital. (United States)

    Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto


    to evaluate the use of identification wristbands among patients hospitalized in inpatient units. quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  10. Inpatient and Day Hospital Treatment of Patients with Depression and Job-related Burnout. (United States)

    Meyer, Lisa Kristin; Lange, Sabine; Behringer, Johanna; Söllner, Wolfgang

    Burnout is a process of physical and emotional exhaustion that often results in clinical depression. Detailed descriptions and evaluations of specialized psychosomatic treatment are rare. This pilot study investigates the feasibility of inpatient and day hospital treatment of patients with burnout syndrome. Additionally, we present results of an initial, noncontrolled, pre-post-evaluation of changes in symptoms and individual work-related risk factors for burnout. Sixty-four consecutive patients with burnout syndrome were assessed before and after specialized multimodal treatment using a clinical symptom checklist (ICD-10 Symptom Rating) and burnout-specific instruments (Maslach Burnout Inventory, Occupational Stress & Coping Inventory). Patients' average age was 45 (range 23 to 61), 70% were currently employed, 24% in managerial positions or self-employed, and 89% diagnosed with an affective disorder. The average length of time off work due to illness in the past year was 13 weeks. Treatment lasted five weeks on average. After treatment, depression (p work (p = 0.001; d = 0.36) decreased, while emotional distancing (p balance and mental stability (p life satisfaction (p work-related risk factors. Controlled studies are necessary to establish treatment efficacy.

  11. Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multistakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis. (United States)

    Septimus, Edward J; Coopersmith, Craig M; Whittle, Jessica; Hale, Caleb P; Fishman, Neil O; Kim, Thomas J


    The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. To promote the appropriate use of antimicrobials and combat antimicrobial resistance, the workgroup provides recommendations for appropriate antibiotics for the treatment of sepsis. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

  12. Time to inpatient rehabilitation hospital admission and functional outcomes of stroke patients. (United States)

    Wang, Hua; Camicia, Michelle; Terdiman, Joe; Hung, Yun-Yi; Sandel, M Elizabeth


    To study the association of time to inpatient rehabilitation hospital (IRH) admission and functional outcomes of patients who have had a stroke. A retrospective cohort study. A regional IRH. Moderately (n = 614) and severely (n = 1294) impaired patients who had a stroke who were admitted to the facility between 2002 and 2006. Not applicable. Change in total, motor, and cognitive Functional Independence Measure (FIM) scores between IRH admission and discharge. After controlling for patient demographics and initial medical conditions and functional status, shorter periods from stroke onset to IRH admission were significantly associated with greater functional gains for these patients during IRH hospitalization. Moderately impaired patients achieved a greater total FIM gain when admitted to an IRH within 21 days of stroke. Severely impaired patients showed a gradient relationship between time to IRH admission and total FIM gain, with significantly different functional gain if admitted to an IRH within 30 and 60 days after stroke diagnosis. Results of multiple regression analysis also showed that age, race/ethnicity, side of stroke, history of a previous stroke, functional measures at IRH admission, IRH length of stay, and selected medications were associated with total, motor, and cognitive FIM score changes. In addition, certain factors such as older age, diagnosis of a hemorrhagic stroke or a previous history of stroke, and initial functional status were associated with longer periods between diagnosis and admission to an IRH after the stroke occurred. Our findings are consistent with the hypothesis that earlier transfer to an IRH may lead to better functional improvement after stroke. However, certain factors such as age, race/ethnicity, initial medical conditions and functional status, and length of stay at an IRH contributed to functional gain. Factors affecting the time to IRH admission also were addressed. Copyright © 2011 American Academy of Physical Medicine

  13. A survey of inpatient practitioner knowledge of penicillin allergy at 2 community teaching hospitals. (United States)

    Staicu, Mary L; Soni, Dipekka; Conn, Kelly M; Ramsey, Allison


    The negative effect of the penicillin allergy label on antibiotic use and patient outcomes has brought to light the need for thorough penicillin allergy assessments and heightened practitioner education. To evaluate practitioner knowledge of penicillin allergy and the clinical approach to the patients with penicillin allergy. An electronic survey was distributed to attending physicians, residents, pharmacists, nurse practitioners, and physician assistants practicing adult inpatient medicine at 2 community-based teaching hospitals from February to April 2016. A total of 276 (39%) of 716 practitioners completed surveys were analyzed. Most respondents were attending physicians (45%) with more than 10 years of experience (53%). Approximately half of the respondents indicated that they were unfamiliar with the rate of cross-reactivity between penicillin and cephalosporin (46%), carbapenem (42%), and monobactam (48%) antibiotics. When evaluating the role of penicillin skin testing and temporary induction of drug tolerance in the case vignettes, only 41% and 19% of respondents appropriately considered these options as the leading antibiotic management plan, respectively. Despite acknowledging the need for allergy/immunology consultation in clinical scenarios, 86% of respondents indicated that they never consult an allergist or immunologist or do so only once per year. Overall, pharmacists had a better understanding of the natural history of penicillin allergy and antibiotic cross-reactivity (P penicillin allergy in the hospital setting, where collaborative efforts between allergy and nonallergy health care practitioners are sparse. The expansion of a multidisciplinary approach may optimize antimicrobial prescribing in this subset of patients. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  14. 77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital... (United States)


    ... [CMS-1350-NC] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA... the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients... available to persons without Federal government identification, commenters are encouraged to leave their...

  15. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. (United States)

    Bohl, Daniel D; Basques, Bryce A; Golinvaux, Nicholas S; Baumgaertner, Michael R; Grauer, Jonathan N


    National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored. The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events. In addition, using the NSQIP database, we identified (4) adverse events that had a higher prevalence after rather than before discharge, which has important implications for interpretation of studies conducted in the NIS. A retrospective cohort study of patients undergoing operative stabilization of transcervical and intertrochanteric hip fractures during 2009 to 2011 was performed in the NIS and NSQIP. Totals of 122,712 and 5021 patients were included from the NIS and NSQIP, respectively. Age, sex, fracture type, and lengths of stay were compared. Comorbidities common to both databases were compared in terms of more or less than twofold difference between the two databases. Similar comparisons were made for adverse events. Finally, adverse events that had a greater postdischarge prevalence were identified from the NSQIP database. Tests for statistical difference were thought to be of little value given the large sample size and the resulting fact that statistical differences would have been identified even for small, clinically inconsequential differences resulting from the associated high power. Because it is of greater clinical importance to focus on the magnitude of differences, the databases were compared by absolute differences. Demographics and hospital lengths of stay were not different between the two databases. In terms of comorbidities

  16. Inpatient satisfaction at different public sector hospitals of a metropolitan city in Pakistan: a comparative cross-sectional study. (United States)

    Hussain, Mehwish; Rehman, Rehana; Ikramuddin, Zia; Asad, Nava; Farooq, Ayesha


    To observe inpatient satisfaction at different public sector hospitals of Karachi, Pakistan. A cross sectional study was carried out during 2010-2012 in four major public sector hospitals of Karachi. A total of 710 patients completed the study. Responses were gathered in a self-structured questionnaire that comprised of four dimensions of satisfaction with doctor, staff, administration and treatment. Average Score of each dimension was taken and compared using one way analysis of variance. Satisfaction with doctors, staff and administration of provincial and federal hospitals were comparatively similar (P > 0.05). However, satisfaction with treatment significantly differed in all four hospitals (P public sector hospitals showed satisfaction with healthcare personnel and related administration. However, treatment dimension needs to be improved to get more satisfaction.

  17. Motivation to change risky drinking and motivation to seek help for alcohol risk drinking among general hospital inpatients with problem drinking and alcohol-related diseases. (United States)

    Lau, Katharina; Freyer-Adam, Jennis; Gaertner, Beate; Rumpf, Hans-Jürgen; John, Ulrich; Hapke, Ulfert


    The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases. The sample consisted of 294 general hospital inpatients aged 18-64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAFmotivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated. During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, PMotivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAFmotivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups. Data suggest that hospital stay seems to be a "teachable moment." Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention. Copyright 2010 Elsevier Inc. All rights reserved.

  18. Hospital Organization, Administration and Wellness Programming. (United States)

    Fleming, Jeanne Hmura


    Hospital organization, administration and planning, and implementation program procedures are reviewed in this article. Hospitals and medical centers are changing their strategies in the area of wellness programming since they offer the appropriate facilities for these programs. Various types of wellness programs currently being promoted are…

  19. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation. (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert


    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. 76 FR 25550 - Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital... (United States)


    ... cited Sec. 482.12(b), under the ``Exercise of rights'' standard in the Patients Rights CoP, to state... that any reference to patient applies solely to inpatient services. Response: We are aware that... inpatients. Simply stated, the hospital and CAH CoPs are intended to ensure the health and safety of those...

  1. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...

  2. Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation. (United States)

    Taube-Schiff, Marlene; Mehak, Adrienne; Marangos, Sandy; Kalim, Anastasia; Ungar, Thomas


    Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

  3. A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia. (United States)

    Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham


    Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

  4. SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury. (United States)

    Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson


    The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

  5. Contract-program evaluation: Impact of the DRG classification system on hospitals' outputs


    Alves, Helder António Pereira Gomes


    A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics The present work project aims at evaluating the impact of contract-program implementation in 2003 and of incentives created in 2007 on hospital output, under the DRG inpatient classification system. A sample of five Portuguese acute public district hospitals was chosen as sample, between 2002 and 2007. Results of hypothesis testing ...

  6. Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit. (United States)

    Munro, Emma L; Hickling, Donna F; Williams, Damian M; Bell, Jack J


    Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure. © 2018 Inc and John Wiley & Sons Ltd.

  7. Inpatient Psychiatric Facility PPS (United States)

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  8. The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial. (United States)

    Ahn, Ki-Yong; Hur, Hyuk; Kim, Dong-Hyun; Min, Jihee; Jeong, Duck Hyoun; Chu, Sang Hui; Lee, Ji Won; Ligibel, Jennifer A; Meyerhardt, Jeffrey A; Jones, Lee W; Jeon, Justin Y; Kim, Nam Kyu


    This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I-III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements. A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), -3.47 to -0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, -38.33 to -1.04 h; p = 0.036). Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I-III colon cancer.

  9. Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006-2012. (United States)

    An, Ruopeng; Wang, Peizhong Peter


    In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831-308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%. The average length of stay for an ITP-related hospitalization was found to be 6.02 days (95% CI: 5.93-6.10), which is 28% higher than that of the overall US discharge population (4.70 days, 95% CI: 4.66-4.74). The average cost of ITP-related hospitalizations was found to be US$16,594 (95% CI: US$16,257-US$16,931), which is 48% higher than that of the overall US discharge population (US$11,200; 95% CI: US$11,033-US$11,368). Gender- and age-adjusted mortality risk in inpatients with ITP was 22% (95% CI: 19%-24%) higher than that of the overall US discharge population. Across diagnosis related groups, length of stay for ITP-related hospitalizations was longest for septicemia (7.97 days, 95% CI: 7.55-8.39) and splenectomy (7.40 days, 95% CI: 6.94-7.86). Splenectomy (US$25,262; 95% CI: US$24,044-US$26,481) and septicemia (US$18,430; 95% CI: US$17,353-US$19,507) were associated with the highest cost of hospitalization. The prevalence of mortality in ITP-related hospitalizations was highest for septicemia (11.11%, 95% CI: 9.60%-12.63%) and intracranial hemorrhage (9.71%, 95% CI: 7.65%-11.77%). Inpatients with ITP had longer hospital stay, bore higher costs, and faced greater risk of mortality than the overall US discharge population.

  10. Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi'an, China: A retrospective study. (United States)

    Ding, Jing-Mei; Zhang, Xian-Zhi; Hu, Xue-Jun; Chen, Huo-Liang; Yu, Min


    The medical costs for inpatients with coronary heart disease (CHD) have risen to unprecedented levels, putting tremendous financial pressure on their families and the entire society. The objective of this study was to examine the actual direct medical costs of inpatients with CHD and to analyze the influencing factors of those costs, to provide advice on the prevention and control of high medical costs of patients with CHD. A retrospective descriptive analysis of hospitalization expenditures data examined 10,301 inpatients with coronary heart disease of a tier-3 hospital in Xi'an from January 1, 2015 to December 31, 2015. The data included demographic information, the average length of stay, and different types of expenses incurred during the hospitalization period. The difference between different groups was analyzed using a univariate analysis, and the influencing factors of hospitalization expenditures were explored by the multiple linear stepwise regression analysis. The average age of these patients was 60.0 years old, the average length of stay was 4.0 days, and the majority were males (7172, 69.6%). The average hospitalization expenses were $6791.38 (3294.16-9, 732.59), and the top 3 expenses were medical consumables, operation fees, and drugs. The influencing factors of hospitalization expenditures included the length of stay, the number of times of admission, the type of medical insurance schemes, whether have a surgery or not, the gender, the age, and the marriage status. The inpatients with CHD in this tier-3 hospital were mostly over 45 years old. The average medical cost of males was much higher than that of females. Our findings suggest that the solution for tremendous hospitalization expenditures should be that more attention is paid to controlling the high expense of medical consumables and that the traditional method of reducing medical expenses by shortening the length of stay is still important in nowadays. Furthermore, the type of medical

  11. Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States. (United States)

    Daras, Laura Coots; Ingber, Melvin J; Deutsch, Anne; Hefele, Jennifer Gaudet; Perloff, Jennifer


    To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions. Observational study. IRFs. Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs). Not applicable. We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state). IRFs' mean risk-standardized hospital readmission rate was 13.00%±0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (Preadmission rates than did IRFs in New England that had the lowest rates. Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Inpatient Management of Diabetes Mellitus among Noncritically Ill Patients at University Hospital of Puerto Rico. (United States)

    Allende-Vigo, Myriam Zaydee; González-Rosario, Rafael A; González, Loida; Sánchez, Viviana; Vega, Mónica A; Alvarado, Milliette; Ramón, Raul O


    To describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes. This was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed. A total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ≥180 mg/dL) and hypoglycemia (blood glucose diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients.


    Directory of Open Access Journals (Sweden)

    A. A. Baranov


    Full Text Available Data on the spread of Streptococcus pneumoniae serotypes in the RF are extremely limited. 3 pneumococcal conjugated vaccines are approved inRussia; however, neither has yet been employed in the framework of the national population immunization program. At the same time, it is the dataon the serotype range of pneumococcal infections that may be considered the prognostic efficacy criterion for the national vaccination programs.The objective of this research is identification of the circulating S. pneumoniae serotypes and spread of pneumococcal etiology infections in the structure of bacterial infections in the infants hospitalized to 5 inpatient hospital of Moscow in 2011–2012. The trial involved 864 patients in tote. Vast majority of patients (86% had acute purulent otitis media and sinusitis. Community-acquired pneumonia was diagnosed in 9% of patients, sepsis and bacteremia — in 3.6%; purulent meningitis — 1.2% of patients. It has been revealed that S. pneumoniae is the primary pathogen in the structure of nasopharyngeal carriage in the children under 5 years of age hospitalized with acute bacterial infections, and the primary bacterial causative agent of acute otitis media at this age. Nasopharyngeal pneumococcal carriage analysis revealed the prevalent serotypes — 19F, 14, 23F, 3, 6A and B; they were present in 3/4 of all cases; 19F was the most frequent (> 20%. Diversity of the S. pneumoniae serotypes detected in middle ear liquid was less significant — 17 serotypes (in comparison with 24 serotypes in nasopharynx. The 5 prevalent serotypes were 19F, 3, 14, 23F, 6B and 19A (> 75% in tote. Detection rate of serotypes 3 and 19A in middle ear liquid significantly exceeded the detection rate of these serotypes in case of nasopharyngeal carriage. The study of invasive infections revealed serotypes 14, 23F, 3 and 15C. These data may be used as a benchmark for future monitoring and evaluation of effect of PCV vaccines on epidemiology of

  14. Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units. (United States)

    Kidd, Sean A; McKenzie, Kwame; Collins, April; Clark, Carrie; Costa, Lucy; Mihalakakos, George; Paterson, Jane


    This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

  15. Prescribing patterns for inpatients with schizophrenia spectrum disorders in a psychiatric hospital in Slovenia: Results of 16-month prospective, non-interventional clinical research. (United States)

    Bole, Cvetka Bačar; Pišlar, Mitja; Mrhar, Aleš; Tavčar, Rok


    In Slovenia, there has been no evidence about the prescribing patterns for inpatients with psychotic disorders. The research aims to analyze drug utilization patterns for inpatients with psychotic disorder that are coded as F20-F29 according to International Classification of Diseases (ICD) 10 th revision (schizophrenia spectrum disorders). Prospective research was conducted at the Psychiatric Hospital Idrija. The medical records of the inpatients admitted over a 12-month period were collected from the beginning to the end of their hospitalization. A total of 311 inpatients with 446 hospitalizations were included, producing a total of 3954 medication prescriptions. Medications prescribed pro re nata (the use of as needed) were also taken into account. Antipsychotics (N=1149, 43% of prescriptions) were the most often prescribed medications, followed by anxiolytics, antiparkinsonians, antidepressants, mood stabilizers and cardiovascular drugs. A total of 256 (82%) inpatients received at least one pro re nata medication. It was observed that the studied population was treated with one antipsychotic on 27 percent of prescriptions. Inpatients with schizophrenia spectrum disorders were exposed to a large number of different drugs. They were not received only psychotropic drugs but also other medications. With the knowledge about medications the implementation of clinical pharmacy services to the psychiatrists would significantly improve medication of inpatients with psychotic disorders and polypharmacotherapy.

  16. Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards. (United States)

    Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John


    Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

  17. Effect of Medicaid disease management programs on emergency admissions and inpatient costs. (United States)

    Conti, Matthew S


    To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.

  18. IVC filter placements in children: nationwide comparison of practice patterns at adult and children's hospitals using the Kids' Inpatient Database. (United States)

    Wadhwa, Vibhor; Trivedi, Premal S; Ali, Sumera; Ryu, Robert K; Pezeshkmehr, Amir


    Inferior vena cava (IVC) filter placement in children has been described in literature, but there is variability with regard to their indications. No nationally representative study has been done to compare practice patterns of filter placements at adult and children's hospitals. To perform a nationally representative comparison of IVC filter placement practices in children at adult and children's hospitals. The 2012 Kids' Inpatient Database was searched for IVC filter placements in children filter insertion (38.7), IVC filter placements were identified. A small number of children with congenital cardiovascular anomalies codes were excluded to improve specificity of the code used to identify filter placement. Filter placements were further classified by patient demographics, hospital type (children's and adult), United States geographic region, urban/rural location, and teaching status. Statistical significance of differences between children's or adult hospitals was determined using the Wilcoxon rank sum test. A total of 618 IVC filter placements were identified in children filters were placed in the setting of venous thromboembolism in children's hospitals (40/44, 90%) compared to adult hospitals (246/573, 43%) (Pfilters comprised 327/573 (57%) at adult hospitals, with trauma being the most common indication (301/327, 92%). The mean length of stay for patients receiving filters was 24.5 days in children's hospitals and 18.4 days in adult hospitals. The majority of IVC filters in children are placed in adult hospital settings. Children's hospitals are more likely to place therapeutic filters for venous thromboembolism, compared to adult hospitals where the prophylactic setting of trauma predominates.

  19. Obesity and Mortality, Length of Stay and Hospital Cost among Patients with Sepsis: A Nationwide Inpatient Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Anh Tuan Nguyen

    Full Text Available The objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older.It was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-payer inpatient care database in the United States. Hospitalizations of sepsis patients 20 years of age or older were included. All 25 primary and secondary diagnosis fields were screened to identify patients with sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Obesity was the exposure of interest. It was one of the 29 standardized Elixhauser comorbidity measures and readily available in the dataset as a dichotomized variable. The outcome measures were all-cause in-hospital death, length of stay and hospital cost.After weighting, our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the US in 2011. The overall all-cause mortality rate was 14.8%, the median hospital length of stay was 7 days and the median hospital cost was $15,917. After adjustment, the all-cause mortality was lower (adjusted OR = 0.84; 95% CI = 0.81 to 0.88; the average hospital length of stay was longer (adjusted difference = 0.65 day; 95% CI = 0.44 to 0.86 and the hospital cost per stay was higher (adjusted difference = $2,927; 95% CI = $1,606 to $4,247 for obese sepsis patients as compared to non-obese ones.With this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; however it was also associated with greater duration and cost of hospitalization.

  20. Quality care for children: inpatient medication use in a mid-Atlantic hospital system 2000-2003. (United States)

    Lasky, Tamar; Lawless, Stephen T; Greenspan, Jay


    The authors report on a preliminary analysis of an electronic database that includes more than 32 000 pediatric hospitalizations during 2000-2003. They analyzed pediatric inpatient medication use in a defined geographic area, the catchment area for the Alfred I. duPont Hospital for Children, serving Delaware, Maryland, New Jersey, and Pennsylvania. The study population included 18 108 female and 14 375 male children. The authors calculated the percentages of children receiving at least 1 administration of each drug. More than 700 drugs were received by children in the study population; 9 were received by at least 10% of all patients. The probability of receiving specific medications varied with patient age, sex, and race, but much further work is needed to quantify the variations. The database has the potential to inform pediatric health services research and pediatric comparative effectiveness research, and it may be the first analysis of hospitalizations for a pediatric population comprising all ages from 0 to 18.

  1. Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool (United States)

    Launay, Cyrille P.; de Decker, Laure; Kabeshova, Anastasiia; Annweiler, Cédric; Beauchet, Olivier


    Background The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Methods Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Results Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (Prisk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients. PMID:25333271

  2. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool. (United States)

    Launay, Cyrille P; de Decker, Laure; Kabeshova, Anastasiia; Annweiler, Cédric; Beauchet, Olivier


    The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (PLHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

  3. Rising utilization of inpatient pediatric asthma pathways. (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D


    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  4. Characteristics of Extended-Spectrum β-Lactamases-Producing Escherichia coli in Fecal Samples of Inpatients of Beijing Tongren Hospital. (United States)

    Xu, Maoye; Fan, Yanyan; Wang, Mei; Lu, Xinxin


    We aimed to investigate the prevalence of extended-spectrum β-lactamases (ESBL)-producing Escherichia coli in Beijing Tongren hospital and to identify a possible relation between colonization and infection. The clinical data on 650 inpatients between March 2012 and July 2012 were retrospectively reviewed. The prevalence of ESBL-producing E. coli among the inpatients was 25.7% (167/650), with the highest level (50.0%) in the rheumatology ward and the lowest (10.0%) in intensive care units. Hospital stay more than 2 years prior to infection, the use of antibiotics within 3 months of infection, and the use of glucocorticoids or immunosuppressive drugs were found to be significantly associated with carriage of ESBL-producing E. coli (P coli was not high. The risk factors of carriage of ESBL-producing E. coli are hospitalization and use of antibiotics, glucocorticoids, or immunosuppressive drugs. ST38, ST10, ST131, and ST167 are the prominent genotypes, but almost 50.0% of STs were scarcely distributed.

  5. Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery. (United States)

    O'Neill, Liam; Dexter, Franklin; Park, Sae-Hwan; Epstein, Richard H


    Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital. Observational study. State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Inpatients discharged with a major therapeutic ("operative") procedure. For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month. Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (Pcosts among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Overall Hospital Cost Estimates in Children with Congenital Heart Disease: Analysis of the 2012 Kid's Inpatient Database. (United States)

    Faraoni, David; Nasr, Viviane G; DiNardo, James A


    This study sought to determine overall hospital cost in children with congenital heart disease (CHD) and to compare cost associated with cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical admissions. The 2012 Healthcare Cost and Utilization Project Kid's Inpatient Database was used to evaluate hospital cost in neonates and children with CHD undergoing cardiac surgery, cardiac catheterization, non-cardiac surgical procedures, and medical treatments. Multivariable logistic regression was applied to determine independent predictors for increased hospital cost. In 2012, total hospital cost was 28,900 M$, while hospital cost in children with CHD represented 23% of this total and accounted for only 4.4% of hospital discharges. The median cost was $51,302 ($32,088-$100,058) in children who underwent cardiac surgery, $21,920 ($13,068-$51,609) in children who underwent cardiac catheterization, $4134 ($1771-$10,253) in children who underwent non-cardiac surgery, and $23,062 ($5529-$71,887) in children admitted for medical treatments. Independent predictors for increased cost were hospital bed size cost in children with CHD represented 23% of global cost while accounting for only 4.4% of discharges. This study identified factors associated with increased cost of cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical management in children with CHD.

  7. A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland.

    LENUS (Irish Health Repository)

    Bartels, C


    BACKGROUND: The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit. AIMS: To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital. METHODS: Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital. RESULTS: Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current\\/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe. CONCLUSIONS: Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.

