Home About us Contact
|
Home About us Contact | ||
|
|
||
Hospital Utilization (hospital + utilization)
Selected AbstractsSurge Capacity Associated with Restrictions on Nonurgent Hospital Utilization and Expected Admissions during an Influenza Pandemic: Lessons from the Toronto Severe Acute Respiratory Syndrome OutbreakACADEMIC EMERGENCY MEDICINE, Issue 11 2006Michael J. Schull MD Background Current influenza pandemic models predict a surge in influenza-related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown. Objectives To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto. Methods The authors compared the expected influenza-related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic with the actual reduction in the number of hospital admissions in Toronto, Ontario, during the first eight weeks of the SARS-related restrictions. Results Influenza modeling for Toronto predicts that there will be 4,819, 8,032, or 11,245 influenza-related admissions in the first eight weeks of a mild, moderate, or severe pandemic, respectively. In the first eight weeks of SARS-related hospital admission restrictions, there were 3,654 fewer hospitalizations than expected in Toronto, representing a modest 12% decrease in the overall admission rate (a reduction of 1.40 admissions per 1,000 population). Therefore, influenza-related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, depending on pandemic severity, which corresponds to an excess of 0.44 to 2.91 influenza-related admissions per 1,000 population per eight weeks, and an increase of 4% to 25% in the overall number of admissions, when compared with nonpandemic conditions. Conclusions Pandemic modeling for Toronto suggests that influenza-related admissions would exceed the reduction in hospitalizations seen during SARS-related nonurgent hospital admission restrictions, even in a mild pandemic. Sufficient surge capacity in a pandemic will likely require the implementation of other measures, including possibly stricter implementation of hospital utilization restrictions. [source] The Effects of a Variant of the Program for All-inclusive Care of the Elderly on Hospital Utilization and OutcomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006Robert L. Kane MD OBJECTIVES: To compare the effects of the Wisconsin Partnership Program (WPP) on hospital, emergency department (ED), and nursing home utilization with those of traditional care. DESIGN: Quasi-experimental longitudinal cohort design. SETTING: Selected counties in Wisconsin. PARTICIPANTS: WPP elderly enrollees and two matched control groups consisting of frail older people enrolled in fee-for-service insurance plans, Medicare, and Medicaid and receiving home- and community-based waiver services, one from the same geographic area as the WPP and another from a location in the state where the WPP was not offered. MEASUREMENTS: Data came from administrative records. Regression and survival analyses were adjusted for case-mix variables. RESULTS: No significant differences in hospital utilization, ED visits, preventable hospitalizations, risk of entry into nursing homes, or mortality were found. WPP enrollees had more contact with care providers than did controls. CONCLUSION: WPP did not dramatically alter the pattern of care. Part of the weak effect may be attributable to the small numbers of WPP cases per participating physician. [source] Surge Capacity Associated with Restrictions on Nonurgent Hospital Utilization and Expected Admissions during an Influenza Pandemic: Lessons from the Toronto Severe Acute Respiratory Syndrome OutbreakACADEMIC EMERGENCY MEDICINE, Issue 11 2006Michael J. Schull MD Background Current influenza pandemic models predict a surge in influenza-related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown. Objectives To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto. Methods The authors compared the expected influenza-related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic with the actual reduction in the number of hospital admissions in Toronto, Ontario, during the first eight weeks of the SARS-related restrictions. Results Influenza modeling for Toronto predicts that there will be 4,819, 8,032, or 11,245 influenza-related admissions in the first eight weeks of a mild, moderate, or severe pandemic, respectively. In the first eight weeks of SARS-related hospital admission restrictions, there were 3,654 fewer hospitalizations than expected in Toronto, representing a modest 12% decrease in the overall admission rate (a reduction of 1.40 admissions per 1,000 population). Therefore, influenza-related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, depending on pandemic severity, which corresponds to an excess of 0.44 to 2.91 influenza-related admissions per 1,000 population per eight weeks, and an increase of 4% to 25% in the overall number of admissions, when compared with nonpandemic conditions. Conclusions Pandemic modeling for Toronto suggests that influenza-related admissions would exceed the reduction