Community Hospital Patients Research Articles

A Population-based Analysis of Outpatient Colonoscopy in Adults Assisted by an Anesthesiologist

The use of propofol to sedate patients for colonoscopy, generally administered by an anesthesiologist in North America, is increasingly popular. In the United States, regional use of anesthesiologist-assisted endoscopy appears to correlate with local payor policy. This study's objective was to identify nonpayor factors (patient, physician, institution) associated with anesthesiologist assistance at colonoscopy. The authors performed a population-based cross-sectional analysis using Ontario health administrative data, 1993-2005. All outpatient colonoscopies performed on adults were identified. Hierarchical multivariable modeling was used to identify patient (age, sex, income quintile, comorbidity), physician (specialty, colonoscopy volume), and institution (type, volume) factors associated with receipt of anesthesiologist-assisted colonoscopy. During the study period, 1,838,879 colonoscopies were performed on 1,202,548 patients. The proportion of anesthesiologist-assisted colonoscopies rose from 8.4% in 1993 to 19.1% in 2005 (P < 0.0001). In the hierarchical model, patients in low-volume community hospitals were five times more likely to receive anesthesiologist-assisted colonoscopy than patients in high-volume community hospitals (odds ration 4.9; 95% confidence interval 4.4-5.5). Less than 1% of colonoscopies in academic hospitals were anesthesiologist-assisted. Compared to gastroenterologists, surgeons were more likely to perform anesthesiologist-associated colonoscopy (odds ratio 1.7; 95% confidence interval 1.1-2.6). In Ontario, rates of anesthesiologist-assisted colonoscopy have risen dramatically. Institution type was most strongly associated with this practice. Further investigation is needed to determine the most appropriate criteria for the use of anesthesiology services during colonoscopy.

The Deadly Toll of Invasive Methicillin‐ResistantStaphylococcus aureusInfection in Community Hospitals

Data regarding the epidemiology, treatment, and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) infections in rural and community hospitals are limited. This cohort study was conducted at 1 tertiary care hospital and 8 community hospitals in the southeastern United States. Patients with a surgical site infection (SSI) and/or bacteremia due to MRSA were prospectively identified at each study hospital during the period 1994-2003. A total of 129 patients with SSI and 564 patients with bacteremia due to MRSA were identified. Only 57 patients with SSI (44.2%) received antibiotics active against MRSA on the initial date of diagnosis; only 95 (73.6%) received an agent active against MRSA by day 7 after diagnosis of SSI due to MRSA. Ninety-five patients with SSI due to MRSA (73.6%) were readmitted to the hospital within 90 days after their original surgery. The 1-year mortality rate among patients with SSI due to MRSA was 22%. Inadequate therapy was also commonly given to patients with bacteremia: only 216 (38.3%) received antibiotics active against MRSA on the initial day of infection, and only 383 (67.9%) received an agent active against MRSA by day 7 after diagnosis. Approximately one-third of patients with bloodstream infection died during their initial hospitalization. Patients hospitalized in community hospitals were less likely to receive effective antimicrobial therapy on both the day of infection and within 7 days after infection, compared with patients in the tertiary care hospital. Inadequate therapy is commonly administered after diagnosis of SSI and bacteremia due to MRSA in patients in community hospitals.

Cosegregation of Gastrointestinal Ulcers and Schizophrenia in a Large National Inpatient Discharge Database

The lifetime prevalence of duodenal ulcer in the United States is 8 to 10%, whereas another 1% of the population is affected by gastric ulcer. Both central and peripheral dopamine...

Physician Patterns of Metabolic Screening for Patients Taking Atypical Antipsychotics

The aim of this retrospective database study was to determine rates of screening for metabolic side effects by physician specialty in community hospital patients prescribed atypical antipsychotics. A pharmacy database review identified patients who were prescribed atypical antipsychotics over a 6-month period from July 1, 2004, to December 31, 2004. This list of patients was then cross-referenced with the laboratory database to determine if screening laboratory tests for metabolic abnormalities had been ordered. 13% of patients prescribed atypical antipsychotics had fasting blood glucose levels measured during the study period. 30% of patients prescribed atypical antipsychotics also had lipid panels measured during the study period. Screening rates varied by specialty of physician. Physicians trained in combined family practice and psychiatry had the highest rate of screening, followed by other nonpsychiatric specialties. Psychiatrists had the lowest rate of screening. The rate of screening for metabolic side effects of atypical antipsychotics in this community hospital setting was low.

Frequency of Aspirin Resistance in a Community Hospital

Aspirin resistance and its predictors were studied in community hospital patients who required antiplatelet therapy for thrombotic event prophylaxis. Demographic and antiplatelet medication data were collected and medication response followed. Aspirin resistance was assayed with the VerifyNow System with > or = 550 aspirin reaction units (ARUs) used as a dichotomous indicator of aspirin resistance. Patients (n = 123) were 21 to 95 years old; 49.6% were women, 77.2% were black, 95.1% were hypertensive, 85.4% had coronary disease, and 30.1% were smokers. ARU score for 325 versus 81 mg/day was 435.2 +/- 93.7 versus 401.9 +/- 83.9 ARU (p = 0.04), with a 12.1% (8 of 66 patients) nonresponse rate to 81 mg/day. Of the 8 patients who were unresponsive to 81 mg/day of aspirin, 7 responded to 325 mg/day. The 5.3% (3 of 57 patients) who were resistant to 325 mg/day received clopidogrel; 2 became responders. Multivariate analysis demonstrated significant associations of aspirin resistance with smoking (risk ratio 11.47, 95% confidence interval 6.69 to 18.63, p < 0.0001), including a significant interaction between smoking and aspirin resistance. In conclusion, this study estimates aspirin resistance prevalence and shows a strong association of smoking with platelet hyperactivity in a diverse community hospital population. Nonresponders to 81 mg/day frequently responded to 325 mg/day or to the addition of clopidogrel.