  8. Inpatient Behavioral Health Recapture A Busiess Case Analysis at Evans Army Community Hospital Fort Carson, Colorado (United States)


    and Obstetrics /Gynecology. Inpatient care includes Obstetrics , Intensive Care, and Post Anesthesia Care/Same Day Surgery. EACH Mission: Delivering...charged with murder in Iraq shooting deaths, 2009). EACH Inpt Psych 13 Fort Carson has not been immune to the increase in suicides and violence identify Soldiers with PTSD symptoms. In 2008, however, attention returned to Fort Carson as a number of local homicides and other violence tied

  9. Seasonality of hospital admissions and birth dates among inpatients with eating disorders: a nationwide population-based retrospective study. (United States)

    Liang, Chih-Sung; Chung, Chi-Hsiang; Tsai, Chia-Kuang; Chien, Wu-Chien


    Seasonal variation exists in the psychopathology of eating disorders. However, it is still unknown whether there is seasonal variation in eating disorder symptom severity. This study investigated seasonal trends in hospital admissions and birth dates among patients with eating disorders in Taiwan (25°N). Subgroup analyses by gender and comorbid affective disorders were also of interest. Data on all hospital admissions between 2000 and 2013 were collected from the Taiwan National Health Insurance Research Database, and 1954 patients with eating disorders were identified. Hospital admissions and birth dates were recorded by day. The four seasons and cross-seasons were defined by solstices and equinoxes. The expected distribution of births was determined using data from all patients hospitalized from 2000 to 2013 (n = 13,139,306). Hospital admissions among patients with eating disorders exceeded the rate of expected hospital admissions in the summer season (p distributions of birth dates among these patients did not differ from the expected distributions. Interestingly, hospital admissions among patients with comorbid affective disorders exceeded the rates of hospital admissions among non-affective patients during the spring (p = 0.004). Moreover, the number of non-affective patients born during autumn exceeded the birth rates of affective patients during this season (p = 0.001). Gender and comorbid affective disorders were not associated with cross-seasonal differences in either hospitalizations or dates of birth. Affective psychopathology in inpatients with eating disorders may substantially contribute to symptom severity that waxes and wanes with the seasons. Moreover, the seasonal distribution of birth dates was significantly different in patients without comorbid affective disorders.

  10. Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality? (United States)

    Zachariah, R.; Hinderaker, S. G.; Khogali, M.; Manzi, M.; van Griensven, J.; Ayada, L.; Jemmy, J. P.; Maalim, A.; Amin, H.


    Setting: A district hospital in conflict-torn Somalia. Objective: To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. Design: Cross-sectional study. Results: Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. Conclusion: Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage. PMID:26393014

  11. Evaluation of a cognitive-behavioral program for chronically psychotic forensic inpatients.

    NARCIS (Netherlands)

    Hornsveld, R.H.J.; Nijman, H.L.I.


    The present study evaluated the progress of four groups of chronically psychotic patients in treatment at De Kijvelanden Forensic Psychiatric Hospital. The psychotic patients were offered a cognitive-behavioral program, including psycho education, grief processing, stress management, functional

  12. Comment to: The effects of an 8-week multicomponent inpatient treatment program on body composition and anaerobic fitness in overweight and obese children and adolescents

    Directory of Open Access Journals (Sweden)

    Radtke T


    Full Text Available Thomas Radtke,1 Bruno H Knöpfli,2 Johannes H Wildhaber,3 Jürg Hammer4 1Division of Cardiovascular Prevention, Rehabilitation and Sports Medicine, Swiss Cardiovascular Center, Inselspital, University Hospital and University of Bern, Bern, 2Kinder und Jugendmedizin, Zurich, 3Department of Pediatrics, Hospital Fribourg, Fribourg, 4Division of Intensive Care and Pulmonology, University Children's Hospital Basel, Basel, SwitzerlandWe note with surprise a recent paper entitled "The effects of an 8-week multicomponent inpatient treatment program on body composition and anaerobic fitness in overweight and obese children and adolescents" by Karner-Rezek et al1 published in the International Journal of General Medicine concerning the effects of an 8-week multicomponent inpatient treatment program on body composition and anaerobic fitness in overweight and obese children and adolescents. We would like to take this opportunity to comment on the study findings and, in particular, address the methodological inconsistencies and ambiguities in this study.View original paper by Karner-Rezek and colleagues.

  13. Length of psychiatric hospitalization is correlated with CYP2D6 functional status in inpatients with major depressive disorder (United States)

    Ruaño, Gualberto; Szarek, Bonnie L; Villagra, David; Gorowski, Krystyna; Kocherla, Mohan; Seip, Richard L; Goethe, John W; Schwartz, Harold I


    Aim This study aimed to determine the effect of the CYP2D6 genotype on the length of hospitalization stay for patients treated for major depressive disorder. Methods A total of 149 inpatients with a diagnosis of major depressive disorder at the Institute of Living, Hartford Hospital (CT, USA), were genotyped to detect altered alleles in the CYP2D6 gene. Prospectively defined drug metabolism indices (metabolic reserve, metabolic alteration and allele alteration) were determined quantitatively and assessed for their relationship to length of hospitalization stay. Results Hospital stay was significantly longer in deficient CYP2D6 metabolizers (metabolic reserve <2) compared with functional or suprafunctional metabolizers (metabolic reserve ≥2; 7.8 vs 5.7 days, respectively; p = 0.002). Conclusion CYP2D6 enzymatic functional status significantly affected length of hospital stay, perhaps due to reduced efficacy or increased side effects of the medications metabolized by the CYP2D6 isoenzyme. Functional scoring of CYP2D6 alleles may have a substantial impact on the quality of care, patient satisfaction and the economics of psychiatric treatment. PMID:23734807

  14. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. (United States)

    Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu


    Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

  15. Impact of Clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: A multicenter retrospective study of inpatients, 2009-2011. (United States)

    Magee, Glenn; Strauss, Marcie E; Thomas, Sheila M; Brown, Harold; Baumer, Dorothy; Broderick, Kelly C


    The recent epidemiologic changes of Clostridium difficile-associated diarrhea (CDAD) have resulted in substantial economic burden to U.S. acute care hospitals. Past studies evaluating CDAD-attributable costs have been geographically and demographically limited. Here, we describe CDAD-attributable burden in inpatients, overall, and in vulnerable subpopulations from the Premier hospital database, a large, diverse cohort with a wide range of high-risk subgroups. Discharges from the Premier database were retrospectively analyzed to assess length of stay (LOS), total inpatient costs, readmission, and inpatient mortality. Patients with CDAD had significantly worse outcomes than matched controls in terms of total LOS, rates of intensive care unit (ICU) admission, and inpatient mortality. After adjustment for risk factors, patients with CDAD had increased odds of inpatient mortality, total and ICU LOS, costs, and odds of 30-, 60- and 90-day all-cause readmission versus non-CDAD patients. CDAD-attributable costs were higher in all studied vulnerable subpopulations, which also had increased odds of 30-, 60- and 90-day all-cause readmission than those without CDAD. Given the significant economic impact CDAD has on hospitals, prevention of initial episodes and targeted therapy to prevent recurrences in vulnerable patients are essential to decrease the overall burden to hospitals. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Inpatient Management Of Diabetes Mellitus Among Noncritically Ill Patients At The University Hospital Of Puerto Rico (United States)

    Allende-Vigo, Myriam Zaydee; González-Rosario, Rafael A.; González, Loida; Sánchez, Viviana; Vega, Mónica A.; Alvarado, Milliette; Ramón, Raul O.


    OBJECTIVE To describe the state of glycemic control in non-critically ill diabetic patients admitted to the PR University Hospital, and the adherence to current standard of care guidelines for the treatment of diabetes. METHODS This was a retrospective study of patients admitted to a General Medicine ward with Diabetes Mellitus as a secondary diagnosis. Clinical data was analyzed for the first 5 days and the last 24 hours of admission. RESULTS One hundred and forty-seven (147) non-critically ill diabetic patients were evaluated. The rate of hyperglycemia and hypoglycemia was 56.7% and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hrs of admission and 54.2% during the last 24 hrs. Mean last glucose value before discharge was 189.6 ± 73 mg/dL. Most patients were treated with subcutaneous insulin with basal insulin alone used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60.0% on day 5, with still 40.0% receiving only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%), however, a substantial portion had no change (23.7%) or even had a decrease (6.2%) in their insulin dose. CONCLUSIONS Even though there are areas of improvement in the management of hospitalized diabetic patients, it is still suboptimal, probably due to clinical inertia. A comprehensive educational diabetes management program, along with standardized insulin orders should be implemented to improve the care of these patients. PMID:24325996

  17. "Cough officer screening" improves detection of pulmonary tuberculosis in hospital in-patients

    Directory of Open Access Journals (Sweden)

    Wen Jen-Ho


    Full Text Available Abstract Background Current tuberculosis (TB reporting protocols are insufficient to achieve the goals established by the Stop TB partnership. Some countries have recommended implementation of active case finding program. We assessed the effect of Cough Officer Screening (an active screening system on the rate of TB detection and health care system delays over the course of four years. Methods Patients who were hospitalized at the Changhua Christian Hospital (Changhua, Taiwan were enrolled from September 2004 to July 2006 (Stage I and August 2006 to August 2008 (Stage II. Stage II was implemented after a Plan-Do-Check-Act (PDCA cycle analysis indicated that we should exclude ICU and paediatric patients. Results In Stage I, our COS system alerted physicians to 19,836 patients, and 7,998 were examined. 184 of these 7,998 patients (2.3% had TB. Among these 184 patients, 142 (77.2% were examined for TB before COS alarming and 42 were diagnosed after COS alarming. In Stage II, a total of 11,323 patients were alerted by the COS system. Among them, 6,221 patients were examined by physicians, and 125 of these patients (2.0% had TB. Among these 125 patients, 113 (90.4% were examined for TB before COS alarming and 12 were diagnosed after COS alarming. The median time from COS alarm to clinical action was significantly less (p = 0.041 for Stage I (1 day; range: 0-16 days than for Stage II (2 days; range: 0-10 days. Conclusion Our COS system improves detection of TB by reducing the delay from infection to diagnosis. Modifications of scope may be needed to improve cost-effectiveness.

  18. An outcome study of an inpatient treatment program for pathological gamblers. (United States)

    Russo, A M; Taber, J I; McCormick, R A; Ramirez, L F


    In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

  19. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

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    Reynolds Matthew W


    Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1

  20. Predominant diagnoses, gender, and admission duration in an adult psychiatric inpatient hospital in United Kingdom

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    Carlo Lazzari


    Full Text Available Introduction: The study objective was to epidemiologically analyse patients presenting at an adult and mixed-gender psychiatric inpatient unit in Essex, Kingswood Centre, UK, to report the predominant diagnoses, gender, and admission duration. Method and material: Meta-analysis and descriptive statistics analysed the year 2016 discharge data on Excel® for 162 patients. ICD-10 codes classified their mental illnesses. Results: Meta-analysis evidenced statistically significant heterogeneity in numbers admissions (I2=95%; p≤0.001, length (I2=78%; p≤0.001, and gender (I2=76%; p≤0.001. The prevailing diagnosis was borderline personality disorder (BPD (rate, 95% CI=0.46 [0.38-0.54]. The longest admission was for schizoaffective disorder (mean duration, 95% CI=53 [22.65-83.34], p=0.001. Gender presented a prevalence of male over female admissions for schizophrenia (OR, 95% CI=0.14 [0.05-0.35], p≤0.001 and BPD with prevalence of female over male admissions (OR, 95% CI=2.79 [1.35-5.76], p=0.05. Conclusion: Female patients with BPD were the most represented category in non-forensic psychiatric inpatient wards in the population studied. Male patients with schizophrenia represented the other gender highly represented. The longest admission was recorded for schizoaffective disorder due to the complexity to treat both mood and psychotic symptoms. It is likely that women with BPD will be the future recipients of psychiatric inpatient and outpatient healthcare services.

  1. Readmission to Acute Care Hospital during Inpatient Rehabilitation for Traumatic Brain Injury (United States)

    Hammond, Flora M.; Horn, Susan D.; Smout, Randall J.; Beaulieu, Cynthia L.; Barrett, Ryan S.; Ryser, David K.; Sommerfeld, Teri


    Objective To investigate frequency, reasons, and factors associated with readmission to acute care (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Design Prospective observational cohort. Setting Inpatient rehabilitation. Participants 2,130 consecutive admissions for TBI rehabilitation. Interventions Not applicable. Main Outcome Measure(s) RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location. Results 183 participants (9%) experienced RTAC for a total 210 episodes. 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. Mean days from rehabilitation admission to first RTAC was 22 days (SD 22). Mean duration in acute care during RTAC was 7 days (SD 8). 84 participants (46%) had >1 RTAC episode for medical reasons, 102 (56%) had >1 RTAC for surgical reasons, and RTAC reason was unknown for 6 (3%) participants. Most common surgical RTAC reasons were: neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurologic (23%), and cardiac (12%). Older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission predicted patients with RTAC. RTAC was less likely for patients with higher admission Functional Independence Measure Motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home. Conclusion(s) Approximately 9% of patients with TBI experience RTAC during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation due to RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting. PMID:26212405

  2. Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center. (United States)

    Nwosu, B O; Eke, N O; Obi-Nwosu, A; Osakwe, O J; Eke, C O; Obi, N P


    This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

  3. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule. (United States)


    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

  4. Overweight, obesity and related conditions: a cross-sectional study of adult inpatients at a Norwegian Hospital (United States)


    Background Overweight, obesity and associated conditions are major public health concerns in Norway. The prevalence of overweight and obesity in the general population in Norway is increasing, but there are limited data on how the situation is in hospitals. This study aimed to find the prevalence of overweight and obesity, and explore the associations of overweight, obesity and its related medical conditions in an adult in-patient sample at specified somatic and psychiatric departments at St. Olavs Hospital, Trondheim. Results A total of 497 patients participated. The mean BMI for the total sample at screening was 25.4 kg/m2. The prevalence of overweight and obesity was 45.1%. There was a higher association of overweight and obesity among patients aged 40–59 years (OR: 1.7) compared to those being younger. There was no significant difference between the somatic and the psychiatric samples. In the somatic sample overweight and obesity was associated with obesity-related conditions for both genders (OR: 2.0 and 2.1, respectively), when adjusted for age. Conclusion The substantial prevalence of overweight and obese patients may pose a threat to future hospital services. To further address the burden of overweight and obesity in hospitals, we need more knowledge about consequences of length of stay, use of resources and overall cost. PMID:24571809

  5. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals]. (United States)

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol


    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  6. Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study. (United States)

    Latta, Linda C; Dick, Ronald; Parry, Carol; Tamura, Glen S


    In pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide "family-centered care" and the attending physician to model communication skills. The authors thus set out to identify how parents responded to participation in interdisciplinary teaching rounds conducted in a large tertiary care children's teaching hospital. A qualitative descriptive study was conducted using data from semistructured interviews of parents who had participated in rounds on the inpatient medical unit of a large academic children's hospital. From December 2004 to April 2005, 18 parents were interviewed after their participation in rounds. Questions assessed their experiences, expectations, preferred communication styles, and suggestions for improvement. Transcripts of the interviews were analyzed using qualitative content analysis. Being able to communicate, understand the plan, and participate with the team in decision making about their child's care were the most frequently cited outcomes of importance to parents. All 18 participants described the overall experience as positive, and 17 of 18 described themselves as "comfortable" with inclusion in rounds. Use of lay terminology and inclusion of nurses in rounds were preferred. Including parents on ward rounds at a teaching hospital was viewed positively by parents. Specific themes of particular importance to parents were identified. Further study is needed to assess the impact of inclusion of parents on rounds on patient outcomes and the resident experience.

  7. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.

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    Cyrille P Launay

    Full Text Available The aims of this study were 1 to confirm that combinations of brief geriatric assessment (BGA items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED; and 2 to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day, use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year. The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.Area under receiver operating characteristic (ROC curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010. Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003. Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4 and a low likelihood ratio of positive test under 5.6.Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

  8. The frequency of smoking and problem drinking among general hospital inpatients in Brazil - using the AUDIT and Fagerström questionnaires

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    Neliana Buzi Figlie


    Full Text Available CONTEXT: Although the CAGE questionnaire is one of the most widely used alcohol screening instruments, it has been criticized for not identifying people who are drinking heavily or who have alcohol related problems but do not as yet show symptoms of alcohol dependence. The AUDIT (Alcohol Use Disorder Identification Test questionnaire was developed by WHO as a screening instrument specifically designed to identify problem drinkers, as well as those who were already dependent on alcohol. OBJECTIVE: The aim of this study was to use the AUDIT and Fagerström questionnaires in a general hospital inpatient population to measure the frequency of problem drinking and nicotine dependence, and to see if levels varied between medical speciality. DESIGN: Retrospective cross-sectional study. SETTING: Federally funded public teaching hospital. SAMPLE: 275 inpatients from both genders. MAIN MEASUREMENTS: Socio-demographic data, AUDIT (Alcohol Use Disorders Identification Test and Fagerström Test for Nicotine Dependence. RESULTS: We interviewed 275 inpatients, 49% of whom were men and 51% women. Thirty-four patients were identified as "cases" by the Audit questionnaire; 22% of the male patients and 3% of the females. Just over 21% of inpatients were current smokers. The gastroenterology (26% and general medicine (16% inpatient units had the largest number of individual cases. CONCLUSIONS: Only by knowing the prevalence of alcohol abuse/dependence and nicotine dependence in a general hospital can we evaluate the need for a specialized liaison service to identify and treat these patients.

  9. Marketing research activities in hospitals. Satisfaction surveys of inpatients and outpatients are the most widely used application. (United States)

    Loubeau, P R; Jantzen, R


    Virtually unheard of in health care 30 years ago, marketing research by hospitals is expanding at a notable rate, particularly among larger institutions located in highly competitive urban markets. Research applications are particularly pronounced at for-profit institutions, those heavily involved in managed care programs, and hospitals that are part of an integrated delivery system. However, the majority of hospital administrators surveyed indicated they do not invest in marketing research to track the effectiveness of their own institution's advertising.

  10. Assessment of hospitalization and mortality of scleroderma in-patients: a thirteen-year study

    Directory of Open Access Journals (Sweden)

    Saeedeh Shenavandeh


    Full Text Available Objective: Systemic sclerosis (SSc is an uncommon non-hereditary sporadic disease that increases the risk of premature death, especially in diffuse type. We determined the prevalence of SSc in the last 13 years in our rheumatologic hospitals as a referral center for southern Iranian patients, the causes of hospitalization, the average length of stay (LOS, the mortality rate, and the reason for their mortality. Material and methods : A cross-sectional study was performed in Shiraz University of Medical Sciences, Iran. The studied population included all patients diagnosed with systemic sclerosis. We calculated the hospitalization rates, in-hospital mortality rates, and mean LOS. Results: There were 446 admissions by 181 patients with SSc. The female to male ratio was about 10.7 : 1. The overall mean LOS was 5.95 days. Digital ulcer and interstitial lung disease (ILD were the most common causes of hospitalizations among the SSc-related events. For those with a non-SSc-related condition, infection was the most prevalent event. Most of the deaths were due to ILD and pulmonary artery hypertension(PAH, and the overall in-hospital mortality rate was 16.5%. Conclusions : Women with SSc had higher rates of hospitalization but lower in-hospital mortality than men.There were some differences between our study and other similar studies in the causes of hospitalization and in-hospital death among SSc patients, especially the lower age of death. The patients with digital ulcers and those with intestinal lung disease or pulmonary hipertension were most commonly admitted to the hospital in our study group. Probably, increasing the skin care of these patients and asking other specialty groups to cooperate will decrease the high rate of hospitalizations in our population.

  11. The Rural Inpatient Mortality Study: Does Urban-Rural County Classification Predict Hospital Mortality in California? (United States)

    Linnen, Daniel T; Kornak, John; Stephens, Caroline


    Evidence suggests an association between rurality and decreased life expectancy. To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications. Ratings included mortality for coronary artery bypass grafting, stroke, chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia across 277 California hospitals between July 2011 and June 2014. We used generalized estimating equations to evaluate the association of urban-rural county classifications on mortality ratings. Unfavorable Medicare hospital mortality rating "worse than the national rate" compared with "better" or "same." Compared with large central "metro" (metropolitan) counties, hospitals in medium-sized metro counties had 6.4 times the odds of rating "worse than the national rate" for hospital mortality (95% confidence interval = 2.8-14.8, p centers may contribute to these results, a potential factor that future research should examine.

  12. Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals. (United States)

    Sercu, Charlotte; Bracke, Piet


    The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.

  13. Lead-time reduction utilizing lean tools applied to healthcare: the inpatient pharmacy at a local hospital. (United States)

    Al-Araidah, Omar; Momani, Amer; Khasawneh, Mohammad; Momani, Mohammed


    The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of > 45% in the drug dispensing cycle time.

  14. The use of Skype in a community hospital inpatient palliative medicine consultation service. (United States)

    Brecher, David B


    Skype™, an Internet-based communication tool, has enhanced communication under numerous circumstances. As telemedicine continues to be an increasing part of medical practice, there will be more opportunities to use Skype and similar tools. Numerous scenarios in the lay literature have helped to highlight the potential uses. Although most commonly used to enhance physician-to-patient communication, there has been limited reported use of Skype for patient-to-family communication, especially in end of life and palliative care. Our inpatient Palliative Medicine Consultation Service has offered and used this technology to enhance our patients' quality of life. The objective was to provide another tool for our patients to use to communicate with family and/or friends, especially under circumstances in which clinical symptoms, functional status, financial concerns, or geographic limitations preclude in-person face-to face communication.

  15. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions. (United States)

    Isenberg, Sarina R; Lu, Chunhua; McQuade, John; Chan, Kelvin K W; Gill, Natasha; Cardamone, Michael; Torto, Deirdre; Langbaum, Terry; Razzak, Rab; Smith, Thomas J


    Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

  16. Partial Hospitalization Programs: A Current Perspective. (United States)

    Whitelaw, Carolyn A.; Perez, Edgardo L.


    Reviews the historical background, standards, the issue of day treatment versus day care, functional issues, specialization, efficacy and cost effectiveness, utilization issues, and alternative models of care of partial hospitalization programs in North America. Emphasizes issues of relevance when planning alternative programs to inpatient…

  17. [Inpatient acute pain management in German hospitals: results from the national survey "Akutschmerzzensus 2012"]. (United States)

    Erlenwein, J; Stamer, U; Koschwitz, R; Koppert, W; Quintel, M; Meißner, W; Petzke, F


    In 2007, the German national guidelines on "Treatment of acute perioperative and post-traumatic pain" were published. The aim of this study was to describe current structure and process data for acute pain management in German hospitals and to compare how the guidelines and other initiatives such as benchmarking or certification changed the healthcare landscape in the last decade. All directors of German departments of anesthesiology according to the DGAI ("Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin", German Society for Anesthesiology and Intensive Care) were mailed a standardized questionnaire on structures and processes of acute pain management in their hospitals. A total of 403 completed questionnaires (46 %) could be evaluated. Of hospitals, 81 % had an acute pain service (ASD), whereby only 45 % met defined quality criteria. Written standards for acute pain management were available in 97 % of the hospitals on surgical wards and 51 % on nonsurgical wards. In 96 %, perioperative pain was regularly recorded (generally pain at rest and/or movement, pain-related functional impairment in 16 % only). Beside these routine measurements, only 38 % of hospitals monitored pain for effectiveness after acute medications. Often interdisciplinary working groups and/or pain managers are established for hospital-wide control. As specific therapy, the patient-controlled analgesia and epidural analgesia are largely prevalent (> 90 % of all hospitals). In the last decade, intravenous and oral opioid administration of opioids (including slow release preparations) has become established in acute pain management. The survey was representative by evaluating 20 % of all German hospitals. The organizational requirements for appropriate pain management recommended by the German guidelines for acute pain recommended have been established in the hospital sector in recent years. However, the organizational enforcement for acute pain management in

  18. Underestimated prevalence of heart failure in hospital inpatients: a comparison of ICD codes and discharge letter information. (United States)

    Kaspar, Mathias; Fette, Georg; Güder, Gülmisal; Seidlmayer, Lea; Ertl, Maximilian; Dietrich, Georg; Greger, Helmut; Puppe, Frank; Störk, Stefan


    Heart failure is the predominant cause of hospitalization and amongst the leading causes of death in Germany. However, accurate estimates of prevalence and incidence are lacking. Reported figures originating from different information sources are compromised by factors like economic reasons or documentation quality. We implemented a clinical data warehouse that integrates various information sources (structured parameters, plain text, data extracted by natural language processing) and enables reliable approximations to the real number of heart failure patients. Performance of ICD-based diagnosis in detecting heart failure was compared across the years 2000-2015 with (a) advanced definitions based on algorithms that integrate various sources of the hospital information system, and (b) a physician-based reference standard. Applying these methods for detecting heart failure in inpatients revealed that relying on ICD codes resulted in a marked underestimation of the true prevalence of heart failure, ranging from 44% in the validation dataset to 55% (single year) and 31% (all years) in the overall analysis. Percentages changed over the years, indicating secular changes in coding practice and efficiency. Performance was markedly improved using search and permutation algorithms from the initial expert-specified query (F1 score of 81%) to the computer-optimized query (F1 score of 86%) or, alternatively, optimizing precision or sensitivity depending on the search objective. Estimating prevalence of heart failure using ICD codes as the sole data source yielded unreliable results. Diagnostic accuracy was markedly improved using dedicated search algorithms. Our approach may be transferred to other hospital information systems.