in hospitalizations seen during SARS-related nonurgent hospital admission restrictions, even in a mild pandemic. Sufficient surge capacity in a pandemic will likely require the implementation of other measures, including possibly stricter implementation of hospital utilization restrictions. [source] The Effects of a Variant of the Program for All-inclusive Care of the Elderly on Hospital Utilization and OutcomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006Robert L. Kane MD OBJECTIVES: To compare the effects of the Wisconsin Partnership Program (WPP) on hospital, emergency department (ED), and nursing home utilization with those of traditional care. DESIGN: Quasi-experimental longitudinal cohort design. SETTING: Selected counties in Wisconsin. PARTICIPANTS: WPP elderly enrollees and two matched control groups consisting of frail older people enrolled in fee-for-service insurance plans, Medicare, and Medicaid and receiving home- and community-based waiver services, one from the same geographic area as the WPP and another from a location in the state where the WPP was not offered. MEASUREMENTS: Data came from administrative records. Regression and survival analyses were adjusted for case-mix variables. RESULTS: No significant differences in hospital utilization, ED visits, preventable hospitalizations, risk of entry into nursing homes, or mortality were found. WPP enrollees had more contact with care providers than did controls. CONCLUSION: WPP did not dramatically alter the pattern of care. Part of the weak effect may be attributable to the small numbers of WPP cases per participating physician. [source] Burden of parkinsonism: A population-based studyMOVEMENT DISORDERS, Issue 3 2003FRCPC, Mark Guttman MD Abstract Parkinson's disease (PD) is associated with a significant burden of illness and cost to society, which has been difficult to quantify. Our objective was to use linked administrative databases from the population of Ontario, Canada, to assess the prevalence of parkinsonism, physician- and drug-related costs, and hospital utilization for parkinsonian patients compared with age/sex matched controls. An inception cohort of parkinsonian cases from 1993/1994 was age and sex matched (1:2) to controls and followed for 6 years. Patients were identified by the diagnostic code for PD, the use of specific PD drugs, or a combination. The parkinsonian case cohort (15,304) was matched to (30,608) controls that did not have parkinsonism. The age-adjusted prevalence rates were 3.63 for men and for 3.24 women per 1,000 (increased by 5.4% for men and 9.8% for women). Physician costs were 1.4 times more, there were 1.44 times more hospital admissions, admissions were on average 1.19 times longer, and drug costs were 3.0 times more for parkinsonian cases. We conclude that the substantially higher physician and drug costs as well as hospitalization rates compared with controls clearly suggest that parkinsonism is associated with large direct costs to society. © 2002 Movement Disorder Society [source] The course and correlates of high hospital utilization in sickle cell disease: Evidence from a large, urban Medicaid managed care organization,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009C. Patrick Carroll Although most patients with sickle cell disease (SCD) are hospitalized infrequently and manage painful crises at home, a small subpopulation is frequently admitted to emergency departments and inpatient units. This small group accounts for the majority of health care expenses for patients with SCD. Using inpatient claims data from a large, urban Medicaid MCO for 5 consecutive years, this study sought to describe the course of high inpatient utilization (averaging four or more admissions enrolled per year for at least 1 year) in members with a diagnosis of SCD and a history of hospitalizations for vaso-occlusive crisis. High utilizers were compared with the other members with SCD on demographics, medical and psychiatric comorbidity, and use of other health care resources. Members who were high utilizers had more diagnostic mentions of sickle cell complications than low utilizers. However, the pattern of high inpatient utilization was likely to moderate over successive years, and return to the pattern after moderation was uncommon. Despite this, a small subpopulation engaged in exceptional levels of inpatient utilization over multiple years. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Databases for outcomes research: what has 10 years of experience taught us?PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2001Lynn Bosco MD Abstract This paper describes how the mission of the Agency for Healthcare Research and Quality (AHRQ) is being executed through the many programs that it has developed and implemented. The Evidence-based Practice Center program was developed to provide systematic reviews on common and expensive conditions and health technologies and to ensure that this information is used to improve health care outcomes and costs. The National Guidelines Clearinghouse provides an internet-based source of clinical practice guidelines that are produced by clinical specialty organizations for the primary purpose of improving health care delivery and outcomes. Relevant to this symposium on databases, AHRQ has supported the development of databases to track hospital utilization on a state-by-state basis. The Healthcare Cost and Utilization Project (HCUP) allows comparisons between states and within regions of individual states. New initiatives have been launched to evaluate interventions across systems rather than focusing on the individual patient (Translating Research into Practice,TRIP). The Centers for Education and Research on Therapeutics (CERTs) program was developed to conduct real world evaluations to better understand the benefits and risks of single and combined therapy. Both programs further the mission of the AHRQ to improve the outcomes and quality of health care, with additional focus on the cost-effectiveness, patient safety, and increasing access to care for all. Information on programs developed by the AHRQ is available in more detail at the Agency Web site http://www.ahrq.gov. Copyright © 2001 John Wiley & Sons, Ltd. [source] The impact of the evolution of invasive surgical procedures for low back pain: a population based study of patient outcomes and hospital utilizationANZ JOURNAL OF SURGERY, Issue 9 2009Rachael Elizabeth Moorin Abstract Background:, Low back pain (LBP) is a ubiquitous health problem in Western societies, and while clinical decision making for patients requiring hospitalization for LBP has changed significantly over the past two decades, knowledge of the net impact on patient outcomes and health care utilization is lacking. The aim of this study was to evaluate the effectiveness of changes in the medical control of lumbar back pain in Western Australia in terms of the rate of patient readmission and the total bed days associated with readmissions. Methods:, A record linkage population-based study of hospitalization for LBP from 1980,2003 in Western Australia was performed. The rate of admission for LBP, changes in re-admission rates and number of bed days accrued 1 and 3 years post-initial admission over time adjusted for potential confounders was evaluated. Results:, The annual rate of first-time hospitalization for LBP halved. The proportion of females admitted increased (+6%). The disease severity increased and the proportion of individuals having an invasive procedure also increased (+75%) over the study period. While rate of readmission for non-invasive procedures fell, readmission for invasive procedures increased over the study period. Overall, the number of bed days associated with readmission reduced over time. Conclusion:, Between 1980 and 2003, there has been a shift from non-invasive procedural treatments towards invasive techniques both at the time of initial hospitalization and upon subsequent readmission. While overall readmission rates were unaffected, there was a reduction in the number of bed days associated with readmissions. [source] Impact of laparoscopic cholecystectomy on hospital utilizationANZ JOURNAL OF SURGERY, Issue 4 2004Michael S. Hobbs Objective: The objective of the present study was to assess the impact of laparoscopic cholecystectomy (LC) and associated endoscopic retrograde pancreatography (ERCP) on hospital utilization. Background: Laparoscopic cholecystectomy (LC) has resulted in marked reductions in average length of hospital stay; but population-based studies of hospital utilization have generally not taken into account increased cholecystectomy rates or associated increases in pre and postoperative admissions. Methods: We conducted a population-based study of all residents of Western Australia who underwent cholecystectomy in the period 1980,2000. Record linkage was used to identify pre and postoperative admissions, and to estimate aggregate length of stay per case based on all relevant admissions. We estimated trends in cholecystectomy rates, proportions of cases with related pre and postoperative hospital admissions, average aggregate length of stay per case and total bed utilization per unit of population. Results: The introduction of LC was associated with a sustained increase in rates of cholecystectomy of 25%. Similar increases occurred in the percentage of cases with related preoperative and postoperative admissions. Average length of stay for index admissions declined by nearly 60% compared with 50% for all related admissions. Per capita hospital utilization for index admissions decreased by 45% compared with 38% for index and associated admissions combined, and 32% for all admissions for biliary disease. Conclusions: Reduced hospital utilization associated with LC was partly offset by increases in pre and postoperative admissions and a sustained increase in cholecystectomy rates. Record linkage is required to assess the true impact of new technologies on hospital utilization. [source] | ||||||||||