  19. Vaccine-preventable, hospitalizations among American Indian/Alaska Native children using the 2012 Kid's Inpatient Database. (United States)

    Nickel, Amanda J; Puumala, Susan E; Kharbanda, Anupam B


    Our aim was to assess the odds of hospitalization for a vaccine-preventable, infectious disease (VP-ID) in American Indian/Alaska Native (AI/AN) children compared to other racial and ethnic groups using the 2012 Kid's Inpatient Database (KID) The KID is a nationally representative sample, which allows for evaluation of VP-ID in a non-federal, non-Indian Health Service setting. In a cross-sectional analysis, we evaluated the association of race/ethnicity and a composite outcome of hospitalization due to vaccine-preventable infection using multivariate logistic regression. AI/AN children were more likely (OR=1.81, 95% CI=1.34, 2.45) to be admitted to the hospital in 2012 for a VP-ID compared to Non-Hispanic white children after adjusting for age, sex, chronic disease status, metropolitan location, and median household income. This disparity highlights the necessity for a more comprehensive understanding of immunization and infectious disease exposure among American Indian children, especially those not covered or evaluated by Indian Health Service. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Deterioro funcional en ancianos ingresados en un hospital sin unidades geriátricas Functional impairment in elderly inpatients in a hospital without geriatric units

    Directory of Open Access Journals (Sweden)

    Alfonso Jesús Cruz Lendínez


    ás influyen en la variación de la capacidad funcional durante la hospitalización. La hospitalización de ancianos en un hospital sin unidad geriátrica supone peores resultados en la capacidad funcional de los pacientes frente a los hospitales que cuentan con unidad de hospitalización geriátrica.Introduction: Increased population of elderly people is becoming more frequent admission to hospitals of people older than 65 years. Hospital stay in conventional units can lead to functional worsening in the elderly. Aim: To identify the profile of elderly patients treated in the Internal Medicine Hospital of Jaén. To analyze variation in functional ability of elderly people following admission to inpatient units of a public hospital. To identify variables that influence the changes in the functional ability of elderly inpatients in hospitals without geriatric units. Methods: Prospective observational study in 3 units of internal medicine units in a hospital belonging to the Andalusian Health Service. A sample of 190 hospitalized elderly patients has been included. Variables related to demographic, hospitalization and functional ability using Barthel Index, were reported. Results: Hospitalization in internal medicine units did not help to improve functional ability in older people; rather, they had a negative effect, promoting functional worsening in an important group of these patients. Depending on the age, among patients studied (65-85 and over, younger patients got better results on functional recovery at discharge, while those above 85 years got worst results. 16% under 85 years and 67.5% of those over 85 lose functional capacity. Conclusions: Most important factors affecting functional ability change during hospitalization were age, functional ability at admission, functional ability at discharge, the presence of companions during hospitalization and discharge destination. Hospitalization of elderly in a nongeriatric inpatient unit at hospital assumes no worse results in

  1. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury


    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore; Matheny, Michael E


    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention.

  2. The feasibility of a holistic wellness program for HIV/AIDS patients residing in a voluntary inpatient treatment program. (United States)

    Morgan, Vanessa


    The purpose of this project was to examine the feasibility of an ongoing holistic wellness program in a residential facility treating persons with HIV/AIDS. The goal was to create a voluntary, four week holistic wellness intensive within the established inpatient behavioral health treatment program. Participants were given practicable holistic self care tools to effectively manage HIV related symptoms, general medical issues, addiction, depression, stress and anxiety. The program incorporated evidence-based holistic activities including yoga, therapeutic dance, meditation, Reiki, and reflective journaling. Narrative survey results and post-program evaluation support that an ongoing holistic wellness program within the existing treatment model is feasible and could have numerous potential beneficial effects. This project clearly exemplified the ideal opportunity for holistic nurses to implement innovative holistic interventions within the current healthcare delivery system. It is the author's observation that future studies with a larger participant group to further examine measurable benefits can lend valuable information and insight into the future development of holistic wellness programs for residential treatment facilities.

  3. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty. (United States)

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace


    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  4. Current understanding of treatment and management protocol for adult diabetic in-patients at a tertiary care hospital

    International Nuclear Information System (INIS)

    Waki, N.; Memon, A.; Khan, M.O.; Masood, S.; Rouf, M.; Mirza, R.


    Objective: To assess the current understanding of treatment and management protocols for adult diabetic in-patients at a tertiary care hospital. Methods: This cross-sectional study, conducted at the Civil Hospital Karachi from July to September 2009, involved 450 participants, who were interviewed through a well-structured questionnaire regarding the patient's demography, clinical features, past medical history, type of diabetes mellitus, duration, associated complications, and also involved patient notes for laboratory tests and management. SPSSv15.0 was used for descriptive analysis. Results: The study population of 450 diabetics had 144 (32%) males and 306 (68%) females. Of the total, 435 (96.7%) patients had type 2 diabetes. There were 231 (51%) patients using insulin, 168 (37.3%) oral hypoglycaemic drugs, and 51 (11.3%) using both. Among patients using insulin, regular insulin usage stood at 30% followed by a combination of regular insulin and NPH (26.7%) and NPH alone at 6%. The most popular drug used was metformin (27.3%) and the least used drug was glitazones (4%). In the study population, 73.3% patients controlled their diabetes with diet, and 24.7% with regular exercise. Conclusion: Majority of the study population had type 2 diabetes with a female preponderance. Insulin was prescribed for half the patients. Metformin was the most frequently used oral hypoglycaemic drug. (author)

  5. Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence. (United States)

    Gardiner, Fergus William; Nwose, Ezekiel Uba; Bwititi, Phillip Taderera; Crockett, Judith; Wang, Lexin


    To determine the extent to which targets for blood pressure (BP) (inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of 7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  6. Heparin-induced thrombocytopenia: reducing misdiagnosis via collaboration between an inpatient anticoagulation pharmacy service and hospital reference laboratory. (United States)

    Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles


    Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.

  7. Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial. (United States)

    van den Bosch, Louisa M C; Sinnaeve, Roland; Hakkaart-van Roijen, Leona; van Furth, Eric F


    Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program. Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design.Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in December 2014. Highly suicidal

  8. Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale. (United States)

    McGirt, Matthew J; Parker, Scott L; Chotai, Silky; Pfortmiller, Deborah; Sorenson, Jeffrey M; Foley, Kevin; Asher, Anthony L


    OBJECTIVE Extended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. METHODS The Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0-12 points), discharge to inpatient facility (0-18 points), and 90-day readmission (0-6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic). RESULTS A total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System

  9. Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. (United States)

    Lowe, Christopher F; Lloyd-Smith, Elisa; Sidhu, Baljinder; Ritchie, Gordon; Sharma, Azra; Jang, Willson; Wong, Anna; Bilawka, Jennifer; Richards, Danielle; Kind, Thomas; Puddicombe, David; Champagne, Sylvie; Leung, Victor; Romney, Marc G


    Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings. A prospective crossover study was conducted on 4 medical inpatient units in an urban, academic Canadian hospital from May 1, 2014-August 10, 2015. Intervention units used CHG over a 7-month period, including a 1-month wash-in phase, while control units used nonmedicated soap and water bathing. Rates of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization or infection were the primary end point. Hospital-associated S. aureus were investigated for CHG resistance with a qacA/B and smr polymerase chain reaction (PCR) and agar dilution. Compliance with daily CHG bathing was 58%. Hospital-associated MRSA and VRE was decreased by 55% (5.1 vs 11.4 cases per 10,000 inpatient days, P = .04) and 36% (23.2 vs 36.0 cases per 10,000 inpatient days, P = .03), respectively, compared with control cohorts. There was no significant difference in rates of hospital-associated Clostridium difficile. Chlorhexidine resistance testing identified 1 isolate with an elevated minimum inhibitory concentration (8 µg/mL), but it was PCR negative. This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  10. 42 CFR 413.40 - Ceiling on the rate of increase in hospital inpatient costs. (United States)


    ... October 1, 2002, is the percentage increase projected by the hospital market basket index. (4) Target... target amount for the previous cost reporting period, updated by the market basket percentage increase... each cost reporting period, the ceiling is determined by multiplying the updated target amount, as...

  11. God imagery and affective outcomes in a spiritually integrative inpatient program. (United States)

    Currier, Joseph M; Foster, Joshua D; Abernethy, Alexis D; Witvliet, Charlotte V O; Root Luna, Lindsey M; Putman, Katharine M; Schnitker, Sarah A; VanHarn, Karl; Carter, Janet


    Religion and/or spirituality (R/S) can play a vital, multifaceted role in mental health. While beliefs about God represent the core of many psychiatric patients' meaning systems, research has not examined how internalized images of the divine might contribute to outcomes in treatment programs/settings that emphasize multicultural sensitivity with R/S. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually integrative inpatient program over a two-year period, this study tested direct/indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes (positive and negative). When accounting for patients' demographic and religious backgrounds, structural equation modeling results revealed: (1) overall effects for God imagery at pre-treatment on post-treatment levels of both positive and negative affect; and (2) religious comforts and strains fully mediated these links. Secondary analyses also revealed that patients' generally experienced reductions in negative emotion in God imagery over the course of their admission. These findings support attachment models of the R/S-mental health link and suggest that religious comforts and strains represent distinct pathways to positive and negative domains of affect for psychiatric patients with varying experiences of God. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  12. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines. (United States)

    Tobe, Makoto; Stickley, Andrew; del Rosario, Rodolfo B; Shibuya, Kenji


    OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee

  13. Validating hospital antibiotic purchasing data as a metric of inpatient antibiotic use. (United States)

    Tan, Charlie; Ritchie, Michael; Alldred, Jason; Daneman, Nick


    Antibiotic purchasing data are a widely used, but unsubstantiated, measure of antibiotic consumption. To validate this source, we compared purchasing data from hospitals and external medical databases with patient-level dispensing data. Antibiotic purchasing and dispensing data from internal hospital records and purchasing data from IMS Health were obtained for two hospitals between May 2013 and April 2015. Internal purchasing data were validated against dispensing data, and IMS data were compared with both internal metrics. Scatterplots of individual antimicrobial data points were generated; Pearson's correlation and linear regression coefficients were computed. A secondary analysis re-examined these correlations over shorter calendar periods. Internal purchasing data were strongly correlated with dispensing data, with correlation coefficients of 0.90 (95% CI = 0.83-0.95) and 0.98 (95% CI = 0.95-0.99) at hospitals A and B, respectively. Although dispensing data were consistently lower than purchasing data, this was attributed to a single antibiotic at both hospitals. IMS data were favourably correlated with, but underestimated, internal purchasing and dispensing data. This difference was accounted for by eight antibiotics for which direct sales from some manufacturers were not included in the IMS database. The correlation between purchasing and dispensing data was consistent across periods as short as 3 months, but not at monthly intervals. Both internal and external antibiotic purchasing data are strongly correlated with dispensing data. If outliers are accounted for appropriately, internal purchasing data could be used for cost-effective evaluation of antimicrobial stewardship programmes, and external data sets could be used for surveillance and research across geographical regions. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e

  14. Reiki training for caregivers of hospitalized pediatric patients: a pilot program. (United States)

    Kundu, Anjana; Dolan-Oves, Rebecca; Dimmers, Martha A; Towle, Cara B; Doorenbos, Ardith Z


    To explore the feasibility of a Reiki therapy-training program for the caregivers of pediatric medical or oncology inpatients, at a large pediatric hospital, a series of Reiki training classes were offered by a Reiki Master. At completion of the training, an interview was conducted to elicit participant's feedback regarding the effectiveness and feasibility of the training program. Seventeen of the 18 families agreed to participate. Most families (65%) attended three Reiki training sessions, reporting that Reiki benefitted their child by improving their comfort (76%), providing relaxation (88%), and pain relief (41%). All caregivers identified becoming an active participant in their child's care as a major gain from participation in the Reiki training. A hospital-based Reiki training program for caregivers of hospitalized pediatric patients is feasible and can positively impact patients and their families. More rigorous research regarding the benefits of Reiki in the pediatric population is needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Inpatient Profile of Patients with Major Depression in Portuguese National Health System Hospitals, in 2008 and 2013: Variation in a Time of Economic Crisis. (United States)

    Rodrigues, Daniel Francisco Santos; Nunes, Carla


    The economic crisis has placed Portugal in a situation of budgetary constraints with repercussions on mental health, since 2009. This study analyses the association between economic crisis and the inpatient profile of major depression in the working-age population in Portuguese National Health System hospitals. This was an observational, descriptive and cross-sectional study. An individual analysis of hospitalisation and an ecological analysis at district level, were performed before 2008 and during the crisis (2013). Data on the hospitalisation episodes, working-age population and psychiatric inpatient beds were analysed. An increase in hospitalisation rates for major depression were observed, and across country, high spatial variations were perceived: districts with lower rates of urbanisation and population density had higher hospitalisation rates for major depression. Hospitalisation rates were positively influenced by the available inpatient beds. The results for 2013 were more critical (higher hospitalisation rates, less beds). Further research is needed to understand all patterns, considering other individual and contextual information.

  16. How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services. (United States)

    Mautner, Dawn; Peterson, Bridget; Cunningham, Amy; Ku, Bon; Scott, Kevin; LaNoue, Marianna


    Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

  17. Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study. (United States)

    Kroll, Ryan R; Boyd, J Gordon; Maslove, David M


    As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of -1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias -0.99 bpm vs -5.02 bpm, P=.02). Personal fitness tracker-derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. NCT02527408; (Archived by WebCite at

  18. The Epidemiological And Susceptibility Study Of Inpatient Blood Cultures In Amir Alam Hospital 1998 - 2000

    Directory of Open Access Journals (Sweden)

    Karimi Shahidi M


    Full Text Available Sepsis is one of the most critical medical emergency situations. Treatment with anti microbial drugs should be initiated as soon as samples of blood and other relevant sites have been cultured. Available information about patterns of anti microbial Susceptibility among bacterial isolates from the community, the hospital, and the patient should be taken in to account. It is important, pending culture results, to initiate empirical anti microbial therapy."nMaterials and methods: In a descriptive study during 3 years (1377-1379, microbial and anti microbial susceptibility patterns evaluated in Amir alam clinical laboratory on 2000 specimen of blood culture received from 765 hospitalized patients at Amir Alam hospital wards."nResults: 113 specimens from 77 patient (10 percent were positive for microbial growth. Enterobacter, S. aureus, S.epidermidis, Pneumococci, Ecoli, and Pseudomonas were the most common isolated etiologic agents(80 percent . The most common organism was Entenobacter in 1377, S.aureus in 1378 and pseudomonas in 1379 There were significant change in patlern of organisms, increase resistance to some important available antibiotics and change in antibiotic susceptibility pattern during three years (disc diffusion method."nConclusions: According to Results of this study due to change in pattern of organism and their antibiotic susceptibility, dynamic microbiological study provide important data for Ordering empirical and culture oriented treatment of patients with bacteremia, Sepsis, anti microbial Chemotherapy, anti microbial susceptibility empirical anti microbial therapy, microbial pattern.

  19. Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota. (United States)

    Smith, Kathryn; Lesser, Julie; Brandenburg, Beth; Lesser, Andrew; Cici, Jessica; Juenneman, Robert; Beadle, Amy; Eckhardt, Sarah; Lantz, Elin; Lock, James; Le Grange, Daniel


    Historically, inpatient protocols have adopted relatively conservative approaches to refeeding in Anorexia Nervosa (AN) in order to reduce the risk of refeeding syndrome, a potentially fatal constellation of symptoms. However, increasing evidence suggests that patients with AN can tolerate higher caloric prescriptions during treatment, which may result in prevention of initial weight loss, shorter hospital stays, and less exposure to the effects of severe malnutrition. Therefore the present study sought to examine the effectiveness of a more accelerated refeeding protocol in an inpatient AN and atypical AN sample. Participants were youth (ages 10-22) with AN ( n  = 113) and atypical AN ( n  = 16) who were hospitalized for medical stabilization. A retrospective chart review was conducted to assess changes in calories, weight status (percentage of median BMI, %mBMI), and indicators of refeeding syndrome, specifically hypophosphatemia, during hospitalization. Weight was assessed again approximately 4 weeks after discharge. No cases of refeeding syndrome were observed, though 47.3 % of participants evidenced hypophosphatemia during treatment. Phosphorous levels were monitored in all participants, and 77.5 % were prescribed supplemental phosphorous at the time of discharge. Higher rates of caloric changes were predictive of greater changes in %mBMI during hospitalization. Rates of caloric and weight change were not related to an increased likelihood of re-admission. Results suggest that a more accelerated approach to inpatient refeeding in youth with AN and atypical AN can be safely implemented and is not associated with refeeding syndrome, provided there is close monitoring and correction of electrolytes. These findings suggest that this approach has the potential to decrease length of stay and burden associated with inpatient hospitalization, while supporting continued progress after hospitalization.

  20. Implementing managed alcohol programs in hospital settings: A review of academic and grey literature. (United States)

    Brooks, Hannah L; Kassam, Shehzad; Salvalaggio, Ginetta; Hyshka, Elaine


    People with severe alcohol use disorders are at increased risk of poor acute-care outcomes, in part due to difficulties maintaining abstinence from alcohol while hospitalised. Managed alcohol programs (MAP), which administer controlled doses of beverage alcohol to prevent withdrawal and stabilise drinking patterns, are one strategy for increasing adherence to treatment, and improving health outcomes for hospital inpatients with severe alcohol use disorders. Minimal research has examined the implementation of MAPs in hospital settings. We conducted a scoping review to describe extant literature on MAPs in community settings, as well as the therapeutic provision of alcohol to hospital inpatients, to assess the feasibility of implementing formal MAPs in hospital settings and identify knowledge gaps requiring further study. Four academic and 10 grey literature databases were searched. Evidence was synthesised using quantitative and qualitative approaches. Forty-two studies met review inclusion criteria. Twenty-eight examined the administration of alcohol to hospital inpatients, with most reporting positive outcomes related to prevention or treatment of alcohol withdrawal. Fourteen studies examined MAPs in the community and reported that they help stabilise drinking patterns, reduce alcohol-related harms and facilitate non-judgemental health and social care. MAPs in the community have been well described and research has documented effective provision of alcohol in hospital settings for addressing withdrawal. Implementing MAPs as a harm reduction approach in hospital settings is potentially feasible. However, there remains a need to build off extant literature and develop and evaluate standardised MAP protocols tailored to acute-care settings. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  1. Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals. (United States)

    Ashcroft, Darren M; Lewis, Penny J; Tully, Mary P; Farragher, Tracey M; Taylor, David; Wass, Valerie; Williams, Steven D; Dornan, Tim


    It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors. This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors. Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors. Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders. The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence

  2. 75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... site to view public comments. Comments received timely will also be available for public inspection... Stimulation System b. IntraOperative Electron RadioTherapy (IOERT) c. Brachytherapy d. Excisional Debridement...

  3. 76 FR 59263 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... submission, we made an error in referencing the number of States in which healthcare associated infections... accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can... statement of the finding and the reasons therefore in the notice. Section 553(d) of the APA ordinarily...

  4. 78 FR 61197 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... typographical and technical errors in referencing an NQF-endorsed measure name. B. Summary of Errors in and... 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can waive this notice... the reasons therefore in the notice. Section 553(d) of the APA ordinarily requires a 30-day delay in...

  5. 75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and... (United States)


    ... adjustment factor for changes in DRG classifications and weights and the geographic adjustment factor (GAF... to account for the increase in case-mix due to changes in documentation and coding practices that do... adjustment to account for the increase in case-mix due to changes in documentation and coding practices that...

  6. 75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services... (United States)


    ... classification that do not reflect real change in case-mix would be 0.0 percent for FY 2010. Therefore, since we... for general information. Gregory J. Savord, (410) 786-1521 for case-mix analysis. SUPPLEMENTARY... case-mix. The adjustment to reflect real case-mix is determined on the basis of the most recent case...

  7. 77 FR 69848 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services... (United States)


    ... adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment... find that the procedure for notice and comment is unnecessary because the formulae used to calculate...

  8. 76 FR 19365 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and... (United States)


    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1357-N] RIN... document, demonstrates that this notice is consistent with the regulatory philosophy and principles.... Kathleen Sebelius, Secretary, Department of Health and Human Services. Addendum This addendum includes...

  9. 77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ....9998 GAF/DRG budget neutrality adjustment factor for FY 2013 is a net change of 0.9998 (or -0.02.../DRG budget neutrality adjustment factors are built permanently into the capital Federal rates. Thus...

  10. Children's experiences as hospital in-patients: voice, competence and work. Messages for nursing from a critical ethnographic study. (United States)

    Livesley, Joan; Long, Tony


    There is growing evidence that children's subjective interpretations of events may differ significantly from those of adults; yet children's and young people's voices and children's knowledge regarding hospital care remain relatively unexplored. To develop insight into children's subjective interpretations and knowledge of being hospital in-patients. Critical ethnography. A nephro-urology ward in a tertiary referral children's hospital in the north of England. A purposive sample was employed of 15 children over 2 phases: six (9-15 years) at home in a reconnaissance first phase, and nine (5-14 years) in hospital in phase 2. A raft of child-friendly, age-appropriate strategies was used to engage children in phase 1. Phase 2 involved over 100 h of field-work with hospitalised children over 6 months, with observation, interview, play and craft activities as prominent methods. Data were analysed using constant comparative methods. The study ward was a place in which children struggled to find a space for their competence to be recognised and their voice heard. Children's voice became manifest in what they said but also through the non-verbal mechanisms of resisting, turning away and being silent. While all the children shared the experience of being in trouble, recognition of their competence was fluid and contingent on their relationships with the nurses alongside other structural and material factors. The children worked hard to maintain their position as knowledgeable individuals. When they could not do so they relied on supportive adults, and in the absence of supportive adults they became marooned and received bare minimum care. The hospital ward was a place for children in which there was little space for children's voices. When their voices were heard, they were often seen as a challenge. Quiet, sick and shy children who were alone were the most likely to have their needs overlooked and become subject to standardised nursing care. A more inclusive and

  11. Development and localisation of casemix applications for inpatient hospital activity in EU member states. (United States)

    Wiley, M M


    The successful infiltration of casemix techniques across geographical, systemic and cultural boundaries provides an interesting and timely example of the translation of research evidence into health policy development. This paper explores the specifics of this policy development by reviewing the application of casemix techniques within the acute hospital systems of European Union member states. The fact that experimentation with or application of casemix measures can be reported for the majority of European Union member states would suggest that the deployment of these measures can be expected to continue to expand within these health systems into the new millennium.

  12. A Multimodal Communication Program for Aphasia during Inpatient Rehabilitation: A Case Study (United States)

    Wallace, Sarah E.; Purdy, Mary; Skidmore, Elizabeth


    BACKGROUND Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. OBJECTIVE The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. METHODS Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. RESULTS Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. CONCLUSIONS Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. PMID:25227547

  13. A multimodal communication program for aphasia during inpatient rehabilitation: A case study. (United States)

    Wallace, Sarah E; Purdy, Mary; Skidmore, Elizabeth


    Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

  14. Student pharmacist experiences as inpatient psychiatry medication education group leaders during an early immersion program. (United States)

    McLaughlin, Jacqueline E; Kennedy, Lindsey; Garris, Shauna; Harris, Suzanne C; Hillman, Ashley; Pinelli, Nicole R; Rhoney, Denise H


    While research suggests that pharmacists generally hold positive attitudes toward consumers of psychiatric medications, they often feel less comfortable talking about these medications and providing services for patients with mental illness. The purpose of this program was to train second and third year student pharmacists as psychiatry medication education groups leaders and to examine resulting student self-efficacy and mental health stigma. In partnership with the University of North Carolina (UNC) Eshelman School of Pharmacy, the inpatient psychiatry service at UNC Medical Center expanded weekly medication education groups with the help of trained student pharmacists. All second- and third-year student pharmacists were invited to participate. Pre/post surveys and reflection statements were collected from 13 students that received training, provided informed consent, and participated in one or more medication education groups. Data were analyzed with a mixed methods approach. Student responses revealed an increase in student self-efficacy (p appreciation for pharmacists and the workplace while developing self-efficacy and strategies for engaging with patients with mental illness as a part of medication education groups. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Role of emerging private hospitals in a post-Soviet mixed health system: a mixed methods comparative study of private and public hospital inpatient care in Mongolia. (United States)

    Tsevelvaanchig, Uranchimeg; Gouda, Hebe; Baker, Peter; Hill, Peter S


    The collapse of the Soviet Union in 1990 severely impacted the health sector in Mongolia. Limited public funding for the post-Soviet model public system and a rapid growth of poorly regulated private providers have been pressing issues for a government seeking to re-establish universal health coverage. However, the evidence available on the role of private providers that would inform sector management is very limited. This study analyses the current contribution of private hospitals in Mongolia for the improvement of accessibility of health care and efficiency. We used mixed research methods. A descriptive analysis of nationally representative hospital admission records from 2013 was followed by semi-structured interviews that were carried out with purposively selected key informants (N = 45), representing the main actors in Mongolia's mixed health system. Private-for-profit hospitals are concentrated in urban areas, where their financial model is most viable. The result is the duplication of private and public inpatient services, both in terms of their geographical location and the range of services delivered. The combination of persistent inpatient-oriented care and perverse financial incentives that privilege admission over outpatient management, have created unnecessary health costs. The engagement of the private sector to improve population health outcomes is constrained by a series of issues of governance, regulation and financing and the failure of the state to manage the private sector as an integral part of its health system planning. For a mixed system like in Mongolia, a comprehensive policy and plan which defines the complementary role of private providers to optimize private public service mix is critical in the early stages of the private sector development. It further supports the importance of a system perspective that combines regulation and incentives in consistent policy, rather than an isolated approach to provide regulation. © The Author

  16. Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks?

    LENUS (Irish Health Repository)

    Kitchen, J


    AIM: To determine non-steroidal anti-inflammatory drug (NSAID) prescribing practices in a tertiary referral hospital. METHODS: A single time-point audit of drug kardexes and clinical notes of n = 388 patients on 2 July 2008 was carried out assessing demographics, gastrointestinal and coronary heart disease risk factors, renal function and co-prescribed medications. RESULTS: Fifty-seven of 388 (14.7%) hospital patients were on NSAIDs. Forty-nine were prescribed NSAID after admission. Nineteen (32.2%) were on regular NSAID (11\\/19 on PPI) and 38 patients were on PRN NSAID (12\\/38 on PPI). Seventeen of 49 patients were on other medications associated with gastrointestinal bleeding (10\\/17 were on PPI). Nineteen patients (33.3%) were >60 years. Eight patients had three or four risk factors for gastrointestinal bleeding; six were on PPI. Thirteen patients had two risks; 7 were on PPI. Six of 19 patients with one risk factor were on PPI. 40.3% had stage 2\\/3 chronic kidney disease. 35.1% had ischaemic heart disease. CONCLUSIONS: NSAIDs and PPIs are often prescribed inappropriately.

  17. Improving the quality of the order-writing process for inpatient orders in a teaching hospital. (United States)

    Boehringer, Peter A; Rylander, Jeanette; Dizon, Dominic T; Peterson, Michael W


    Physicians' illegible handwriting is a notorious contributing factor to medical errors. Furthermore, an illegible signature or failure to print prescribers' name interferes with the ability of staff to clarify orders. We surveyed support medical staff at a teaching hospital before and 2 months after providing all internal medicine department residents a self-inking stamp with their name and pager number. Responses were received from 51% at the first and 36% at the second survey of 401 eligible staff. Responses to questions regarding illegible or absent signature, illegible or absent pager number, and failure to print prescribers' name showed a significant improvement (P writing process. This kind of signature allows clarification of orders in a timely fashion.

  18. Acceptance of hospital diets and nutritional status among inpatients with cancer. (United States)

    Ferreira, Daiane; Guimarães, Tessa Gomes; Marcadenti, Aline


    To verify acceptance of hospital diets as to the nutritional status among patients admitted to the Oncology/Hematology Unit of a tertiary care hospital. A cross-sectional study conducted among 100 patients, aged ≥ 18 years, of both genders. Body mass index and subjective global nutritional evaluation by patients were used to detect the nutritional status. The rest-ingestion index was used to evaluate diet acceptance, and the reasons for non-acceptance were identified by means of a questionnaire. Data were expressed in means and standard deviation, or medians and percentages. Comparisons were made using the Student's t test, Wilcoxon Mann-Whitney test, and Pearson's χ² test. A total of 59% of patients were males, and mean age was 51.6±13.5 years. According to the global subjective nutritional evaluation done by the patients themselves, 33% of the participants were considered malnourished and the body mass index detected 6.3% of malnutrition. The main symptoms reported were lack of appetite, xerostomia (dry mouth), constipation, dysgeusia, odor-related nausea, and early satiety. The rest-ingestion index was approximately 37% and significantly greater among the malnourished relative to the well-nourished (58.8 versus 46.4%; p=0.04). The primary reasons reported for non-acceptance of the diet offered were lack of flavor, monotonous preparations, large quantities offered, lack of appetite, and inappropriate temperature of the meal. A high the rest-ingestion index was seen among the patients with cancer, especially those who were malnourished according to the global nutritional evaluation produced by the patient.

  19. Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital? (United States)

    Fazal, Muhammad W; Andrews, Jane M; Thomas, Josephine; Saffouri, Eliana


    Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long-term morbidity and allows for prompt iron repletion, avoiding ID anaemia (IDA) and the need for blood transfusion. To evaluate the management of ID in two internal medicine units (general medical (GM) and gastroenterology (GE)) in a large metropolitan hospital and compare it to international guidelines. All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities. Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM (P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient. There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia. © 2017 Royal Australasian College of Physicians.

  20. Quality of inpatient pediatric case management for four leading causes of child mortality at six government-run Ugandan hospitals.

    Directory of Open Access Journals (Sweden)

    David Sears

    Full Text Available A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.Appropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality

  1. Inpatient Obstetric Care at Irwin Army Community Hospital: A Study to Determine the Most Efficient Organization (United States)


    Reese’s new birthing suites may curb maternity malpractice suits. Modern Healthcare, 16 (11), 48. Clark, L., & Stewart, R. (1982). Nurse-midwifery...Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law , no person shall be...US Army Medical Department Center and School Bldg 2841 MCCS-HRA (US Army-Baylor Program in HCA) 3151 Scott Road, Suite 1412 Fort Sam Houston, TX 78234

  2. Comparison of Corporate Image a nd Patient Loyalty Perceptions of Outpatients and Inpatients: Example of a Training and Research Hospital in Ankara

    Directory of Open Access Journals (Sweden)

    Ömer Rıfkı Önder


    Full Text Available The purpose of this study is to determine the level of corporate image and patient loyalty of outpatients and inpatients who get services from a hospital and to evaluate the relationship between corporate images’ factors and patient loyalty. Totally 600 patients from a training and research hospitals in Ankara, formed the study sample. As a result, outpatients’ loyalty and image perceptions found medium level; while inpatients’ level found high. In addition, the effect of corporate image factors on patient loyalty was determined that there is a statistically significant , strong and positive correlation and 83% of patient loyalty is explained by corporate image factors. Based on the research findings, making improvements especially in quality and also physical, communication, social responsibility factors can obtain loyal patients. It is suggested to adopt different strategies to outpatients and inpatients while implementing these improvements.

  3. 42 CFR 412.71 - Determination of base-year inpatient operating costs. (United States)


    ... education costs as described in § 413.85 of this chapter. (2) Capital-related costs as described in § 413... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES...

  4. A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy

    NARCIS (Netherlands)

    Thunnissen, M.; Duivenvoorden, H.; Busschbach, J.; Hakkaart-van Roijen, L.; van Tilburg, W.; Verheul, R.; Trijsburg, W.


    Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight

  5. A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy

    NARCIS (Netherlands)

    M. Thunnissenl (Moniek); H.J. Duivenvoorden (Hugo); J.J. van Busschbach (Jan); L. van Hakkaart-van Roijen (Leona); W. van Tilburg (Willem); R. Verheul (Roel); W. Trijsburg (Wim)


    textabstractAlthough several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred

  6. Development of a hospital-based care coordination program for children with special health care needs. (United States)

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten


    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  7. Physician perspectives on collaborative working relationships with team-based hospital pharmacists in the inpatient medicine setting. (United States)

    Makowsky, Mark J; Madill, Helen M; Schindel, Theresa J; Tsuyuki, Ross T


    Collaborative care between physicians and pharmacists has the potential to improve the process of care and patient outcomes. Our objective was to determine whether team-based pharmacist care was associated with higher physician-rated collaborative working relationship scores than usual ward-based pharmacist care at the end of the COLLABORATE study, a 1 year, multicentre, controlled clinical trial, which associated pharmacist intervention with improved medication use and reduced hospital readmission rates. We conducted a cross-sectional survey of all team-based and usual care physicians (attending physicians and medical residents) who worked on the participating clinical teaching unit or primary healthcare teams during the study period. They were invited to complete an online version of the validated Physician-Pharmacist Collaboration Index (PPCI) survey at the end of the study. The main endpoint of interest was the mean total PPCI score. Only three (response rate 2%) of the usual care physicians responded and this prevented us from conducting pre-specified comparisons. A total of 23 team-based physicians completed the survey (36%) and reported a mean total PPCI score of 81.6 ± 8.6 out of a total of 92. Mean domain scores were highest for relationship initiation (14.0 ± 1.4 out of 15), and trustworthiness (38.9 ± 3.7 out of 42), followed by role specification (28.7 ± 4.3 out of 35). Pharmacists who are pursuing collaborative practice in inpatient settings may find the PPCI to be a meaningful tool to gauge the extent of collaborative working relationships with physician team members. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  8. 76 FR 26489 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program (United States)


    ... also be aligned with best practices among other payers and the needs of the end users of the measures... have been subsequently shown to not represent the best clinical practice. We interpreted this provision... of measures, including clinical process of care measures, risk adjusted outcome measures, the HCAHPS...

  9. [Screening of the risk of functional decline performed by an inpatient geriatric consultation team in a general hospital]. (United States)

    Benoît, F; Bertiaux, M; Schouterden, R; Huard, E; Segers, K; Decorte, L; Robberecht, J; Simonetti, C; Surquin, M


    The Mobile Geriatric Team (MGT) is part of the Geriatric Care Program and aims to provide interdisciplinary geriatric expertise to other professionals for old patients hospitalized outside geriatric department. Our hospital has a MGT since 2008. Our objective is to retrospectively describe the population of patients of 75 years and older hospitalized outside the geriatric ward and screened for the risk of functional decline by the MGT between 1 October 2009 and 30 September 2011. We recorded the risk of functional decline, as indicated by the Identification of Senior At Risk score (ISAR) performed within 48 h after admission, place of living, discharge destination, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores. In two years, 1.568 patients > or = 75 Y were screened with the ISAR score (mean age 82.5 Y, 60.7% of women). We identified 833 patients with a high-risk of functional decline (ISAR > or = 3). The majority of high-risk subjects (78%) were living at home before hospitalization and 58.7% returned home after discharge. Depression and cognitive impairment were identified among respectively 41% and 59% of high-risk subjects. Only 128 patients were admitted for fall. Most of the faller patients were living at home prior hospitalization and had an ISAR score > or = 3. The MGT allowed identifying many patients > or = 75 Y living at home and presenting with high-risk of functional decline and geriatric syndromes, confirming that good screening procedures are necessary to optimize management of hospitalized olders. Most of faller patients have an ISAR score > or = 3 and should benefit a comprehensive geriatric assessment.

  10. Limited Documentation and Treatment Quality of Glycemic Inpatient Care in Relation to Structural Deficits of Heterogeneous Insulin Charts at a Large University Hospital. (United States)

    Kopanz, Julia; Lichtenegger, Katharina M; Sendlhofer, Gerald; Semlitsch, Barbara; Cuder, Gerald; Pak, Andreas; Pieber, Thomas R; Tax, Christa; Brunner, Gernot; Plank, Johannes


    Insulin charts represent a key component in the inpatient glycemic management process. The aim was to evaluate the quality of structure, documentation, and treatment of diabetic inpatient care to design a new standardized insulin chart for a large university hospital setting. Historically grown blank insulin charts in use at 39 general wards were collected and evaluated for quality structure features. Documentation and treatment quality were evaluated in a consecutive snapshot audit of filled-in charts. The primary end point was the percentage of charts with any medication error. Overall, 20 different blank insulin charts with variable designs and significant structural deficits were identified. A medication error occurred in 55% of the 102 audited filled-in insulin charts, consisting of prescription and management errors in 48% and 16%, respectively. Charts of insulin-treated patients had more medication errors relative to patients treated with oral medication (P international standards, a new insulin chart was developed to overcome these quality hurdles.

  11. Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) (United States)

    McCurdy, BR


    Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients with Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: For more information on the economic analysis, please visit the PATH website: The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: Objective The objective of this analysis was to compare hospital-at-home care with inpatient hospital care for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) who present to the emergency department (ED). Clinical Need: Condition and Target Population Acute Exacerbations of Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease is a disease

  12. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study. (United States)

    Spruit, Martijn A; Janssen, Paul P; Willemsen, Sonja C P; Hochstenbag, Monique M H; Wouters, Emiel F M


    Although lung cancer is a highly prevalent type of cancer, the effects of an inpatient multidisciplinary rehabilitation program on pulmonary function and exercise capacity have never been studied in these patients. Pulmonary function, 6-min walking distance and peak exercise capacity of 10 patients with a severely impaired pulmonary function following treatment of lung cancer were assessed in this pilot study before and after an 8-week inpatient multidisciplinary rehabilitation program. At baseline, patients had a restrictive pulmonary function and an apparent exercise intolerance (median 6-min walking distance: 63.6% predicted; median peak cycling load: 58.5% predicted). Despite the lack of change in median pulmonary function [FEV1: -0.01L, p = 0.5469], functional exercise capacity [145 m; 43.2% of the initial values, p=0.0020] and peak exercise capacity [26 W; 34.4% of the initial values, p = 0.0078] improved significantly compared to baseline. Future trials have to corroborate the present findings. Nevertheless, patients with lung cancer have a clear indication to start a comprehensive rehabilitation program following intensive treatment of their disease. In fact, based on the results of the present pilot study it appears that these patients are good candidates for pulmonary rehabilitation programs.

  13. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program. (United States)

    Müller, Carsten; Krauth, Konstantin A; Gerß, Joachim; Rosenbaum, Dieter


    Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models. Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p cancer patients.

  14. Eventos adversos a antibióticos em pacientes internados em um hospital universitário Adverse events to antibiotics in inpatients of a university hospital

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    Estela Louro


    Full Text Available OBJETIVO: Antibióticos são os medicamentos que mais causam eventos adversos, gerando problemas aos pacientes e custos adicionais ao sistema de saúde. Assim, objetivou-se analisar a ocorrência de eventos adversos a antibióticos em pacientes internados em um hospital. MÉTODOS: Realizou-se monitoramento intensivo do uso de antibióticos em pacientes adultos internados no município de Maringá, Paraná, de setembro de 2002 a fevereiro de 2003. Foram pesquisadas variáveis relativas aos medicamentos em uso, em particular aos antibióticos e aos eventos adversos. Com base em critérios para a avaliação do uso correto dos antibióticos, os eventos observados foram classificados como reações adversas, erros de medicação e "quase erros". Para relação de causalidade entre a administração do fármaco e o surgimento dos eventos utilizou-se o algoritmo de Naranjo. RESULTADOS: Foram acompanhados 87 pacientes e identificados 91 eventos adversos, sendo três deles (3,3% reações adversas a medicamentos, sete (7,7% erros de medicação, e 81 (89,0% "quase erros". As reações a medicamentos ocorreram devido ao uso de quinolonas e foram consideradas "prováveis" utilizando-se o algoritmo de Naranjo. Os sete erros de medicação ocorreram devido a quatro prescrições incorretas de dose e três interações medicamentosas. CONCLUSÕES: Os resultados sugerem que a falta de conhecimento do medicamento ou a falta de informação sobre o paciente no momento da prescrição tenham sido os principais fatores envolvidos na ocorrência das reações a medicamentos.OBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS: An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern

  15. Clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care. (United States)

    Olanipekun, Titilope O; Salemi, Jason L; Mejia de Grubb, Maria C; Gonzalez, Sandra J; Zoorob, Roger J


    Type 2 diabetes mellitus (T2DM) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. Not much is known about the impact of Clostridium difficile infection (CDI) on health outcomes in hospitalized patients with T2DM. We estimated the prevalence and temporal trends of CDI; evaluated the associations between CDI and in-hospital mortality, length of stay (LOS), and the costs of inpatient care; and compared the impact of CDI with that of other infections commonly seen in patients with T2DM. We conducted a cross-sectional analysis using data from the Nationwide Inpatient Sample among patients ⩾18years with T2DM and generalized linear regression was used to analyze associations and jointpoint regression for trends. The prevalence of CDI was 6.8 per 1000 hospital discharges. Patients with T2DM and CDI had increased odds of in-hospital mortality (OR, 3.63; 95% CI 3.16, 4.17). The adjusted mean LOS was higher in patients with CDI than without CDI (11.9 vs. 4.7days). That translated to average hospital costs of $23,000 and $9100 for patients with and without CDI, respectively. The adjusted risk of mortality in patients who had CDI alone (OR 3.75; 95% CI 3.18, 4.41) was similar to patients who had CDI in addition to other common infections (OR 3.25; 95% CI 2.58, 4.10). CDI is independently associated with poorer health outcomes in patients with T2DM. We recommend close surveillance for CDI in hospitalized patients and further studies to determine the cost effectiveness of screening for CDI among patients with T2DM. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Quality of Recovery, Postdischarge Hospital Utilization, and 2-Year Functional Outcomes After an Outpatient Total Knee Arthroplasty Program. (United States)

    Gauthier-Kwan, Olivier Y; Dobransky, Johanna S; Dervin, Geoffrey F


    Outpatient total knee arthroplasty (TKA) has been made possible with advances in perioperative care and standardized clinical inpatient pathways. While many studies report on benefits of outpatient programs, none explore patient-reported outcome measures. As such, our goals were to compare the short-term quality of recovery; highlight postdischarge hospital resources utilization; and report on 2-year functional outcomes scores. This was a prospective comparative cohort study of 43 inpatients (43 TKAs) and 43 outpatients (43 TKAs) operated on by a single surgeon between September 28, 2010 and May 5, 2015. All patients were given a diary to complete at 1, 3, 7, 14, and 28 days postoperatively; we collected 90-day complications, readmissions, and emergency department visits; Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index scores were completed preoperatively and 2 years postoperatively. SPSS (IBM, version 22.0) was used for all statistical analyses. Quality of recovery (QoR-9) was similar in the outpatient TKA group compared with the inpatient group. No statistically significant differences were observed for Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index subscores (P > .05). There was 1 readmission in both outpatient and inpatient groups. Six inpatients and 8 outpatients returned to the emergency department for any reason within 90 days, with no statistical significance observed between the 2 groups (P = .771). Outpatient TKA in selected patients produced similar short-term and 2-year patient-reported outcome measures and a comparable 90-day postdischarge hospital resource utilization when compared to an inpatient cohort, supporting further investigation into outpatient TKA. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients. (United States)

    Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas


    Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the

  18. [Physical medicine in hospital. Minimum standards in a physical medical department in acute inpatient areas in rheumatology]. (United States)

    Reißhauer, A; Liebl, M E


    Standards for what should be available in terms of equipment and services in a department of physical medicine caring for acute inpatients do not exist in Germany. The profile of a department determines the therapeutic services it focuses on and hence the technical facilities required. The German catalogue of operations and procedures defines minimum thresholds for treatment. In the opinion of the authors a department caring for inpatients with acute rheumatic diseases must, as a minimum, have the facilities and equipment necessary for offering thermotherapeutic treatment. Staff trained in physical therapeutic procedures and occupational therapy is also crucial. Moreover, it is desirable that the staff should be trained in manual therapy.

  19. Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China [version 1; referees: 2 approved

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    Nan Zhang


    Full Text Available Background: In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices.   Objective: To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China.   Methods: A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes.   Results: Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81 and insulin therapy (RRR=1.94, 95% CI=1.29-2.91 compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61 and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67 than lifestyle management

  20. Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. (United States)

    Wichrowski, Matthew; Whiteson, Jonathan; Haas, François; Mola, Ana; Rey, Mariano J


    To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.

  1. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study. (United States)

    Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W


    Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials. (United States)

    Shih, Sophy T F; Carter, Rob; Heward, Sue; Sinclair, Craig


    While skin cancer is still the most common cancer in Australia, important information gaps remain. This paper addresses two gaps: i) the cost impact on public hospitals; and ii) an up-to-date assessment of economic credentials for prevention. A prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using State service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Combining inpatient and outpatient costs, total annual costs for Victoria were $48 million to $56 million. The SunSmart program is estimated to have prevented more than 43,000 skin cancers between 1988 and 2010, a net cost saving of $92 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). At about $50 million per year for hospitals in Victoria alone, the cost burden of a largely preventable disease is substantial. Skin cancer prevention remains highly cost-effective, yet underfunded. Implications for public health: Increased funding for skin cancer prevention must be kept high on the public health agenda. Hospitals would also benefit from being able to redirect resources to non-preventable conditions. © 2017 The Authors.

  3. Referral patterns and service utilization in a pediatric hospital-wide intimate partner violence program. (United States)

    Cruz, Mario; Cruz, Patricia B; Weirich, Christine; McGorty, Ryan; McColgan, Maria D


    To describe the referral patterns and utilization of on-site intimate partner violence (IPV) services in both inpatient and outpatient settings at a large urban children's hospital. Retrospective review of case records from IPV victims referred to an on-site IPV counselor between September 2005 and February 2010. Descriptive statistics were used to examine IPV victim demographics, number of referrals per hospital department, referral source (type of staff member), time spent by IPV counselor for initial consultation, and services provided to IPV victims. A total of 453 unique referrals were made to the IPV counselor: 81% were identified by universal screening and 19% by risk-based screening. Thirty-six percent of IPV victims were referred from primary care clinics; 26% from inpatient units; 13% from outpatient subspecialty clinics; 12.5% from the emergency department; 5% from the Child Protection Program; and 4% were employee self-referrals. Social workers generated the most referrals (55%), followed by attending physicians (17%), residents (13%), nurses (7%), and other individuals (self-referrals) (4%). The median initial IPV intervention required 42 minutes. Supportive counseling and safety planning were the services most often utilized by IPV victims. IPV screening can be successfully integrated in both inpatient and outpatient settings by a multidisciplinary group of hospital staff. Most referrals were generated by universal screening outside of the primary care setting. IPV victims generally desired supportive counseling and safety planning over immediate housing relocation. Many IPV screening opportunities were missed by using verbal screening alone. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Improving the management of diabetes in hospitalized patients: the results of a computer-based house staff training program. (United States)

    Vaidya, Anand; Hurwitz, Shelley; Yialamas, Maria; Min, Le; Garg, Rajesh


    Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital. We implemented a computer-based training program on inpatient diabetes for internal medicine house staff at the Brigham and Women's Hospital (Boston, MA) in September 2009. House staff were required to complete the program and answer a set of questions, before and after the program, to evaluate their level of comfort and knowledge of inpatient diabetes. Chart reviews of all non-critically ill patients with diabetes managed by house staff in August 2009 (before the program) and December 2009 (after the program) were performed. Chart reviews were also performed for August 2008 and December 2008 to compare house staff management practices when the computer-based educational program was not available. A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (Pstaff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P=0.06) and decreased use of sliding-scale insulin (P=0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P>0.90). Overall, house staff evaluated the training program as "very relevant" and the technology interface as "good." A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.

  5. Study of the inpatient admission unit condition in the educational hospitals of Lorestan univercity of medical sciences in 2009

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    mahnaz Samadbeik


    Conclusion: The condition of the investigated admission departments was evaluated as average. To improve admission process, some solutions should be taken into consideration including: preparing and supplying special strategies of inpatient admission department, employing professional and interested staff, holding postgraduation courses, ideal allotting of resources and space, regular evaluation of the admission department function and implementing process improvement procedures.

  6. A MiniReview of the Use of Hospital-based Databases in Observational Inpatient Studies of Drugs

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Cars, Thomas; Hallas, Jesper


    inpatient databases in Asia, the United States and Europe were found. Most databases were automatically collected from claims data or generated from electronic medical records. The contents of the databases varied as well as the potential for linkage with other data sources such as laboratory and outpatient...

  7. [Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease]. (United States)

    Lee, Chang Kwan


    The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

  8. Examining quality improvement programs: the case of Minnesota hospitals. (United States)

    Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M


    To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. DATA COLLECTION/DATA EXTRACTION: Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings. The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.

  9. Suicide risk among inpatients at a university general hospital Risco de suicídio em pacientes internados em um hospital geral universitário

    Directory of Open Access Journals (Sweden)

    Marianne Herrera Falceti Ferreira


    Full Text Available OBJECTIVE: To estimate the proportion of inpatients at a university general hospital who are at risk of committing suicide. METHOD: A random sample of 253 patients (57% males aged 18 years old or older, admitted to surgical and clinical wards, was assessed using the the Mini International Neuropsychiatric Interview, which has a section that evaluates the risk for suicide. Uni- and multivariate analyses were performed. RESULTS: There were 58 (23% patients with a risk for suicide, 13 (5% of total of whom presented a high risk. The prevalence of suicide risk was greater in young adult patients, those with no matrimonial relationship and those diagnosed with major depression (univariate analysis, Chi-squared test; p = 0.01, 0.03 and 0.0001, respectively. The multivariate analysis revealed that the risk for suicide in individuals younger than 30 years old was two fold higher than in those individuals between the ages of 30 and 59 years (OR = 0.45, 95% CI = 0.22-0.93; p = 0.03 and four fold greater than in those who were 60 years old or older (OR = 0.25, 95% CI = 0.1-0.64; p = 0.004. CONCLUSION: When young adults are admitted to general hospitals they should receive special attention due to their suicidal potential.OBJETIVO: Estimar a proporção de pacientes internados em um hospital geral universitário que têm risco de suicídio. MÉTODO: Uma amostra aleatória de 253 pacientes (57% do sexo masculino com 18 anos ou mais, internados em enfermarias clínicas e cirúrgicas, foi avaliada por meio do Mini International Neuropsychiatric Interview, o qual possui uma seção que avalia risco de suicídio. Foram realizadas analises uni e multivariadas. RESULTADOS: Cinqüenta e oito (23% pacientes tinham risco de suicídio, 13 dos quais (5% do total risco elevado. A prevalência de risco de suicídio foi maior em adultos jovens, nos que não tinham vínculo matrimonial e nos que tiveram um diagnóstico de depressão maior (análise univariada, teste do Qui

  10. Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals. (United States)

    O'Neill, Liam; Dexter, Franklin; Park, Sae-Hwan; Epstein, Richard H


    Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10-20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases. Observational study. State of Texas hospital discharge abstract data for 1st quarter of 2016, 4th quarter of 2015, 1st quarter of 2015, and 4th quarter of 2014. Discharged from an acute care hospital in Texas with at least 1 major therapeutic ("operative") procedure. Counts of discharges for each procedure or combination of procedures, classified by ICD-10-PCS or ICD-9-CM. At the average hospital, most surgical discharges were for procedures performed at most once a month at the hospital (54%, 95% confidence interval [CI] 51% to 55%). At the average hospital, approximately 90% of procedures were performed at most once a month at the hospital (93%, CI 93% to 94%). The percentages were insensitive to the quarter of the year. The percentages were 3% to 6% greater with ICD-10-PCS than for the superseded ICD 9 CM. There are many different procedure codes, and many different combinations of codes, relative to the number of different hospital discharges. Since most procedures at most hospitals are performed no more than once a month, activity-based cost accounting with a sample size sufficient to be useful is impractical for the vast majority of procedures, in contrast to analysis by surgeon and/or subspecialty. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD. (United States)

    Silver, Patty C; Kollef, Marin H; Clinkscale, Darnetta; Watts, Peggy; Kidder, Robin; Eads, Brittany; Bennett, Debbie; Lora, Carolyn; Quartaro, Michael


    Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99). Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. ( registration NCT01543217.). Copyright © 2017 by Daedalus Enterprises.

  12. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

    Directory of Open Access Journals (Sweden)

    Ann Versporten, MPH


    Full Text Available Summary: Background: The Global Point Prevalence Survey (Global-PPS established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals, and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to. We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4% received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3% were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial

  13. Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

    Directory of Open Access Journals (Sweden)



    Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.


    Directory of Open Access Journals (Sweden)

    Muh. Ryman Napirah


    Full Text Available Aim: In order to determine the fares of surgery, there are two types of fares used by hospitals namely Indonesian Case Based Groups fare (INA-CBG s and Governor Regulation fare. This study aimed to identify and analyze both types of fares in orthopedic surgery, general, eyes, midwifery, mouth, ENT, urology at inpatient room of Undata Regional Public Hospital in Palu during year 2014. Method: This was a quantitative study with descriptive approach with 46 cases as the number of surgery. Data were collected through observation and analysis of secondary data were gotten from medical record, pharmaceutical installation of IBS/IDR, inpatient therapy room (Matahari, Aster, and Teratai pavilions and cashier of inpatient room in form of cost details and patient data from January to December 2014. Data Presentation was formed on tables, where the existing fares are grouped based on the component of each cost then summed and calculated the deviation between the two types of fares. Results: This study indicated that orthopedic surgery with deviation of Rp 11.311.365, general surgery with deviation of Rp 6.438.409, eyes surgery with deviation of Rp 45.173.741, midwifery surgery with deviation of Rp 6.645.765, oral surgery with deviation of Rp 6.105.659, and urological surgery with deviation of Rp. 3.809.959. Conclusion: It can be concluded that INA-CBG's fares are higher than Governor Regulation fares except orthopedic surgery, where the Governor Regulation faresare higher than INA-CBG’s fares.

  15. Hospital-Acquired Condition Reduction Program (United States)

    U.S. Department of Health & Human Services — In October 2014, CMS began reducing Medicare payments for subsection (d) hospitals that rank in the worst performing quartile with respect to hospital-acquired...

  16. Unintentional carbon monoxide poisoning hospitalization and emergency department counts and rates by county, year, and fire-relatedness among California residents,2000-2007 (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of unintentional carbon monoxide poisoning (CO) inpatient hospitalizations and emergency...

  17. The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation (United States)

    Doran, Tim; Cookson, Richard


    Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. Conclusions Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples’ entire lifetimes, despite increased costs due to longer life expectancies. PMID:27189975

  18. 78 FR 61191 - Medicare Program; FY 2014 Inpatient Prospective Payment Systems: Changes to Certain Cost... (United States)


    ... calculated by the our Office of the Actuary, to determine both the aggregate amount of empirically justified... Office of the Actuary used the March 2013 update of the Medicare Hospital Cost Report Information System..., as these hospitals do not receive a Medicare DSH payment. The CMS Office of the Actuary's final...

  19. Thrombolytic utilization for ischemic stroke in US hospitals with neurology residency program. (United States)

    Moradiya, Yogesh; Crystal, Howard; Valsamis, Helen; Levine, Steven R


    We aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals. A retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education-accredited NR program-affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment. A total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44-1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73-1.91 [NR vs NT]). Acute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.

  20. 29 CFR 825.114 - Inpatient care. (United States)


    ... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  1. Inpatient management of borderline personality disorder at Helen ...

    African Journals Online (AJOL)

    Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg. ... South African Journal of Psychiatry ... to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over ...

  2. Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals. (United States)

    Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B


    To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

  3. Risk factors of falls in inpatients and their practical use in identifying high-risk persons at admission: Fukushima Medical University Hospital cohort study. (United States)

    Hayakawa, Takehito; Hashimoto, Shigeatsu; Kanda, Hideyuki; Hirano, Noriko; Kurihara, Yumi; Kawashima, Takako; Fukushima, Tetsuhito


    To clarify the risk factors for falls in hospital settings and to propose the use of such factors to identify high-risk persons at admission. Prospective cohort study. Fukushima Medical University Hospital, Japan, from August 2008 and September 2009. 9957 adult consecutive inpatients admitted to our hospital. Information was collected at admission from clinical records obtained from a structured questionnaire conducted in face-to-face interviews with subjects by nurses and doctors and fall events were collected from clinical records. The proportion of patients who fell during follow-up was 2.5% and the incidence of falls was 3.28 per 100 person-days. There were significant differences in age, history of falling, cognitive dysfunction, planned surgery, wheelchair use, need for help to move, use of a remote caring system, rehabilitation, use of laxative, hypnotic or psychotropic medications and need for help with activities of daily living (ADL) between patients who did and did not fall. Multivariable adjusted ORs for falls showed that age, history of falls and need for help with ADL were common risk factors in both men and women. Using psychotropic medication also increased the risk of falling in men while cognitive dysfunction and use of hypnotic medication increased the risk of falling in women. Planned surgery was associated with a low risk of falls in women. To prevent falls in inpatients it is important to identify high-risk persons. Age, history of falling and the need for help with ADL are the most important pieces of information to be obtained at admission. Care plans for patients including fall prevention should be clear and considered.

  4. Performance of a Modern Glucose Meter in ICU and General Hospital Inpatients: 3 Years of Real-World Paired Meter and Central Laboratory Results. (United States)

    Zhang, Ray; Isakow, Warren; Kollef, Marin H; Scott, Mitchell G


    Due to accuracy concerns, the Food and Drug Administration issued guidances to manufacturers that resulted in Center for Medicare and Medicaid Services stating that the use of meters in critically ill patients is "off-label" and constitutes "high complexity" testing. This is causing significant workflow problems in ICUs nationally. We wished to determine whether real-world accuracy of modern glucose meters is worse in ICU patients compared with non-ICU inpatients. We reviewed glucose results over the preceding 3 years, comparing results from paired glucose meter and central laboratory tests performed within 60 minutes of each other in ICU versus non-ICU settings. Seven ICU and 30 non-ICU wards at a 1,300-bed academic hospital in the United States. A total of 14,763 general medicine/surgery inpatients and 20,970 ICU inpatients. None. Compared meter results with near simultaneously performed laboratory results from the same patient by applying the 2016 U.S. Food and Drug Administration accuracy criteria, determining mean absolute relative difference and examining where paired results fell within the Parkes consensus error grid zones. A higher percentage of glucose meter results from ICUs than from non-ICUs passed 2016 Food and Drug Administration accuracy criteria (p meter results with laboratory results. At 1 minute, no meter result from ICUs posed dangerous or significant risk by error grid analysis, whereas at 10 minutes, less than 0.1% of ICU meter results did, which was not statistically different from non-ICU results. Real-world accuracy of modern glucose meters is at least as accurate in the ICU setting as in the non-ICU setting at our institution.

  5. How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data. (United States)

    Pisa, Federica Edith; Palese, Francesca; Romanese, Federico; Barbone, Fabio; Logroscino, Giancarlo; Riedel, Oliver


    Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used. Copyright © 2018 John Wiley & Sons, Ltd.

  6. Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery. (United States)

    Spiroski, Dejan; Andjić, Mojsije; Stojanović, Olivera Ilić; Lazović, Milica; Dikić, Ana Djordjević; Ostojić, Miodrag; Beleslin, Branko; Kostić, Snežana; Zdravković, Marija; Lović, Dragan


    Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57.72 ± 7.61 years, left ventricular ejection fraction 55% ± 5.81%), who participated in a 3-week clinical and 6-month outpatient cardiac rehabilitation program. The Inpatient program consisted of cycling 7 times/week and daily walking for 45 minutes. The outpatient program consisted mainly of walking 5 times/week for 45 minutes and cycling 3 times/week. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute at the start, for 3 weeks, and for 6 months. After 3 weeks of an exercise-based cardiac rehabilitation program, exercise tolerance improved as compared to baseline, as well as peak respiratory exchange ratio. Most importantly, peak VO 2 (16.35 ± 3.83 vs 17.88 ± 4.25 mL/kg/min, respectively, P exercise training in patients with MI treated with CABG surgery is safe and improves functional capacity. © 2017 Wiley Periodicals, Inc.

  7. Dermatology consultations significantly contribute quality to care of hospitalized patients: a prospective study of dermatology inpatient consults at a tertiary care center. (United States)

    Galimberti, Fabrizio; Guren, Lauren; Fernandez, Anthony P; Sood, Apra


    Cutaneous abnormalities are common in hospitalized patients but are frequently missed or misdiagnosed by admitting teams. Inpatient dermatology consultations provide important information to help diagnose and manage these patients. However, few studies have analyzed dermatology inpatient consultations and their effect. We prospectively collected information for 691 consecutive dermatology consultations from November 2013 to November 2014. Patients ranged in age from newborns to 97 years old. The internal medicine service requested the most consultations (45%). Only 6.5% of consultations were requested within 24 hours of appearance of cutaneous findings. Before consultation, 70.3% of patients did not receive treatment for or based on their cutaneous findings. Dermatology consultation resulted in treatment change in 81.9% of patients. The most common diagnoses were drug rash and contact dermatitis. Biopsies confirmed 71.7% of the initial bedside diagnoses by the dermatology consultation team. Common skin diseases were responsible for the majority of dermatology consultations. Most patients were not treated for their cutaneous conditions before the dermatology consultation. Dermatology consultations resulted in treatment changes in the majority of cases. © 2016 The International Society of Dermatology.

  8. ALARM, a life saving training program for inpatient mental health care staff. Tallinn, Estland (27-30 augustus 2014) : Oral presentation European Symposium on Suicide and Suicidal Behaviour

    NARCIS (Netherlands)

    Nienke Kool


    Oral presentation European Symposium on Suicide and Suicidal Behaviour. Titel: ALARM, a life saving training program for inpatient mental health care staff. Tallinn, Estland (27-30 augustus 2014) Introduction Despite precautions, suicide does happen. Sometimes patients are found while attempting

  9. Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia. (United States)

    Katzenellenbogen, Judith M; Miller, Laura J; Somerford, Peter; McEvoy, Suzanne; Bessarab, Dawn


    The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital readmissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes.

  10. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

    Directory of Open Access Journals (Sweden)

    Cynthia Chen

    Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

  11. Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany. (United States)

    Schädlich, Peter K; Kentsch, Michael; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, Eduard


    To estimate, from the hospital perspective in Germany, the cost effectiveness of the low-molecular-weight heparin (LMWH) subcutaneous enoxaparin sodium 40 mg once daily (ENOX) relative to no pharmacological prophylaxis (NPP) and relative to subcutaneous unfractionated heparin (UFH) 5,000 IU three times daily (low-dose UFH [LDUFH]). Each is used in addition to elastic bandages/compression stockings and physiotherapy in the prevention of venous thromboembolic events (VTE) in immobilised acutely ill medical inpatients without impaired renal function or extremes of body weight. The incremental cost-effectiveness ratios (ICERs) of the 'additional cost for ENOX per clinical VTE avoided versus NPP' and 'additional cost for ENOX per episode of major bleeding avoided versus LDUFH' were chosen as target variables. The target variables were quantified using a modelling approach based on the decision-tree technique. Resource use during thromboprophylaxis, diagnosis and treatment of VTEs, episode of major bleeding and secondary pneumonia after pulmonary embolism (PE) was collected from a hospital survey. Costs were exclusively those to hospitals incurred by staff expenses, drugs, devices, disposables, laboratory tests and equipment for diagnostic procedures. These costs were determined by multiplying utilised resource items by the price or tariff of each item as of the first quarter of 2003. Safety and efficacy values of the comparators were taken from the MEDENOX (prophylaxis in MEDical patients with ENOXaparin) and the THE-PRINCE (THromboEmbolism-PRevention IN Cardiac or respiratory disease with Enoxaparin) trials and from a meta-analysis. The evaluation encompassed 8 (6-14) days of thromboprophylaxis plus time to treat VTE and episode of major bleeding in hospital. Point estimates of all model parameters were applied exclusively in the base-case analysis. There were incremental costs of euro 1,106 for ENOX per clinical VTE avoided versus NPP (1 euro approximately equals 1

  12. 76 FR 26431 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate... (United States)


    ... to calculate cost weights for Wages and Salaries, Benefits, and Contract Labor for IPPS hospitals for... information regarding the market basket and labor-related share). Theresa Bean, (410) 786-2287 (for... Equipment q. Miscellaneous Products r. Professional Fees: Labor-Related s. Administrative and Business...

  13. 75 FR 23105 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System Payment-Update for... (United States)


    ...-charge ratio. CAH Critical access hospital. DSM-IV-TR Diagnostic and Statistical Manual of Mental... Revision of the American Psychiatric Association's Diagnostic and Statistical Manual, (DSM-IV-TR). IPF... psychiatric principal diagnosis that is listed in Chapter Five (``Mental Disorders'') of the International...

  14. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system. (United States)


    ... inpatient operating costs and capital-related costs for each discharge only following submission of a..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL... education program, blood clotting factors, anesthesia services furnished by hospital-employed nonphysician...

  15. Surgical inpatient satisfaction: what are the real drivers? (United States)

    Danforth, Rachel M; Pitt, Henry A; Flanagan, Mindy E; Brewster, Benjamin D; Brand, Elizabeth W; Frankel, Richard M


    Inpatient satisfaction is a key element of hospital pay-for-performance programs. Communication and pain management are known to influence results, but additional factors may affect satisfaction scores. We tested the hypothesis that patient factors and outcome parameters not considered previously are clinically important drivers of inpatient satisfaction. Medical records were reviewed for 1,340 surgical patients who returned nationally standardized inpatient satisfaction questionnaires. These patients were managed by 41 surgeons in seven specialties at two academic medical centers. Thirty-two parameters based on the patient, surgeon, outcomes, and survey were measured. Univariate and multivariable analyses were performed. Inpatients rated their overall experience favorably 75.7% of the time. Less-satisfied patients were more likely to be female, younger, less ill, taking outpatient narcotics, and admitted via the emergency department (all P expectations of patients with cancer, and postoperative complications are important and clinically relevant drivers of surgical inpatient satisfaction. Programs to manage expectations of cancer patient expectations and decrease postoperative morbidity should improve surgical inpatient satisfaction. Further efforts to risk-adjust patient satisfaction scores should be undertaken. Copyright © 2014 Mosby, Inc. All rights reserved.

  16. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization? (United States)

    Rasekaba, T M; Williams, E; Hsu-Hage, B


    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  17. A multicomponent approach to identify predictors of hospital outcomes in older in-patients: a multicentre, observational study.

    Directory of Open Access Journals (Sweden)

    Stefanie L De Buyser

    Full Text Available BACKGROUND: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation is important to provide an effective healthcare service. OBJECTIVE: To identify factors related to older patients' clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. DESIGN AND SETTING: The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. SUBJECTS: One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. METHODS: Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. RESULTS: Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7-14 days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of in-hospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. CONCLUSIONS: Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded.

  18. 76 FR 42169 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical... (United States)


    ...) 786-4533, and Jana Lindquist, (410) 786-4533, Partial hospitalization and community mental health... Laboratory Fee Schedule CMHC Community Mental Health Center CMS Centers for Medicare & Medicaid Services CPT... community mental health centers (CMHCs)) and hospital outpatient services that are furnished to inpatients...

  19. The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program. (United States)

    Holmes, George M; Pink, George H; Friedman, Sarah A


    To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

  20. [Mortality of psychiatric patients. A retrospective cohort study of in-patients at the Psychiatric Hospital of Reggio Emilia]. (United States)

    Ballone, E; Contini, G


    The authors report the results of historical cohort study in long-term patients of psychiatric hospitals in Reggio Emilia. The cohort was formed by 790 patients hospitalized before 1978, and has been followed-up until 31/12/'89. The results of the study are: 269 subjects deceased (34%); 117 discharges (14.8%) and 411 (52.1%) still in hospital on 1/1/'90. An excess mortality was observed in the cohort. Mortality appears to be particularly high among young patient and females.

  1. Drug-food interaction counseling programs in teaching hospitals. (United States)

    Wix, A R; Doering, P L; Hatton, R C


    The results of a survey to characterize drug-food interaction counseling programs in teaching hospitals and solicit opinions on these programs from pharmacists and dietitians are reported. A questionnaire was mailed to the pharmacy director and the director of dietary services at teaching hospitals nationwide. The questionnaire contained 33 questions relating to hospital characteristics, drug-food interaction counseling programs, and the standard calling for such programs issued by the Joint Commission on Accreditation of Healthcare Organizations. Of 792 questionnaires mailed, 425 were returned (response rate, 53.7). A majority of the pharmacists and dietitians (51.2%) did not consider their drug-food interaction counseling program to be formal; some had no program. The pharmacy department was involved more in program development than in the daily operation of such programs. The most frequent methods of identifying patients for counseling were using lists of patients' drugs and using physicians' orders. A mean of only five drugs were targeted per program. Slightly over half the respondents rated the Joint Commission standard less effective than other standards in its ability to improve patient care. A majority of teaching hospitals did not have formal drug-food interaction counseling programs. Pharmacists and dietitians did not view these programs as greatly beneficial and did not believe that the Joint Commission has clearly delineated the requirements for meeting its standard.

  2. Estimating the effectiveness of pulmonary rehabilitation for COPD exacerbations: reduction of hospital inpatient days during the following year

    Directory of Open Access Journals (Sweden)

    Katajisto M


    Full Text Available Milla Katajisto,1,2 Tarja Laitinen3 1Clinical Research Unit for Pulmonary Diseases, Division of Pulmonology, Helsinki University Hospital Heart and Lung Center, 2Helsinki University, Helsinki, 3Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, University of Turku, Turku, Finland Aims: To study the short- and long-term results of pulmonary rehabilitation (PR given in the Helsinki University Heart and Lung Center and to understand the hospital resources used to treat severe COPD exacerbations in the city of Helsinki.Materials and methods: Seventy-eight inactive patients with severe COPD were recruited for a PR course; three of them did not finish the course. The course took 6–8 weeks and included 11–16 supervised exercise sessions. Using electronic medical records, we studied all COPD patients with hospital admission in the city of Helsinki in 2014, including COPD diagnosis, criteria for exacerbation, and potential exclusion/inclusion criteria for PR.Results: Seventy-five of the patients finished the PR course and 92% of those patients showed clinically significant improvement. Their hospital days were reduced by 54% when compared to the year before. At 1 year after the course, 53% of the patients reported that they have continued with regular exercise training. In the city of Helsinki, 437 COPD patients were treated in a hospital due to exacerbation during 2014. On the basis of their electronic medical records, 57% of them would be suitable for PR. According to a rough estimate, 10%–20% hospital days could be saved annually if PR was available to all, assuming that the PR results would be as good as those shown here.Conclusions: The study showed that in a real-world setting, PR is efficient when measured by saved hospital days in severe COPD. Half of the patients could be motivated to continue exercising on their own. Keywords: COPD, severe exacerbation, pulmonary rehabilitation, physical inactivity, COPD

  3. Home-based intermediate care program vs hospitalization (United States)

    Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael


    OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

  4. 76 FR 25787 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for... (United States)


    ... comments. Comments received timely will also be available for public inspection, generally beginning... Array Deep Brain Stimulation System 3. MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat...

  5. Hospital financing: calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme. (United States)

    Vogl, Matthias


    The paper analyzes the German inpatient capital costing scheme by assessing its cost module calculation. The costing scheme represents the first separated national calculation of performance-oriented capital cost lump sums per DRG. The three steps in the costing scheme are reviewed and assessed: (1) accrual of capital costs; (2) cost-center and cost category accounting; (3) data processing for capital cost modules. The assessment of each step is based on its level of transparency and efficiency. A comparative view on operating costing and the English costing scheme is given. Advantages of the scheme are low participation hurdles, low calculation effort for G-DRG calculation participants, highly differentiated cost-center/cost category separation, and advanced patient-based resource allocation. The exclusion of relevant capital costs, nontransparent resource allocation, and unclear capital cost modules, limit the managerial relevance and transparency of the capital costing scheme. The scheme generates the technical premises for a change from dual financing by insurances (operating costs) and state (capital costs) to a single financing source. The new capital costing scheme will intensify the discussion on how to solve the current investment backlog in Germany and can assist regulators in other countries with the introduction of accurate capital costing. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Medicare Provider Utilization and Payment Data - Inpatient (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  7. High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

    DEFF Research Database (Denmark)

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan


    to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should......High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact...... be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages....

  8. Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital. (United States)

    Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung


    Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents

  9. 42 CFR 412.20 - Hospital services subject to the prospective payment systems. (United States)


    ... payment systems. 412.20 Section 412.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient...

  10. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. (United States)

    Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark


    Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

  11. Computational tool kit for evaluating air kerma with the purpose of radiation protection of hospital inpatients: proposal of a simple experimental evaluation method

    Energy Technology Data Exchange (ETDEWEB)

    Hoff, Gabriela; Fischer, Andreia Caroline Fischer da Silveira, E-mail: [Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, (Brazil); Andrade, Jose Rodrigo Mendes; Bacelar, Alexandre [Service of Medical Physics and Radioprotection, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS (Brazil)


    Objective: To present a data analysis toolkit that may be utilized with the purpose of radiation protection of hospital inpatients and workers in areas where mobile apparatuses are used. Materials and methods: an Excel Active Sheet was utilized to develop a computational toolkit with exposure measurements to generate a database of shape factors and to calculate the air kerma around hospital beds. The initial database included data collected with three mobile apparatuses. A non-anthropomorphic phantom was utilized and exposure measurements were performed on a (4.2 x 4.2) m{sup 2} mesh-grid at 0.3 m steps. Results: The toolkit calculates the air kerma (associated with patients' radiation exposure and with ambient equivalent dose) under secondary radiation. For distances lower than 60.0 cm, values above the maximum ambient equivalent dose threshold defined for radiation free areas (0.5 mSv/year) were verified. Data collected at 2.1 m have always presented values lower than 12% of that threshold. Conclusion: The toolkit can aid in the radiological protection of patients and workers, provided it is combined with appropriate data collection, since it allows the determination of radiation free areas around beds in rooms where mobile X-ray apparatuses are utilized. (author)

  12. Computational tool kit for evaluating air kerma with the purpose of radiation protection of hospital inpatients: proposal of a simple experimental evaluation method

    International Nuclear Information System (INIS)

    Hoff, Gabriela; Fischer, Andreia Caroline Fischer da Silveira; Andrade, Jose Rodrigo Mendes; Bacelar, Alexandre


    Objective: To present a data analysis toolkit that may be utilized with the purpose of radiation protection of hospital inpatients and workers in areas where mobile apparatuses are used. Materials and methods: an Excel Active Sheet was utilized to develop a computational toolkit with exposure measurements to generate a database of shape factors and to calculate the air kerma around hospital beds. The initial database included data collected with three mobile apparatuses. A non-anthropomorphic phantom was utilized and exposure measurements were performed on a (4.2 x 4.2) m 2 mesh-grid at 0.3 m steps. Results: The toolkit calculates the air kerma (associated with patients' radiation exposure and with ambient equivalent dose) under secondary radiation. For distances lower than 60.0 cm, values above the maximum ambient equivalent dose threshold defined for radiation free areas (0.5 mSv/year) were verified. Data collected at 2.1 m have always presented values lower than 12% of that threshold. Conclusion: The toolkit can aid in the radiological protection of patients and workers, provided it is combined with appropriate data collection, since it allows the determination of radiation free areas around beds in rooms where mobile X-ray apparatuses are utilized. (author)

  13. Health-Related Quality of Life, Anxiety, and Depression in Bariatric Surgery Candidates Compared to Patients from a Psychosomatic Inpatient Hospital. (United States)

    Osterhues, Alexandra; von Lengerke, Thomas; Mall, Julian W; de Zwaan, Martina; Müller, Astrid


    Past research indicated high psychiatric comorbidity and poor health-related quality of life (HRQOL) in patients seeking surgical treatment for obesity. This study investigated if preoperative bariatric surgery patients perceive equally poor HRQOL and increased levels of anxiety and depression as mentally ill patients. The study included four groups: 192 bariatric surgery candidates (PRE, 71% women, BMI 48.35 ± 8.98 kg/m 2 ), 96 psychotherapy inpatients with mental disorders (PSY, 77% women, BMI 27.12 ± 9.17 kg/m 2 ), 103 postoperative bariatric surgery patients (POST, 78% women, BMI 30.38 ± 2.88 kg/m 2 ), and a convenience sample of 96 non-clinical volunteers with pre-obesity or obesity grade 1 (CG, 52% women, BMI 29.22 ± 2.64 kg/m 2 ). HRQOL was measured using the 12-item short form health survey (SF-12), and psychopathology was assessed with the hospital anxiety and depression scale (HADS). The PRE group exhibited the lowest physical HRQOL, and the PSY group the lowest mental HRQOL. The highest mental/physical HRQOL was reported by the POST group and the CG, without significant differences between these two groups. While the PSY group scored higher on HADS-anxiety scale than the PRE group, neither group differed with regards to symptoms of depression. The lowest levels of HADS-depression were found in the POST group and the CG. The present findings suggest that bariatric surgery candidates may suffer from equally high levels of depression as psychotherapy inpatients, but they perceive better mental well-being. Routine mental health evaluation should incorporate assessments for both psychopathology and HRQOL. DRKS00009901.

  14. Comparative evaluation of the drug interaction screening programs MediQ and ID PHARMA CHECK in neurological inpatients. (United States)

    Zorina, Olesya I; Haueis, Patrick; Semmler, Alexander; Marti, Isabelle; Gonzenbach, Roman R; Guzek, Markus; Kullak-Ublick, Gerd A; Weller, Michael; Russmann, Stefan


    The comparative evaluation of clinical decision support software (CDSS) programs regarding their sensitivity and positive predictive value for the identification of clinically relevant drug interactions. In this research, we used a cross-sectional study that identified potential drug interactions using the CDSS MediQ and the ID PHARMA CHECK in 484 neurological inpatients. Interactions were reclassified according to the Zurich Interaction System, a multidimensional classification that incorporates the Operational Classification of Drug Interactions. In 484 patients with 2812 prescriptions, MediQ and ID PHARMA CHECK generated a total of 1759 and 1082 alerts, respectively. MediQ identified 658 unique potentially interacting combinations, 8 classified as "high danger," 164 as "average danger," and 486 as "low danger." ID PHARMA CHECK detected 336 combinations assigned to one or several of 12 risk and management categories. Altogether, both CDSS issued alerts relating to 808 unique potentially interacting combinations. According to the Zurich Interaction System, 6 of these were contraindicated, 25 were provisionally contraindicated, 190 carried a conditional risk, and 587 had a minimal risk of adverse events. The positive predictive value for alerts having at least a conditional risk was 0.24 for MediQ and 0.48 for ID PHARMA CHECK. CDSS showed major differences in the identification and grading of interactions, and many interactions were only identified by one of the two CDSS. For both programs, only a small proportion of all identified interactions appeared clinically relevant, and the selected display of alerts that imply management changes is a key issue in the further development and local setup of such programs. Copyright © 2012 John Wiley & Sons, Ltd.

  15. Employee assistance programs in the hospital industry. (United States)

    Howard, J C; Szczerbacki, D


    The health care literature describes the industry's need for employee assistance programs (EAPs). New research results show the degree to which EAPs are used in the industry and ways to determine their success.

  16. Closing the patient experience chasm: A two-level validation of the Consumer Quality Index Inpatient Hospital Care

    NARCIS (Netherlands)

    Smirnova, A.; Lombarts, K.; Arah, O.A.; Vleuten, C.P.M. van der


    BACKGROUND: Evaluation of patients' health care experiences is central to measuring patient-centred care. However, different instruments tend to be used at the hospital or departmental level but rarely both, leading to a lack of standardization of patient experience measures. OBJECTIVE: To validate

  17. Closing the patient experience chasm: A two-level validation of the Consumer Quality Index Inpatient Hospital Care

    NARCIS (Netherlands)

    Smirnova, Alina; Lombarts, Kiki M. J. M. H.; Arah, Onyebuchi A.; van der Vleuten, Cees P. M.


    BackgroundEvaluation of patients' health care experiences is central to measuring patient-centred care. However, different instruments tend to be used at the hospital or departmental level but rarely both, leading to a lack of standardization of patient experience measures. ObjectiveTo validate the

  18. The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program. (United States)

    Scovil, Carol Y; Flett, Heather M; McMillan, Lan T; Delparte, Jude J; Leber, Diane J; Brown, Jacquie; Burns, Anthony S


    To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Quality improvement. SCI Rehabilitation Center. Inpatients admitted January 2012 to July 2013. Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.

  19. Medication errors in pediatric inpatients

    DEFF Research Database (Denmark)

    Rishoej, Rikke Mie; Almarsdóttir, Anna Birna; Christesen, Henrik Thybo


    The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010–2014. We included reports from public hospitals on pati...... safety in pediatric inpatients.(Table presented.)...

  20. Effect of Inpatient Dobutamine versus Milrinone on Out-of-Hospital Mortality in Patients with Acute Decompensated Heart Failure. (United States)

    King, Jordan B; Shah, Rashmee U; Sainski-Nguyen, Amy; Biskupiak, Joseph; Munger, Mark A; Bress, Adam P


    To determine the effect of dobutamine versus milrinone on out-of-hospital mortality in the treatment of patients with acute decompensated heart failure (ADHF). Propensity score weighted retrospective cohort study with mortality as the primary outcome. An academic health care system. Five hundred adult patients with a prior history of heart failure who survived a hospitalization for ADHF that included treatment with dobutamine or milrinone between January 1, 2006, and April 30, 2014. ADHF events were defined as a hospitalization with receipt of an intravenous loop diuretic or a brain-type natriuretic peptide (BNP) value greater than 400 pg/ml during the hospitalization. Patients were followed until death or 180 days from hospital discharge. Risk ratios (RRs) for mortality associated with dobutamine compared with milrinone were calculated at 15, 30, and 180 days postdischarge using Poisson regression with robust error variance. Mean age was 62.7 years, 65.4% were male, and 48.2% had a mean left ventricular ejection fraction (LVEF) of 40% or lower. Overall, 55 (18%) of dobutamine-treated versus 23 (12%) of milrinone-treated patients died during follow-up (RR 1.27, 95% confidence interval [CI] 0.76-2.13, p=0.360). For death from cardiovascular causes, the RR for dobutamine was 1.49 (95% CI 0.79-2.82, p=0.214). For death from worsening heart failure, the RR for dobutamine was 2.55 (95% CI 1.07-6.10, p=0.035). A trend toward significance was observed at day 15 after discharge for all mortality analyses (all p values milrinone in patients with ADHF. These results replicate and extend prior associations with mortality and should be confirmed in a prospective study. © 2017 Pharmacotherapy Publications, Inc.

  1. Inpatient cognitive behaviour therapy for adolescents with anorexia nervosa: immediate and longer-term effects

    Directory of Open Access Journals (Sweden)

    Riccardo eDalle Grave


    Full Text Available Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based upon enhanced cognitive behaviour therapy (CBT-E. The patients were assessed before and after hospitalization, and six and 12 months later. Results: Twenty-six patients (96% completed the program. In these patients there was a substantial improvement in weight, eating disorder features and general psychopathology that was well maintained at 12-month follow-up. Conclusions: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa.

  2. The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care. (United States)

    Tsopra, Rosy; Peckham, Daniel; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; White, Helen; Jais, Jean-Philippe; Ghosh, Dipansu; Whitaker, Paul; Clifton, Ian J; Wyatt, Jeremy C


    Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p coded from the discharge summary with medical support (70% vs 60% respectively, p coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. [Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital]. (United States)

    Christaras, A; Schaper, J; Strelow, H; Laws, H-J; Göbel, U


    Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. An unchanged population of 349 patients associated with 1,731 inpatient stays of a Clinic of Pediatric Oncology, Hematology, and Immunology in 2004 was analyzed by methods and means of G-DRG systems 2004, 2005, and 2006. DRGs and additional payments for drugs and procedures eligible for all and/or individual hospitals were calculated. G-DRG system 2005 resulted in overall reimbursement loss of 3.77 % compared to G-DRG 2004. G-DRG 2006 leads to slightly improved overall reimbursements compared to G-DRG 2005 by increasing DRG-based revenues. G-DRG 2006 effects 2.40 % reduction in overall reimbursement compared to G-DRG 2004. This loss includes ameliorating effects of additional payments for drugs and blood products already. Despite introduction of additional payments especially designed for children and teenagers in 2006, additional payment volume is decreased by 21.71 % from 2005 to 2006. G-DRG 2006 yields over-all reimbursement losses of 1.45 % in comparison to G-DRG 2004. Overall reimbursements include introduced additional payments for drugs and blood products. (Reimbursements resulting out of DRG payment alone drop by 14.73 % from 2004 to 2005, and increase by 3.26 % from 2005 to 2006 (2004 vs. 2006 11.95 %). Introduction of additional payments for drugs and blood products on a Germany-wide basis introduced in 2005 dampens DRG-based reimbursement losses. Despite introduction of dosage

  4. Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients. (United States)

    Knapen, Jan; Van de Vliet, Peter; Van Coppenolle, Herman; David, Ans; Peuskens, Joseph; Pieters, Guido; Knapen, Koen


    The first objective of this study was to compare the changes in physical self-concept, global self-esteem, depression and anxiety after participation in one of two 16-week psychomotor therapy programs for nonpsychotic psychiatric inpatients. The second objective was to study the relationship between changes in these variables. One hundred and ninety-nine inpatients were randomly assigned to either a personalized psychomotor fitness program, consisting of aerobic exercise and weight training, or a general program of psychomotor therapy, consisting of different forms of physical exercises and relaxation training. Physical self-concept was evaluated using the Dutch version of the Physical Self-Perception Profile at baseline, after 8 weeks, and after completion of the 16-week interventions. At the same time points, additional variables of global self-esteem, depression and anxiety were assessed by means of the Rosenberg Self-Esteem Inventory, the Beck Depression Inventory and the Trait Anxiety Inventory, respectively. After 16 weeks, both groups showed significant improvements in all outcome measures (p values ranged from 0.01 to self-esteem and decreased depression and anxiety levels (p self-esteem, depression and anxiety supports the potential role of the physical self-concept in the recovery process of depressed and anxious psychiatric inpatients. Copyright (c) 2005 S. Karger AG, Basel.

  5. Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin.

    Directory of Open Access Journals (Sweden)

    Arnaud Setondji Amoussouhoui


    Full Text Available Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin.A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients' understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question-answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers.Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their treatment. This

  6. Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment. (United States)

    Pecoraro, Anna; Horton, Terry; Ewen, Edward; Becher, Julie; Wright, Patricia A; Silverman, Basha; McGraw, Patty; Woody, George E


    Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients. Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable). Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1

  7. Posttraumatic stress disorder (PTSD) in the German Armed Forces: a retrospective study in inpatients of a German army hospital


    Bandelow, Borwin; Koch, Manuel; Zimmermann, Peter; Biesold, Karl-Heinz; Wedekind, Dirk; Falkai, Peter


    In 2006 and 2007, around 0.4 and 0.7% of all German soldiers involved in missions abroad were registered as suffering from PTSD. The frequency of PTSD in the German Armed Forces was assessed from army records. All soldiers admitted to the German Military Hospital in Hamburg, Germany, with PTSD (n = 117) in the years 2006 and 2007 were assessed by using questionnaires and structure interviews. Risk factors associated with PTSD were identified. Of the 117 soldiers with PTSD, 39.3% were in missi...

  8. The logistics of an inpatient dermatology service. (United States)

    Rosenbach, Misha


    Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.

  9. Predictors of Readmission after Inpatient Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Umang Jain


    Full Text Available Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020, previous percutaneous coronary intervention (PCI (OR, 2.69; CI, 1.21-5.97; P=0.015, hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001, bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046, American Society of Anesthesiologists (ASA class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004, and obesity (body mass index ≥30 (OR, 1.43; CI, 1.09-1.88, P=0.011 to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

  10. HCUP State Inpatient Databases (SID) - Restricted Access File (United States)

    U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...

  11. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. (United States)

    Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan


    Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

  12. [Multiprofessional inpatient psychotherapy of depression in old age]. (United States)

    Cabanel, N; Kundermann, B; Franz, M; Müller, M J


    Depression is common in old age but is often underdiagnosed and inadequately treated. Although psychotherapy is considered effective for treating elderly patients with depression, it is rarely applied in inpatient settings. Furthermore, treatment on inpatient units specialized for elderly patients and implementation of a psychotherapeutic treatment approach are currently more the exception. From this background, a multiprofessional inpatient behavioral treatment program (MVT) for elderly depressed patients was developed at a specialized unit of a university-affiliated regional psychiatric hospital. The MVT is based on specific and modularized group therapies accompanied by individual therapeutic interventions. While the provision of group therapies (such as psychotherapy, social skills training, relaxation training, euthymic and mindfulness-based methods, exercise and occupational therapy as well as psychoeducational sessions for relatives) is assigned to specific professional groups, a joint multiprofessional treatment planning is of central relevance. First evaluations of different treatment components support the high acceptability of the MVT and highlight that psychotherapeutic inpatient treatment programs for the elderly are feasible. Further research is required to investigate the clinical efficacy of psychotherapy in elderly depressive inpatients.

  13. Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. (United States)

    Tang, Clarice Y; Blackstock, Felicity C; Clarence, Michael; Taylor, Nicholas F


    To determine whether an early rehabilitation program was safe and feasible for patients during an acute exacerbation of chronic obstructive pulmonary disease (COPD). In this phase 1 randomized controlled trial, patients with an acute exacerbation of COPD admitted to the hospital were randomly allocated to a low-intensity exercise group, a moderate- to high-intensity exercise group, or a control group, who received routine physical therapy. In addition to routine physical therapy, patients in the exercise group had to participate in an exercise program. The program consisted of twice-daily aerobic and resistance exercise sessions. Primary outcomes were the number and classification of adverse events and program adherence. In 174 exercise sessions, there was 1 serious adverse event of arrhythmia in the low-intensity exercise group that resolved within 1 hour. There were 12 other minor adverse events involving 5 patients with no significant differences between groups. Patients completed an average of 80% of their scheduled sessions with no significant between-group differences. The exercise groups improved significantly in walking distance; however, no significant between-group differences were observed. There was preliminary evidence that it was safe and feasible to implement an exercise program for patients during an acute exacerbation of COPD. Additional studies with larger sample sizes are required to accurately evaluate program effectiveness.


    Directory of Open Access Journals (Sweden)

    Nurul Hidayah


    Full Text Available Abstract: This study aims to determine the effect of warm water compress therapy on the incidence of hyperemia in 40 patients with phlebitis at the Inpatient Installation of H. Hasan Basry General Hospital Kandangan. Research method used quasi-experimental with two group; control and intervention. The control group was untreated phlebitis, while the intervention group was a phlebitis patient treated with warm water compresses. Data collection was collected by measuring the redness diameter before and after warm compress therapy. The result showed that the mean of intervention group diameter before treatment 49.3 mm and after treatment 40.2 mm. The mean diameter of control group before treatment 48.1 mm and after treatment 46.4 mm. The mean diameter of intervention group was decreased 9.1 mm and 1.7 mm in the control group. Statistically result test show that there was a significant difference of mean hyperemia diameter between intervention and control group (p<0.05. Statistically result test also shows that there was a significant difference of mean hyperemia between pre- and post-treatment with warm water (p<0.05. It was concluded that the warm compress therapy could decreased the incidence of hyperemia in phlebitis patients.

  15. [Pain therapy in in-patients with cancer. Effects of a manual-based approach as guideline for pain-consulting service at a university hospital]. (United States)

    Brinkers, M; Pfau, Gernot; Lux, A; Pfau, Giselher; Schneemilch, C; Meyer, F; Grond, S


    Appropriate medication is an important and substantial part in the therapy of tumor-induced pain. The objective of this study was to investigate the efficiency of anaesthesiology-based consultant service characterizing the quality of this type of treatment in daily clinical practice of a university hospital, i. e., in the patient profile of a tertiary center (study design: systematic clinical, unicenter observational study reflecting clinical practice and study-based control of therapeutic care quality). In the course of consulting function with regard to pain care on the single wards a considerable portion of cancer patients are recieving drugs. For most patients such care comprises several consultations and subsequently initiated treatment modifications. The consulting function ends if the patients feel free of pain or report a substantial improvement. From 1/1/2010 to 12/31/2012 detailed information on the drug therapy applied prior to, during and after the consultation was prospectively documented.This data was retrospectively evaluated as "pre-vs.-post" comparison (Chi-squared test, Fisher's exact test and McNemar's test), in particular, focussing on the quality of pain medication using the WHO index as well as pain intensity obtained by means of the visual analogue scale (VAS). In total, 375 in-patients were treated. The modified pain medication by the anesthesiological consultant service led to a significant increase (p therapy for cancer-related pain. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Financial Performance of Hospitals in the Mississippi Delta Region Under the Hospital Readmissions Reduction Program and Hospital Value-based Purchasing Program. (United States)

    Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick


    Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.

  17. Molecular epidemiology of Staphylococcus aureus strains isolated from inpatients with infected diabetic foot ulcers in an Algerian University Hospital. (United States)

    Djahmi, N; Messad, N; Nedjai, S; Moussaoui, A; Mazouz, D; Richard, J-L; Sotto, A; Lavigne, J-P


    Staphylococcus aureus is the most common pathogen cultured from diabetic foot infection (DFI). The consequence of its spread to soft tissue and bony structures is a major causal factor for lower-limb amputation. The objective of the study was to explore ecological data and epidemiological characteristics of S. aureus strains isolated from DFI in an Algerian hospital setting. Patients were included if they were admitted for DFI in the Department of Diabetology at the Annaba University Hospital from April 2011 to March 2012. Ulcers were classified according to the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification system. All S. aureus isolates were analysed. Using oligonucleotide arrays, S. aureus resistance and virulence genes were determined and each isolate was affiliated to a clonal complex. Among the 128 patients, 277 strains were isolated from 183 samples (1.51 isolate per sample). Aerobic Gram-negative bacilli were the most common isolated organisms (54.9% of all isolates). The study of ecological data highlighted the extremely high rate of multidrug-resistant organisms (MDROs) (58.5% of all isolates). The situation was especially striking for S. aureus [(85.9% were methicillin-resistant S. aureus (MRSA)], Klebsiella pneumonia (83.8%) and Escherichia coli (60%). Among the S. aureus isolates, 82.2% of MRSA belonged to ST239, one of the most worldwide disseminated clones. Ten strains (13.7%) belonged to the European clone PVL+ ST80. ermA, aacA-aphD, aphA, tetM, fosB, sek, seq, lukDE, fnbB, cap8 and agr group 1 genes were significantly associated with MRSA strains (p study shows for the first time the alarming prevalence of MDROs in DFI in Algeria. ©2013 The Authors Clinical Microbiology and Infection ©2013 European Society of Clinical Microbiology and Infectious Diseases.

  18. Effects of inpatient geriatric interventions in a German geriatric hospital: Impact on ADL, mobility and cognitive status. (United States)

    Bordne, S; Schulz, R-J; Zank, S


    Given the demographic changes, the need for effective geriatric intervention is obvious. Geriatric care aims to maintain the highest possible level of independence and quality of life and to reduce the risk of need for care. This study investigated the benefits of geriatric care on functional performance, mobility and cognition. This study involved a retrospective analysis of clinical data from 646 patients. At hospital admission and discharge functional status was assessed using the Barthel index. Mobility was evaluated by means of the Tinetti test and cognition by the mini-mental state examination (MMSE). A follow-up was conducted on 112 patients 2-5 months after hospital discharge. Statistical analysis included t-tests including Cohen's d for effect size and multivariate regression analysis. The mean age of the study population was 81.1 ± 7.1 years including 439 women (68%) and 207 men (32%). There were significant average improvements for activities of daily living (ADL), mobility and cognition comparing discharge and admission scores. For functional and mobility status, effect sizes were medium to high. Regression analyses showed that ADL improvement was predicted by functional, mobile and cognitive status at admission. Follow-up analyses revealed a high percentage of former patients still living at home and an overall maintenance of ADL levels. Geriatric patients seem to experience long-term improvements during geriatric treatment, which appears to fulfill its aim of recovering independence. For a better understanding of relevant factors for the recreation of geriatric patients, further research is needed, e.g. with respect to the impact of the nutritional status.

  19. 42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities. (United States)


    ... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

  20. Vertical integration strategies: revenue effects in hospital and Medicare markets. (United States)

    Cody, M


    The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.

  1. Internal Contamination Program in hospital and biomedical research institutions

    International Nuclear Information System (INIS)

    Tellez de Cepeda, M.; Macias, M.T.; Plaza, R.; Martinez Hidalgo, C.


    Program and the criteria for establishing such program to control the internal contamination from a point of view, not yet systematized and standardized in Hospital and Biomedical Research centers. The main purpose of this work is to review our own situation, to establish and systematize an operative program with variable means (instruments) and the use of external means if need. This program will be established taking into account the new recommendations of I.C.R.P. and the new criteria A.L.I. (author)

  2. [Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care]. (United States)

    Geuss, S; Jungmeister, A; Baumgart, A; Seelos, R; Ockert, S


    In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety. A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality. A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p  0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.

  3. Relative effects of heavy alcohol use and hepatitis C in decompensated chronic liver disease in a hospital inpatient population. (United States)

    Mankal, Pavan Kumar; Abed, Jean; Aristy, Jose David; Munot, Khushboo; Suneja, Upma; Engelson, Ellen S; Kotler, Donald P


    Heavy alcohol use has been hypothesized to accelerate disease progression to end-stage liver disease in patients with hepatitis C virus (HCV) infection. In this study, we estimated the relative influences of heavy alcohol use and HCV in decompensated chronic liver disease (CLD). Retrospectively, 904 patients with cirrhotic disease admitted to our hospitals during January 2010-December 2012 were identified based on ICD9 codes. A thorough chart review captured information on demographics, viral hepatitis status, alcohol use and progression of liver disease (i.e. decompensation). Decompensation was defined as the presence of ascites due to portal hypertension, bleeding esophageal varices, hepatic encephalopathy or hepatorenal syndrome. Heavy alcohol use was defined as a chart entry of greater than six daily units of alcohol or its equivalent. 347 patients were included based on our selection criteria of documented heavy alcohol use (n = 215; 62.0%), hepatitis titers (HCV: n = 182; 52.5%) and radiological evidence of CLD with or without decompensation (decompensation: n = 225; 64.8%). Independent of HCV infection, heavy alcohol use significantly increased the risk of decompensation (OR = 1.75, 95% CI 1.11-2.75, p < 0.02) relative to no heavy alcohol use. No significance was seen with age, sex, race, HIV, viral hepatitis and moderate alcohol use for risk for decompensation. Additionally, dose-relationship regression analysis revealed that heavy, but not moderate alcohol use, resulted in a three-fold increase (p = 0.013) in the risk of decompensation relative to abstinence. While both heavy alcohol use and HCV infection are associated with risk of developing CLD, our data suggest that heavy, but not moderate, alcohol consumption is associated with a greater risk for hepatic decompensation in patients with cirrhosis than does HCV infection.

  4. Phenotypic and molecular detection of the bla KPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil. (United States)

    Ribeiro, Patricia Cristina Saldanha; Monteiro, Andrea Souza; Marques, Sirlei Garcia; Monteiro, Sílvio Gomes; Monteiro-Neto, Valério; Coqueiro, Martina Márcia Melo; Marques, Ana Cláudia Garcia; de Jesus Gomes Turri, Rosimary; Santos, Simone Gonçalves; Bomfim, Maria Rosa Quaresma


    Bacteria that produce Klebsiella pneumoniae carbapenemases (KPCs) are resistant to broad-spectrum β-lactam antibiotics. The objective of this study was to phenotypically and genotypically characterize the antibiotic susceptibility to carbapenems of 297 isolates recovered from clinical samples obtained from inpatients at 16 hospitals in São Luis (Maranhão, Brazil). The study was conducted using phenotypic tests and molecular methods, including polymerase chain reaction (PCR), sequencing and enterobacterial repetitive intergenic consensus (ERIC)-PCR. The nonparametric chi-square test of independence was used to evaluate the associations between the bacterial bla KPC gene and the modified Hodge test, and the chi-square adherence test was used to assess the frequency of carbapenemases and their association with the bla KPC gene. The most frequently isolated species were Acinetobacter baumannii (n = 128; 43.0%), K. pneumoniae (n = 75; 25.2%), and Pseudomonas aeruginosa (n = 42; 14.1%). Susceptibility assays showed that polymixin B was active against 89.3% of the bacterial isolates. The Acinetobacter spp. and K. pneumoniae strains were susceptible to amikacin and tigecycline, and Pseudomonas spp. were sensitive to gentamicin and amikacin. Among the 297 isolates, 100 (33.7%) were positive for the bla KPC gene, including non-fermentative bacteria (A. baumannii) and Enterobacteriaceae species. Among the isolates positive for the bla KPC gene, K. pneumoniae isolates had the highest positivity rate of 60.0%. The bla KPC gene variants detected included KPC-2, which was found in all isolates belonging to species of the Enterobacteriaceae family. KPC-2 and KPC-3 were observed in A. baumannii isolates. Importantly, the bla KPC gene was also detected in three Raoultella isolates and one isolate of the Pantoea genus. ERIC-PCR patterns showed a high level of genetic diversity among the bacterial isolates; it was capable of distinguishing 34 clones among 100 strains

  5. Establishing the effectiveness, cost-effectiveness and student experience of a Simulation-based education Training program On the Prevention of Falls (STOP-Falls) among hospitalised inpatients: a protocol for a randomised controlled trial. (United States)

    Williams, Cylie; Bowles, Kelly-Ann; Kiegaldie, Debra; Maloney, Stephen; Nestel, Debra; Kaplonyi, Jessica; Haines, Terry


    Simulation-based education (SBE) is now commonly used across health professional disciplines to teach a range of skills. The evidence base supporting the effectiveness of this approach for improving patient health outcomes is relatively narrow, focused mainly on the development of procedural skills. However, there are other simulation approaches used to support non-procedure specific skills that are in need of further investigation. This cluster, cross-over randomised controlled trial with a concurrent economic evaluation (cost per fall prevented) trial will evaluate the effectiveness, cost-effectiveness and student experience of health professional students undertaking simulation training for the prevention of falls among hospitalised inpatients. This research will target the students within the established undergraduate student placements of Monash University medicine, nursing and allied health across Peninsula Health acute and subacute inpatient wards. The intervention will train the students in how to provide the Safe Recovery program, the only single intervention approach demonstrated to reduce falls in hospitals. This will involve redevelopment of the Safe Recovery program into a one-to-many participant SBE program, so that groups of students learn the communication skills and falls prevention knowledge necessary for delivery of the program. The primary outcome of this research will be patient falls across participating inpatient wards, with secondary outcomes including student satisfaction with the SBE and knowledge gain, ward-level practice change and cost of acute/rehabilitation care for each patient measured using clinical costing data. The Human Research Ethics Committees of Peninsula Health (LRR/15/PH/11) and Monash University (CF15/3523-2015001384) have approved this research. The participant information and consent forms provide information on privacy, storage of results and dissemination. Registration of this trial has been completed with the

  6. 78 FR 8329 - Federal Housing Administration (FHA): Hospital Mortgage Insurance Program-Refinancing Hospital Loans (United States)


    ... available through other sources, and to eliminate from eligibility hospitals with poor financial performance... terminology, based on experience to date, to facilitate understanding how the Section 242 program works. C... divide other. Additionally, revises certain threshold factors that make an initial determination of a...

  7. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial. (United States)

    Meng, Karin; Musekamp, Gunda; Seekatz, Bettina; Glatz, Johannes; Karger, Gabriele; Kiwus, Ulrich; Knoglinger, Ernst; Schubmann, Rainer; Westphal, Ronja; Faller, Hermann


    Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients' self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. This study evaluates the effectiveness of a

  8. The Hospital at Home program: no place like home. (United States)

    Lippert, M; Semmens, S; Tacey, L; Rent, T; Defoe, K; Bucsis, M; Shykula, T; Crysdale, J; Lewis, V; Strother, D; Lafay-Cousin, L


    The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

  9. Inpatient Consultative Dermatology. (United States)

    Biesbroeck, Lauren K; Shinohara, Michi M


    Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Aynalem Mohammed


    Full Text Available Background. The widespread uses of antibiotics, together with the length of time over which they have been available, have led to the emergence of resistant bacterial pathogens contributing to morbidity and mortality. This study was aimed to assess bacterial isolates and their drug susceptibility patterns from inpatients and outpatients with pus and/or wound discharge. Methods. A cross-sectional study was conducted at the University of Gondar Referral Hospital from March to May, 2014. Wound swab samples were collected from each study participant and inoculated into appropriate media. The bacterial pathogens were identified using standard microbiological methods. Antimicrobial susceptibility tests were performed using disk diffusion technique following Kirby-Bauer method. Results. A total of 137 study subjects were included in the study with bacterial isolation rate of 115 (83.9%. Of all, 81 (59.1% were males. Seventy-seven (57% of the isolates were Gram-negative and 59 (43% were Gram-positive. From the total isolates, Staphylococcus aureus was the most predominant isolate 39/115 (34% followed by Klebsiella species (13%, coagulase negative staphylococci spp. (12% and Pseudomonas aeruginosa. Gram-positive isolates were resistant to ampicillin (86.4%, amoxicillin (83%, penicillin (81.3%, oxacillin (74.6%, and tetracycline (59.4%, while Gram-negative isolates were resistant to amoxicillin (97.4%, ampicillin (94.8%, tetracycline (72.7%, trimethoprim/sulfamethoxazole (66%, and chloramphenicol (54.5%. Conclusion. High prevalence of bacterial isolates was found, Staphylococcus aureus being the most dominant. High rates of multiple drug resistance pathogens to the commonly used antimicrobial agents were isolated. Therefore, concerned bodies should properly monitor the choice of antibiotics to be used as prophylaxis and empiric treatment in the study area.

  11. Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol. (United States)

    Guo, Ping; Dzingina, Mendwas; Firth, Alice M; Davies, Joanna M; Douiri, Abdel; O'Brien, Suzanne M; Pinto, Cathryn; Pask, Sophie; Higginson, Irene J; Eagar, Kathy; Murtagh, Fliss E M


    Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision. Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set. The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public. ISRCTN90752212. © Article author

  12. Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Kathryn Curtis


    Full Text Available Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N=10 admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing, psychological variables (depression, anxiety, and experiences with injustice, mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1 anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18 = 4.74, p<.05, and ηp2 = .35, (2 Self-Compassion Scale-Short Form, F(2,18 = 3.71, p<.05, and ηp2 = .29, and (3 Magnification subscale of the Pain Catastrophizing Scale, F(2,18 = 3. 66, p<.05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.

  13. Validation of a proposal for evaluating hospital infection control programs. (United States)

    Silva, Cristiane Pavanello Rodrigues; Lacerda, Rúbia Aparecida


    To validate the construct and discriminant properties of a hospital infection prevention and control program. The program consisted of four indicators: technical-operational structure; operational prevention and control guidelines; epidemiological surveillance system; and prevention and control activities. These indicators, with previously validated content, were applied to 50 healthcare institutions in the city of São Paulo, Southeastern Brazil, in 2009. Descriptive statistics were used to characterize the hospitals and indicator scores, and Cronbach's α coefficient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certification. The construct validity analysis was based on exploratory factor analysis with a tetrachoric correlation matrix. The indicators for the technical-operational structure and epidemiological surveillance presented almost 100% conformity in the whole sample. The indicators for the operational prevention and control guidelines and the prevention and control activities presented internal consistency ranging from 0.67 to 0.80. The discriminant validity of these indicators indicated higher and statistically significant mean conformity scores among the group of institutions with healthcare certification or accreditation processes. In the construct validation, two dimensions were identified for the operational prevention and control guidelines: recommendations for preventing hospital infection and recommendations for standardizing prophylaxis procedures, with good correlation between the analysis units that formed the guidelines. The same was found for the prevention and control activities: interfaces with treatment units and support units were identified. Validation of the measurement properties of the hospital infection prevention and control program indicators made it possible to develop a tool for evaluating these programs

  14. Neonatal Abstinence Syndrome (NAS): Transitioning Methadone Treated Infants From An Inpatient to an Outpatient Setting (United States)

    Backes, Carl H.; Backes, Carl R.; Gardner, Debra; Nankervis, Craig A.; Giannone, Peter J.; Cordero, Leandro


    Background Each year in the US approximately 50,000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). Objective To compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program. Design/Methods Retrospective review (2007-9). Infants were born to mothers maintained on methadone or buprenorphine in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 pts) was inpatient while the combined group (46 pts) was outpatient. Results Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, GA and the incidence of prematurity (34 & 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25d; p < 0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21d, p<0.01), the cumulative methadone dose was similar (3.6 vs 3.1mg/kg, p 0.42). Follow-up: Information was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ≤ 72 hours from hospital discharge. Breast feeding was more common among infants in the combined group (24 vs. 8% p<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (<37w GA) was the only predictor for hospital readmission for NAS in both groups (p 0.02, OR 5). Average hospital cost for each infant in the combined group was $13,817 less than in the traditional group. Conclusions A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long term benefits of the combined approach on infants and their families. PMID:21852772

  15. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care... (United States)


    ... standardized amount— (i) Is adjusted for the applicable hospital inpatient prospective payment system DRG... applicable hospital inpatient prospective payment system DRG weighting factors; (ii) Is adjusted by the... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...

  16. Evaluation of a Hospital-Based Pneumonia Nurse Navigator Program. (United States)

    Seldon, Lisa E; McDonough, Kelly; Turner, Barbara; Simmons, Leigh Ann


    The aim of this study is to evaluate the effectiveness of a hospital-based pneumonia nurse navigator program. This study used a retrospective, formative evaluation. Data of patients admitted from January 2012 through December 2014 to a large community hospital with a primary or secondary diagnosis of pneumonia, excluding aspiration pneumonia, were used. Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected. Descriptive statistics and parametric testing were used to analyze data. Core measure performance was sustained at the 90th percentile 2 years after the implementation of the navigator program. The ALOS did not decrease to established benchmarks; however, the SD for ALOS decreased by nearly half after implementation of the navigator program, suggesting the program decreased the number and length of extended stays. Charges per case decreased by 21% from 2012 to 2014. Variable costs decreased by 4% over a 2-year period, which increased net profit per case by 5%. Average readmission payments increased by 8% from 2012 to 2014, and the net revenue per case increased by 8.3%. The pneumonia nurse navigator program may improve core measures, reduce ALOS, and increase net revenue. Future evaluations are necessary to substantiate these findings and optimize the cost and quality performance of navigator programs.

  17. [Treatment of eating disorders during hospitalization: presentation of a hospital intensive care program in pediatric age]. (United States)

    D'Argenio, L; Zaccagnino, M; Donati, C; Perini, A; Fazzi, E


    The aim of this study was to present a hospital intensive care program for patients affected by a severe eating disorders, with a significant loss of weight (BMI110 bpm or inability to sustain core body temperature), abnormal laboratory data, especially electrolyte imbalance and refusal to take food and fluids. In our study we reported 2 year follow-up of 16 patients treated with the hospital intensive care program between 2007 and 2008 in our department. The proposed program was proved an efficient method in a critical phase of the alimentary behavior disorders. It was possible for all the patients to avoid alternative feeding techniques (enteral or parenteral) and to obtain a correct alimentation with a satisfactory improvement of clinical conditions. Eight patients (50%) fully recovered. 5 patients (31.25%) had a significant improvement reaching a BMI>18.5 and one of them had a regular menstrual cycle, too. However in this group of patients a strict modality to alimentation and concern about weight and physical appearance remain. In 3 patients (18.5%) the BMI is still low and amenorrhea persists. The hospital intensive care program, inspired by the cognitive-behavioral model, through a food rehabilitation and a psychotherapeutic and psychoeducational help, lets the patients and their family understand and modify the dysfunctional patterns, experimenting a right modality to approach alimentation, with a satisfactory improvement in clinical conditions.

  18. The AAHA Computer Program. American Animal Hospital Association. (United States)

    Albers, J W


    The American Animal Hospital Association Computer Program should benefit all small animal practitioners. Through the availability of well-researched and well-developed certified software, veterinarians will have increased confidence in their purchase decisions. With the expansion of computer applications to improve practice management efficiency, veterinary computer systems will further justify their initial expense. The development of the Association's veterinary computer network will provide a variety of important services to the profession.

  19. Using a New Measurement to Evaluate Pain Relief Among Cancer Inpatients with Clinically Significant Pain Based on a Nursing Information System: A Three-Year Hospital-Based Study. (United States)

    Wang, Wei-Yun; Chu, Chi-Ming; Sung, Chun-Sung; Ho, Shung-Tai; Wu, Yi-Syuan; Liang, Chun-Yu; Wang, Kwua-Yun


    Developing a new measurement index is the first step in evaluating pain relief outcomes. Although the percentage difference in pain intensity (%PID) is the most popular indicator, this indicator does not take into account the goal of pain relief. Therefore, the aims of this study were to develop a pain relief index (PRI) for outcome evaluation and to examine the index using demographic characteristics of cancer inpatients with clinically significant pain. Retrospective cohort study. A national hospital. All cancer inpatients. Pain intensity was assessed using a numerical rating scale, a faces pain scale or the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Tool. Using a nursing information system, a pain score database containing data from 2011 through 2013 was analyzed. Cancer patients representing 93,812 hospitalizations were considered in this study. We focused on cancer patients for whom the worst pain intensity (WPI) was ≥ 4 points. PRI values of -62.02% to -72.55% were observed in the WPI ≥ 7 and 4 ≤ WPI ≤ 6 groups. Significant (P 65 years old, those who were admitted to the medicine or gynecology and those who had a hospital stay > 30 days. This hospital-based study demonstrated that the PRI is an effective and valid measure for evaluating outcome data using an electronic nursing information system. We will further define the meaningful range of percentage difference in PRI from various perspectives. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail:

  20. Opt-out of Voluntary HIV Testing: A Singapore Hospital's Experience


    Chua, Arlene C.; Leo, Yee Sin; Cavailler, Philippe; Chu, Christine; Ng, Aloysius; Ng, Oon Tek; Krishnan, Prabha


    INTRODUCTION: Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore. METHODS AND FINDINGS: From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were ...

  1. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R; van Gemert-Pijnen, Julia Ewc


    BACKGROUND: Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital.

  2. 42 CFR 412.104 - Special treatment: Hospitals with high percentage of ESRD discharges. (United States)


    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for Inpatient... established that ESRD beneficiary discharges, excluding discharges classified into MS-DRG 652 (Renal Failure...

  3. Marketing skills for hospital-based laboratory managers in a managed care environment. (United States)

    Marchwinski, J; Coggins, F


    Managers of hospital-based laboratories have begun to realize the importance of a successful outreach program in protecting against declining inpatient activity. Succeeding in the highly competitive field of outpatient testing requires some new skills and techniques that may not have been apparent when addressing normal inpatient requirements. This article provides an overview of some very basic marketing concepts and attempts to show how they can assist the hospital-based laboratory manager in developing a successful outreach program.

  4. Preceptor Support in Hospital Transition to Practice Programs. (United States)

    Blegen, Mary A; Spector, Nancy; Ulrich, Beth T; Lynn, Mary R; Barnsteiner, Jane; Silvestre, Josephine


    The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.

  5. Sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study. (United States)

    Rise, Marit B; Gismervik, Sigmund Ø; Johnsen, Roar; Fimland, Marius S


    Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons' perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy. Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach. At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process. The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse

  6. Exploring the Rate and Causes of Deductions Imposed on Social Security and Health Insurance`s Bills Related to Inpatients in Two Hospitals Affiliated with Tabriz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Hossein Rezvanjou


    Full Text Available Background and Objectives: Annually, a large amount of fees that are paid by hospitals, will not be reimbursed as deductions by health insurance which imposes irreparable financial losses on hospitals. The purpose of this study was to determine the amount of deductions imposed on social security and health insurance`s bills and its causes related to inpatients in two hospitals affiliated with Tabriz University of Medical Sciences. Material and Methods: This was a cross-sectional study conducted in Alavi and Madani hospitals affiliated with Tabriz University of Medical Sciences by using 2015 data.  Researcher-designed checklist was used for data collecting. According to population size, census method and random sampling were used in Alavi and Madani hospitals, respectively. Gathered data were analyzed through descriptive statistics assisted by Excel v.13 software. Results: In the studied hospitals, most of the deductions in the Alavi and Madani hospitals were related to charge of surgeon and angioplasty, respectively. Also, in Alavi Hospital among deductions factors, the most repeated one was extra application in contrary to determined tariffs. In both hospitals, the role of the human factor in cases of error cannot be denied. Extra applications, inaccuracy in registration costs and lack of knowledge of the approved insurance tariffs are the main important factors influential on the deduction. Conclusion: Due to high rates of preventable deductions in both hospitals and being given the multiplicity and variety of services offered at the health centers, establishing income monitoring unit in hospitals and use of experienced staff is inevitable.

  7. Use of children's artwork to evaluate the effectiveness of a hospital preparation program. (United States)

    Wilson, C J


    Approximately 1.5 million children are hospitalized on an emergency basis per year and are not able to be fully prepared for the event due to the emergency (Azarnoff & Woody, 1981). For this reason many pre-crisis hospital preparation programs are being instituted by hospitals and pediatric nurses. This pilot study investigated the use of children's artwork to evaluate the effectiveness of a hospital preparation program. The 6 to 10 year old children attending summer school at a day care center participated in a hospital preparation program. The purpose of the program was to decrease children's anxieties and fears in the event of an emergency hospitalization.

  8. Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post-inpatient rehabilitation brain injury programs. (United States)

    Eicher, Vicki; Murphy, Mary Pat; Murphy, Thomas F; Malec, James F


    To compare progress in 4 types of post-inpatient rehabilitation brain injury programs. Quasiexperimental observational cohort study. Community and residential. Individuals (N=604) with acquired brain injury. Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments. Mayo-Portland Adaptability Inventory (MPAI-4). Program types differed in participant age (F=10.69, PMPAI-4 score (F=6.89, PMPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores. Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year. (United States)

    Bäuerle, Kathrin; Feicke, Janine; Scherer, Wolfgang; Spörhase, Ulrike; Bitzer, Eva-Maria


    To modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching. This was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n=215) received the usual lecture-based education program, and the intervention group (n=209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values. Statistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 (95%-CI 0.8-2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P=0.06, η2=0.01). The modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge. Structured and behavioral patient education fosters patient's disease management ability. Possible ways of improving asthma control need to be explored. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. [Intervention programs in hospital nutrition: actions, design, components and implementation]. (United States)

    Santana Porben, S; Barreto Penié, J


    Metabolic, Nutrient and Feeding Intervention Programs must become the methodological tool for dealing with the health problem posed by disease-associated-malnutrition on one side, and the "Bad Practices" affecting the nutritional status of the patient, on the other one. Programs like these ones should prescribe clear policies and actions in the three domains of contemporary medical practice: assistance, research and education. The fullfillment of these Program's objectives, and the relization of the implicit benefits, will only be possible if a methodological platform that armonically integrates elements of Continuous Education, Cost Analysis, Recording and Documentation, and Quality Control and Assurance, is created. The experience acumulated after the inception and conduction of the Intervention Program at the Clinical-Surgical "Hermanos Ameijeiras" Hospital (Havana City, Cuba) has served to demostrate that it is feasible not only to create a theoretical and practical body to satisfy the aforementioned goals, but, also, to export it to another institutions of the country, in view of the fact that minimal investments for adquiring the resources needed to deploy such Program, as well as for training and capacitation of medic and paramedic personel in the corresponding Recording & Documentation and Feeding & Nutrition Good Practices might result in short-term economical and medical care benefits.

  11. Measuring outcomes in psychiatry: an inpatient model. (United States)

    Davis, D E; Fong, M L


    This article describes a system for measuring outcomes recently implemented in the department of psychiatry of Baptist Memorial Hospital, a 78-bed inpatient and day treatment unit that represents one service line of a large, urban teaching hospital in Memphis. In June 1993 Baptist Hospital began a 15-month pilot test of PsychSentinel, a measurement tool developed by researchers in the Department of Community Medicine at the University of Connecticut. The hospital identified the following four primary goals for this pilot project: provide data for internal hospital program evaluation, provide data for external marketing in a managed care environment, satisfy requirements of the Joint Commission on Accreditation of Health Care Organizations, and generate studies that add to the literature in psychiatry and psychology. PsychSentinel is based on the standardized diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The outcome measure assesses the change in the number of symptoms of psychopathology that occurs between admission and discharge from the hospital. Included in the nonproprietary system are risk adjustment factors, as well as access to a national reference database for comparative analysis purposes. Data collection can be done by trained ancillary staff members, with as much or as little direct physician involvement as desired. The system has proven to be both time effective and cost effective, and it provides important outcome information both at the program level and at the clinician level. After the pilot test, the staff at Baptist Memorial Hospital determined that the system met all initial objectives identified and recently adopted the system as an ongoing measure of quality patient care in the department of psychiatry.

  12. Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

    Directory of Open Access Journals (Sweden)

    Storey Donald F


    Full Text Available Abstract Background Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback. Methods For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents. Results The antimicrobial stewardship team (AST made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 – December 2010. Physicians implemented recommendation(s from each of 234 (75% audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 – August 2009, there was a 22% decrease in defined daily doses per 100 admissions (P = .006 and a 16% reduction per 1000 patient-days (P = .013. There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013 and a 25% acquisition cost reduction per patient-day (P = .022. Conclusions An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

  13. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities. (United States)


    ... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

  14. Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program. (United States)

    Ninot, Gregory; Moullec, Gregory; Desplan, Jacques; Prefaut, Christian; Varray, Alain


    Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p self-esteem and physical self scores between the two home periods (p self-worth at home post-discharge compared to pre-admission (p self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.

  15. Prevalence and trend in the use of hospital-based standing orders programs for influenza and pneumococcal vaccination. (United States)

    Pentakota, Sri Ram; Halperin, William


    In 2002, federal regulations authorized the use of standing orders programs (SOPs) for promoting influenza and pneumococcal vaccination. In 2003, the New Jersey Hospital Association conducted a demonstration project illustrating the efficacy of SOPs, and the state health department informed healthcare facilities of their benefits. We describe the prevalence of reported use of SOPs in New Jersey hospitals in 2003 and 2005 and identify hospital characteristics associated with the use of SOPs. A survey was mailed to the directors of infection control at 117 New Jersey hospitals during the period from January to May 2005 (response rate, 90.6%). Data on hospital characteristics were obtained from hospital directories and online resources. The prevalence of use of SOPs for influenza vaccination was 50% (95% confidence interval [CI], 40.1%-59.9%) in 2003, and it increased to 78.3% (95% CI, 69.2%-85.7%) in 2005. The prevalence of SOP use for pneumococcal vaccination was similar. In 2005, the reported rate of use of SOPs for inpatients (influenza vaccination, 76.4%; pneumococcal vaccination, 75.5%) was significantly higher than that for outpatients (influenza vaccination, 9.4%; pneumococcal vaccination, 8.5%). Prevalence ratios for SOP use comparing acute care and non-acute care hospitals were 1.71 (95% CI, 1.2-2.5) for influenza vaccination SOPs and 1.8 for (95% CI, 1.2-2.7) pneumococcal vaccination SOPs. Acute care hospitals with a ratio of admissions to total beds greater than 36.7 reported greater use of SOPs for pneumococcal vaccination, compared with those that had a ratio of less than 36.7. The increase in the prevalence of reported use of SOPs among New Jersey hospitals in 2005, compared with 2003, was contemporaneous with SOP-related actions taken by the federal government, the state government, and the New Jersey Hospital Association. Opportunities persist for increased use of SOPs among non-acute care hospitals and for outpatients.

  16. Factors of risk for relapse of pulmonary tuberculosis in-patient of the Hospital Santa Clara from Bogota 1992/2000

    International Nuclear Information System (INIS)

    Hidalgo Martinez, Patricia; Awad Garcia, Carlos; Pavia Albor, Jacqueline


    Pulmonary tuberculosis relapse is defined as these patients that make recurrence of tuberculosis after complete an adequate treatment, and these patients are again diagnosed bacteriologically with tuberculosis. We tried to identify the risk factors for relapse among adults, through an analytical study of cases and controls, with eighty patients among the tuberculosis programmed of Santa Clara Hospital between 1992-2000 with relapse diagnosis which meet criterion of case and eighty patients which meet criterion of control. We did a bivariate analysis with confidence intervals and univariate calculation with logistic regression analysis to predict the development of relapse for the different variables. Diabetes mellitus, chronic renal failure, silicosis are associated with relapse, but in our study we found another factors which are joined to relapse and we suggest that if we find these factors among tuberculosis patients would indicate the chance of relapse and this would create the necessity of use a larger number of doses of antituberculosis medicaments

  17. Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

    Directory of Open Access Journals (Sweden)

    Jan Krüger

    Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

  18. Integration between orthodox medicine, homeopathy and acupuncture for inpatients: Three years experience in the first hospital for Integrated Medicine in Italy

    Directory of Open Access Journals (Sweden)

    Simonetta Bernardini


    Up to now 532 inpatients suffering from acute illnesses, relapse of a chronic illness or neurological or orthopaedic rehabilitation following strokes, brain haemorrhage, neurological illness or limb prosthesis operations have been treated. This work has tried to illustrate the innovative and positive experience for the Italian public health authorities so that it may also be useful to anyone who would like to promote similar initiatives within its public health Institution.

  19. 42 CFR 409.63 - Reduction of inpatient psychiatric benefit days available in the initial benefit period. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reduction of inpatient psychiatric benefit days available in the initial benefit period. 409.63 Section 409.63 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of...

  20. First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service. (United States)

    Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip


    There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

  1. Grade pending: lessons for hospital quality reporting from the New York City restaurant sanitation inspection program. (United States)

    Ryan, Andrew M; Detsky, Allan S


    Public quality reporting programs have been widely implemented in hospitals in an effort to improve quality and safety. One such program is Hospital Compare, Medicare's national quality reporting program for US hospitals. The New York City sanitary grade inspection program is a parallel effort for restaurants. The aims of Hospital Compare and the New York City sanitary inspection program are fundamentally similar: to address a common market failure resulting from consumers' lack of information on quality and safety. However, by displaying easily understandable information at the point of service, the New York City sanitary inspection program is better designed to encourage informed consumer decision making. We argue that this program holds important lessons for public quality reporting of US hospitals. © 2014 Society of Hospital Medicine.

  2. An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New Zealand. (United States)

    Alhaidari, Abdullah Ao; Allen-Narker, Rosalind Ac


    A process evaluation was carried out to assess and potentially improve the design and implementation of a hospital-wide delirium program. A mixed-methods sequential-explanatory design was used; retrospective chart reviews for 100 older (75+) medical inpatients were conducted to measure nurses', doctors' and coders' adherence to key program processes following which interviews were conducted to identify potential barriers to implementation. Delirium occurred in 49% of patients. Chart reviews revealed suboptimal adherence to the delirium risk assessment (66%), the Short Confusion Assessment Method (50% on admission, 58% during admission), documentation of delirium in clinical records (80%) and discharge letters (38%) and coding for delirium (49%). The major barriers to implementation identified were failure to recruit non-nursing staff, unclear goals and instructions, difficulties using the Short-CAM, time constraints with competing priorities and lack of outcome expectancy. A new delirium program was needed based on these findings. © 2017 AJA Inc.

  3. Transitioning home: A four-stage reintegration hospital discharge program for adolescents hospitalized for eating disorders. (United States)

    Dror, Sima; Kohn, Yoav; Avichezer, Mazal; Sapir, Benjamin; Levy, Sharon; Canetti, Laura; Kianski, Ela; Zisk-Rony, Rachel Yaffa


    Treatment for adolescents with eating disorders (ED) is multidimensional and extends after hospitalization. After participating in a four-step reintegration plan, treatment success including post-discharge community and social reintegration were examined from perspectives of patients, family members, and healthcare providers. Six pairs of patients and parents, and seven parents without their children were interviewed 2 to 30 months following discharge. All but two adolescents were enrolled in, or had completed school. Five worked in addition to school, and three completed army or national service. Twelve were receiving therapeutic care in the community. Adolescents with ED can benefit from a systematic reintegration program, and nurses should incorporate this into care plans. © 2015, Wiley Periodicals, Inc.

  4. Hospital Market Structure and the Behavior of Not-for-Profit Hospitals: Evidence from Responses to California's Disproportionate Share Program


    Mark Duggan


    I exploit a plausibly exogenous change in hospital financial incentives to examine whether the behavior of private not-for-profit hospitals varies with the share of nearby hospitals organized as for-profit firms. My results show that not-for-profit hospitals in for-profit intensive areas are significantly more responsive to an increased incentive to treat low-income patients insured by the Medicaid program than are other not-for-profit providers. The heterogeneity in behavior is not due to di...

  5. Higher Education Program Curricula Models in Tourism and Hospitality Education: A Review of the Literature (United States)

    Scotland, Miriam


    The relevancy of program curricula in tourism and hospitality education has been called into question by key stakeholders in light of ongoing changes in the multifaceted tourism and hospitality industry. Various program models have been identified. Program content and quality of student preparedness have been debated. Balance and areas of emphasis…

  6. A survey of medical quality assurance programs in Ontario hospitals.


    Barrable, B


    OBJECTIVE: To determine the prevalence and types of medical quality assurance practices in Ontario hospitals. DESIGN: Survey. SETTING: All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990. PARTICIPANTS: The person deemed by the chief executive officer of each hospital to be most responsible for medical administration. INTERVENTION: A questionnaire to obtain information on each hospital's use of cri...

  7. Effect of a multifactorial fall-and-fracture risk assessment and management program on gait and balance performances and disability in hospitalized older adults: a controlled study. (United States)

    Trombetti, A; Hars, M; Herrmann, F; Rizzoli, R; Ferrari, S


    This controlled intervention study in hospitalized oldest old adults showed that a multifactorial fall-and-fracture risk assessment and management program, applied in a dedicated geriatric hospital unit, was effective in improving fall-related physical and functional performances and the level of independence in activities of daily living in high-risk patients. Hospitalization affords a major opportunity for interdisciplinary cooperation to manage fall-and-fracture risk factors in older adults. This study aimed at assessing the effects on physical performances and the level of independence in activities of daily living (ADL) of a multifactorial fall-and-fracture risk assessment and management program applied in a geriatric hospital setting. A controlled intervention study was conducted among 122 geriatric inpatients (mean ± SD age, 84 ± 7 years) admitted with a fall-related diagnosis. Among them, 92 were admitted to a dedicated unit and enrolled into a multifactorial intervention program, including intensive targeted exercise. Thirty patients who received standard usual care in a general geriatric unit formed the control group. Primary outcomes included gait and balance performances and the level of independence in ADL measured 12 ± 6 days apart. Secondary outcomes included length of stay, incidence of in-hospital falls, hospital readmission, and mortality rates. Compared to the usual care group, the intervention group had significant improvements in Timed Up and Go (adjusted mean difference [AMD] = -3.7s; 95 % CI = -6.8 to -0.7; P = 0.017), Tinetti (AMD = -1.4; 95 % CI = -2.1 to -0.8; P fall-and-fracture risk-based intervention program, applied in a dedicated geriatric hospital unit, was effective and more beneficial than usual care in improving physical parameters related to the risk of fall and disability among high-risk oldest old patients.

  8. [Development and short-term effects of a standardized patient education program for in-patient cardiologic rehabilitation]. (United States)

    Seekatz, B; Haug, G; Mosler, G; Schwaab, B; Altstidl, R; Worringen, U; Faller, H; Meng, K


    Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme. In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434). Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program. A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful

  9. Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center. (United States)

    Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J


    Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (PSCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

  10. Delay discounting, treatment motivation and treatment retention among substance-dependent individuals attending an in inpatient detoxification program

    NARCIS (Netherlands)

    Stevens, Laura; Verdejo-García, Antonio; Roeyers, Herbert; Goudriaan, Anna E.; Vanderplasschen, Wouter


    Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be

  11. Heterogeneity among hospitals statewide in percentage shares of the annual growth of surgical caseloads of inpatient and outpatient major therapeutic procedures. (United States)

    Dexter, Franklin; Jarvie, Craig; Epstein, Richard H


    Suppose that it were a generalizable finding, in both densely populated and rural states, that there is marked heterogeneity among hospitals in the percentage change in surgical caseload and/or in the total change in caseload. Then, individual hospitals should not simply rely on federal and state forecasts to infer their expected growth. Likewise, individual hospitals and their anesthesiology groups would best not rely on national or US regional surgical trends as causal reasons for local trends in caseload. We examined the potential utility of using state data on surgical caseload to predict local growth by using 6 years of data for surgical cases performed at hospitals in the States of Florida and Iowa. Observational cohort study. 303 hospitals in Iowa and Florida. Cases with major therapeutic procedures in 2010 or 2011 were compared pairwise by hospital with such cases in 2015 and 2016. Changes in counts of cases were decreases or increases, while study of growth set decreases equal to zero. Hospitals in Iowa had slightly lesser percentage changes than did hospitals in Florida (Mann-Whitney P = 0.016). Hospitals in Iowa had greater variability among hospitals in the change in counts of cases with a major therapeutic procedure than did hospitals in Florida (P < 0.0001). The 10% of hospitals with the largest growths in counts of cases accounted for approximately half of the total growth in Iowa (70%) and Florida (54%). The large share of total growth attributable to the upper 10th percentile of hospitals was not caused solely by the hospitals having large percentage growths, based on there being weak correlation between growth and percentage growth, among the hospitals that grew (Iowa: Kendall's tau = 0.286 [SE 0.120]; Florida tau = 0.253 [SE 0.064]). Even if the data from states or federal agencies reported growth in surgical cases, there is too much concentration of growth at a few hospitals for statewide growth rates to be useful for

  12. 30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program? (United States)

    Brandao, Luis Felipe; Zargar, Homayoun; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Ko, Oliver; Samarasekera, Dinesh; Li, Jianbo; Rabets, John; Krishnan, Jayram; Haber, Georges-Pascal; Kaouk, Jihad; Stein, Robert J


    After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates. We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy. From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher. Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Modification of severe violent and aggressive behavior among psychiatric inpatients through the use of a short-term token economy. (United States)

    Park, Jae Soon; Lee, Kyunghee


    Meager research has been carried out to determine the effectiveness of the token economy among patients behaving violently in mental hospitals. The purpose of this study was to examine the effectiveness of the Short-Term Token Economy (STTE) on violent behavior among chronic psychiatric in-patients. A nonequivalent control group design method was utilized. Participants in an experimental group (n=22) and control group (n=22) took part in this study from January to April, 2008. Observation on aggressive behavior among male in-patients in one hospital as a baseline was made during the week before the behavior modification program and measurement of aggressive behavior was done using the Overt Aggression Scale (OAS), which includes verbal attacks, property damage and physical attacks. The aggressive behavior scores of the experimental group decreased, those of the control group, scores showed an increase after the eight-week behavior modification program utilizing STTE. The results of the study indicate that STTE is effective in reducing the incidence of aggressive behavior among male in-patients in psychiatric hospitals. The outcome of this study should be helpful in reducing the use of coercive measures or psychoactive medication in controlling the violent behavior among in-patients in hospitals.

  14. 78 FR 308 - Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health... (United States)


    ... (PQRS), the Children's Health Insurance Program (CHIP), and the Pioneer Accountable Care Organization... No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical...

  15. 76 FR 78926 - Medicare and Medicaid Programs; Announcement of Application From Hospital Requesting Waiver for... (United States)


    ... comment period. SUMMARY: This notice with comment period announces a waiver request from Pioneer Community... which the hospital is located: Pioneer Community Hospital (Medicare provider number 25-1302), of... No. 93.773, Medicare--Hospital Insurance; Program No. 93.774, Medicare-- Supplementary Medical...

  16. 78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for... (United States)


    ...] Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for Available... announces the closure of two teaching hospitals and the initiation of an application process where hospitals... modifying language at section 1886(d)(5)(B)(v) of the Act, to instruct the Secretary to establish a process...

  17. Organizational and market factors associated with leadership development programs in hospitals: a national study. (United States)

    Kim, Tae Hyun; Thompson, Jon M


    Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.

  18. 42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals. (United States)


    ... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...


    Directory of Open Access Journals (Sweden)

    A.A. Baranov


    Full Text Available Inpatient care for children has been considered to play an important role and to be influential in Russian healthcare system. However, a long lasting extensive development of health care system lacking sufficient finance and recourses has created a gap between the healthcare structure and capacity to provide healthcare and the needs of qualitative healthcare in the population. High number of limited ability hospitals without appropriate recourse base has already had its's day as a stage of inpatients care development. These hospitals could not provide a base for modern technology implementation and provision of present day high b quality medical care. Moreover, the current mechanism of financing «the hospital bed» but the patient has hampered medical care intensification and implementation of new technologies through loss of result orientation in medical specialists. Elaboration of efficacious means to optimize inpatient care would allow to control the rates assessing TH children's health in the country's population and to promote medical, social and economic efficacy of the inpatient care system.Key words: inpatient care, healthcare quality.

  20. Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System. (United States)

    Balaban, Richard B; Zhang, Fang; Vialle-Valentin, Catherine E; Galbraith, Alison A; Burns, Marguerite E; Larochelle, Marc R; Ross-Degnan, Dennis


    With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period. Randomized controlled trial conducted October 2011 through April 2013. Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease. The analytic sample included 739 intervention patients, 1182 controls. Through hospital visits and 30 days of post-discharge telephone outreach, PNs provided coaching and assistance with medications, appointments, transportation, communication with primary care, and self-care. Primary outcomes: (1) hospital-based utilization, a composite of ED visits and hospital admissions; (2) hospital admissions; (3) ED visits; and (4) outpatient visits. We evaluated outcomes following an index discharge, stratified by patient age (≥ 60 and safety-net patients differentially impacted patients based on age, and among younger patients, outcomes varied over time. Our findings highlight the importance for future research to evaluate care transition programs among different subpopulations and over longer time periods.

  1. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, A.H.M.; Sinha, Bhanu; Lo-Ten-Foe, Jerome R.; van Gemert-Pijnen, Julia E.W.C.


    Background Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlier

  2. A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program. (United States)

    Neufeld, Nathan J; Hoyer, Erik H; Cabahug, Philippines; González-Fernández, Marlís; Mehta, Megha; Walker, N Colbey; Powers, Richard L; Mayer, R Samuel


    Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.

  3. The financial impact of multidisciplinary cleft care: an analysis of hospital revenue to advance program development. (United States)

    Deleyiannis, Frederic W-B; TeBockhorst, Seth; Castro, Darren A


    The purpose of this study was to determine the financial impact of cleft care on the hospital and to evaluate trends in reimbursement over the past 6 years. Medical and accounting records of 327 consecutive infants undergoing cleft repair between 2005 and 2011 were reviewed. Charges, payments, and direct cost data were analyzed to illustrate hospital revenue and margins. Hospital payments for all inpatient services (cleft and noncleft) during the first 24 months of life were $9,483,168. Mean hospital payment varied from $5525 (Medicaid) to $10,274 (managed care) for a cleft lip repair (p < 0.0001) and from $6573 (Medicaid) to $12,933 (managed care) for a cleft palate repair (p < 0.0001). Hospital charges for a definitive lip or palate repair to both Medicaid and managed care more than doubled between 2005 and 2011 (p < 0.0001). Overall, mean hospital margins were $3904 and $3520, respectively, for a cleft lip repair and cleft palate repair. Medicaid physician payments for cleft lip and palate were, respectively, $588 and $646. From 2005 to 2006, 2007 to 2008, and 2009 to 2010, 41 percent, 43 percent, and 63 percent of patients, respectively, were enrolled in Medicaid. Cleft care generates substantial revenue for the hospital. For their mutual benefit, hospitals should join with their cleft teams to provide administrative support. Bolstered reimbursement figures, based on the overall value of cleft care to the hospital system, would better attract and retain skilled clinicians dedicated to cleft care. This may become particularly important if Medicaid enrollment continues to increase.

  4. Hospital safeguards capital program through private sector partnership. (United States)

    Thomas, J; Lungo, A; Bobrow, M


    As access to capital tightens, more hospitals are exploring the benefits of partnerships with private companies. A California hospital, burdened by the long-term debt it incurred for a medical office building, worked together with its medical staff and an outside real estate developer. By selling the building to the developer, not only was the hospital able to finance a much-needed expansion and reconstruction project, but the hospital's medical staff had an opportunity to become limited partners in the ownership of the building.

  5. Dermatology hospital fellowships: present and future. (United States)

    Sun, Natalie Z; Fox, Lindy P


    The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. Though mostly in their infancy, these programs have primary or secondary goals to train providers in the dermatologic care of the hospitalized patient. This article presents a brief synopsis of the history of traditional hospitalist fellowships and extrapolates these findings to existing hospitalist dermatology fellowships. As more of these programs arise, these fellowships are poised to revolutionize dermatologic inpatient care from a systems perspective. ©2017 Frontline Medical Communications.

  6. Does It Pay to Penalize Hospitals for Excess Readmissions? Intended and Unintended Consequences of Medicare's Hospital Readmissions Reductions Program. (United States)

    Mellor, Jennifer; Daly, Michael; Smith, Molly


    To incentivize hospitals to provide better quality care at a lower cost, the Affordable Care Act of 2010 included the Hospital Readmissions Reduction Program (HRRP), which reduces payments to hospitals with excess 30-day readmissions for Medicare patients treated for certain conditions. We use triple difference estimation to identify the HRRP's effects in Virginia hospitals; this method estimates the difference in changes in readmission over time between patients targeted by the policy and a comparison group of patients and then compares those difference-in-differences estimates in patients treated at hospitals with readmission rates above the national average (i.e., those at risk for penalties) and patients treated at hospitals with readmission rates below or equal to the national average (those not at risk). We find that the HRRP significantly reduced readmission for Medicare patients treated for acute myocardial infarction (AMI). We find no evidence that hospitals delay readmissions, treat patients with greater intensity, or alter discharge status in response to the HRRP, nor do we find changes in the age, race/ethnicity, health status, and socioeconomic status of patients admitted for AMI. Future research on the specific mechanisms behind reduced AMI readmissions should focus on actions by healthcare providers once the patient has left the hospital. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Experiences of older adults in a group physiotherapy program at a rehabilitation hospital: A qualitative study. (United States)

    Raymond, Melissa J; Burge, Angela T; Soh, Sze-Ee; Jeffs, Kimberley J; Winter, Adele; Holland, Anne E


    Physiotherapy delivered in a group setting has been shown to be effective in a variety of populations. However, little is known about the attitudes of older adults toward participating in group physiotherapy. The objectives of this study were to explore older inpatients' perceptions and experiences of group physiotherapy using qualitative methods. Twelve hospitalized adults aged ≥65 years who were involved in a larger randomized controlled trial undertook individual semistructured interviews regarding their experiences in group physiotherapy. Interviews were transcribed verbatim, and line by line, iterative thematic analysis was undertaken. Descriptive codes were developed, compared, and grouped together to create themes. Analysis revealed 6 major themes and 10 subthemes. All participants reported feeling happy to attend group sessions, a satisfactory alternative to individual physiotherapy. Participants described physical benefits that increased their motivation, and comparisons with their peers either motivated them or made them feel gratitude for their own health. Perceived attentiveness of group instructors contributed to participants reporting that treatment was individualized and similar to individual physiotherapy. Motivation and camaraderie with peers contributed to their enjoyment of group physiotherapy. Hospitalized older adults enjoyed exercising with their peers and valued the physical and social benefits of group physiotherapy. Journal of Hospital Medicine 2016;11:358-362. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  8. Factors associated to inpatient mortality rates in type-2-diabetic patients: a cross-sectional analytical study in three Peruvian hospitals. (United States)

    Atamari-Anahui, Noé; Martinez-Ninanqui, Franklin W; Paucar-Tito, Liz; Morales-Concha, Luz; Miranda-Chirau, Alejandra; Gamarra-Contreras, Marco Antonio; Zea-Nuñez, Carlos Antonio; Mejia, Christian R


    Diabetes mortality has increased in recent years. In Peru, there are few studies on in-hospital mortality due to type 2 diabetes in the provinces. To determine factors associated to hospital mortality in patients with diabetes mellitus type 2 in three hospitals from Cusco-Peru. An analytical cross-sectional study was performed. All patients with diabetes mellitus type 2 hospitalized in the city of Cusco during the 2016 were included. Socio-educational and clinical characteristics were evaluated, with "death" as the variable of interest. The crude (cPR) and adjusted (aPR) prevalence ratios were estimated using generalized linear models with Poisson family and log link function, with their respective 95% confidence intervals (95% CI). The values p diabetes mellitus type 2 patients died during the study period. Mortality was increased as age rises, patients admitted through emergency rooms, patients who were readmitted to the hospital, and patients who had metabolic or renal complications. Patients admitted for a urinary tract infection had a lower mortality rate.

  9. The effects of an 8-week multicomponent inpatient treatment program on body composition and anaerobic fitness in overweight and obese children and adolescents

    Directory of Open Access Journals (Sweden)

    Karner-Rezek K


    Full Text Available Klaus Karner-Rezek,1 Beat Knechtle,2,3 Matthias Fenzl,4 Christian Schlegel,4 Manuela Konrad,5 Thomas Rosemann2 1Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein, 2Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland; 3Gesundheitszentrum St Gallen, St Gallen, Switzerland; 4Swiss Olympic Medical Center, Medizinisches Zentrum Bad Ragaz, Switzerland; 5University of Applied Sciences JOANNEUM, Bad Gleichenberg, Austria Background: High intensity exercise is considered as an effective means for reducing body fat. The aims of the present study were to investigate (1 whether body mass would be lost and body composition would change and (2 whether variables of anaerobic fitness prior to the intervention period would be related to loss of body mass and changes in body composition in overweight and obese children and adolescents. Methods: A total of 28 children and adolescents (19 boys, 9 girls attended an 8-week multicomponent inpatient program. Caloric intake was based on the subject's weight and a daily energy deficit of ~500 kcal was targeted. At the beginning and at the end of the program, variables of anaerobic fitness were assessed using Wingate tests. Body composition was measured before and after the program using dual-energy X-ray absorptiometry. Results: Body mass decreased by 11.4% ± 1.6% in boys and by 11.0% ± 2.8% in girls (P < 0.001. Fat mass decreased by 23.8% ± 6.1% in boys and by 21.5% ± 5.2% in girls (P < 0.001. The decrease in fat mass was associated with the decrease in body mass in boys (r = 0.54, P = 0.017 but not in girls (P > 0.05. The decrease in body mass and the decrease in fat mass were neither associated with overall energy expenditure nor with the energy deficit in both genders (P > 0.05. Mean power in W/kg increased in the Wingate tests by 95.4% ± 109.1% in boys and by 100.0% ± 119.9% in girls (P < 0.001. Conclusions

  10. A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals. (United States)

    Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B


    The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

  11. Implementing a sharps injury reduction program at a charity hospital in India. (United States)

    Gramling, Joshua J; Nachreiner, Nancy


    Health care workers in India are at high risk of developing bloodborne infections from needlestick injuries. Indian hospitals often do not have the resources to invest in safety devices and protective equipment to decrease this risk. In collaboration with hospital staff, the primary author implemented a sharps injury prevention and biomedical waste program at an urban 60-bed charity hospital in northern India. The program aligned with hospital organizational objectives and was designed to be low-cost and sustainable. Occupational health nurses working in international settings or with international workers should be aware of employee and employer knowledge and commitment to occupational health and safety. Copyright 2013, SLACK Incorporated.

  12. Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa. (United States)

    Krüger, C; Lewis, C


    The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards deinstitutionalisation. This article investigates patient and social work factors related to successful community placement, in the context of limited community care facilities. Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions, and the most common type of interventions. The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female, in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support. The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients, limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments.

  13. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs. (United States)

    Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace


    Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p 3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.

  14. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study. (United States)

    Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad


    The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017

  15. Potential drug-drug interactions on in-patient medication ...

    African Journals Online (AJOL)

    Potential drug-drug interactions on in-patient medication prescriptions at Mbarara Regional Referral Hospital (MRRH) in western Uganda: prevalence, clinical importance and associated factors. SJ Lubinga, E Uwiduhaye ...

  16. HCUP National (Nationwide) Inpatient Sample (NIS) - Restricted Access File (United States)

    U.S. Department of Health & Human Services — The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each...

  17. 42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Lifetime maximum on inpatient psychiatric care. 409....62 Lifetime maximum on inpatient psychiatric care. There is a lifetime maximum of 190 days on inpatient psychiatric hospital services available to any beneficiary. Therefore, once an individual receives...

  18. 42 CFR 440.160 - Inpatient psychiatric services for individuals under age 21. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient psychiatric services for individuals... Definitions § 440.160 Inpatient psychiatric services for individuals under age 21. “Inpatient psychiatric... physician; (b) Are provided by— (1) A psychiatric hospital that undergoes a State survey to determine...

  19. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial. (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung


    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001). An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status an