Cerclage utilization in the new millennium: Comparison of a community and university hospital

NITY AND UNIVERSITY HOSPITAL DANIEL STEWART, MILDRED RAMIREZ, MARK TURRENTINE, University of Texas Health Science Center at Houston, Department of Obstetrics, Gynecology and Reproductive Sciences, Houston, Texas, Kelsey-Seybold Clinic, Department of Obstetrics & Gynecology, Houston, Texas OBJECTIVE: Despite frequent utilization of cerclage, randomized prospective trials have shown no overall significant reduction in the risk of pregnancy loss. No data is available regarding current clinical practices of obstetrician’s indications for cerclage placement. The purpose of this study was to compare the indications of cerclage between a community and university hospital. STUDY DESIGN: A retrospective review of cerclage utilization from 1/1/ 2000 through 12/31/ 2001 was performed at two obstetrical centers. One a community hospital (CH) with no obstetrical residents and private physicians. The other is associated with a university-based obstetrics and gynecology residency program. Both have level III nurseries and maternal-fetal-medicine physicians on staff. Data was analyzed using two-by-two tables, significance was considered if p ! .05. RESULTS: 387 cerclages (2.4% of deliveries) were placed at the CH compared to the 19 (0.3% of deliveries) at the university hospital (UH), p !. 05. No significant (NS) difference was noted in the number of cerclages placed by a MFM physician at the CH (40.6%) versus (vs) the UH (68.4%). The CH patients were older (31 vs 27 years), more likely to be Caucasian (53.7% vs 21.1%), and have private insurance (95.9% vs 42.1%), p!0.5. NS difference was seen in the median gravidity (3 vs 4) or the number of nulligravid receiving a cercalge (13.4% vs 0%). A significant difference for cerclage indication was noted in women with R two 2nd trimester losses of which 57.9% (n=11) were performed at UH compared to 24.8% (n=96) at the CH, p ! .05.) NS difference was seen between the CH vs. UH for previous cerclage 23.5% (n=91) vs. 26.3% (n=5); short cervix 13.7% (n=53) vs. 0%; history of LEEP or cone 17.6% (n=68) vs 5.3% (n=1); or multiple gestations 11.4% (n=44) vs 10.5% (n=2). CONCLUSION: Cerclage is commonly performed (1/40 deliveries) in a community hospital as compared to a univeristy hospital. Randomized controlled trials are needed to optimize utilization of cerclage and minimize potential over-utilization of this procedure. 445 OBSTETRICAL OUTCOMES ASSOCIATED WITH LAPAROSCOPIC-ASSISTED ABDOMINAL CERCLAGE: AN OBSERVATIONAL STUDY W WHITTLE (F), L GLAUDE, J THOMAS, L ALLEN, S KEATING, R WINDRIM, Mount Sinai Hospital, Obstetrics and Gynecology; Division of Maternal Fetal Medicine, Toronto, Ontario, Canada, Mount Sinai Hospital, Obstetrics and Gynecology, Toronto, Ontario, Canada, Mount Siani Hospital, Pathology and Laboratory Medicine, Toronto, Ontario, Canada OBJECTIVE: Abdominal cerclage is utilized as a management strategy for the true incompetent cervix with previous failed vaginal cerclage; recently the laparoscopic approach to abdominal cerclage placement has been introduced. STUDY DESIGN: The objective of this observational study was to determine the obstetrical outcome associated with laparoscopic-assisted abdominal cerclage. RESULTS: 10 cerclages were placed pre-pregnancy and the remaining 17 cerclages were placed in the first trimester of the index pregnancy. 3 cases were converted from laparoscopy to laparotomy due to technical difficulties; no other surgical complications were reported. 30 pregnancies have occurred with 27 extending beyond the first trimester. 1 pregnancy is currently ongoing. 67% (18/27) of pregnancies were delivered at O32w gestation (mean 36.5w; range 32-39w) due to either idiopathic preterm labor or elective term delivery; no perinatal deaths or longterm neonatal complications were reported. 8 pregnancies (30%) were delivered at !32w with a mean gestational age of 24w (range 17-29w); 4 pregnancies were delivered previablilty (!24w) and 1 neonatal death occurred following delivery at 25w. 6 pregnancies were delivered secondary to clinical chorioamnionitis; placental pathology revealed severe chorioamnionitis in each case with no evidence of other pathologies including ischemic-thrombotic damage. 5 of these cases presented as a cerclage failure with a short/dilated cervix and underwent rescue vaginal cerclage; all 6 cases were delivered within 2w of presentation regardless of management. 2 pregnancies were delivered secondary to idiopathic preterm labor; placental pathology revealed acute abruption in 1 case. The timing of the cerclage placement did not influence obstetrical outcome. CONCLUSION: The laparoscopic assisted abdominal cerclage is associated with w70% successful pregnancy outcome. However, the incompetent cervix appears to encompass a spectrum of disease for which, in the extreme circumstance, an abdominal cerclage may not prevent the cervical failure that leads to preterm birth.

Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres

To understand the impact of hospital-acquired infections on mortality and medical costs in modern medical care systems in different healthcare settings, we performed a case-control study at a medical centre and two community hospitals. A total of 144 and 129 adult case-control pairs who received care in a 2000-bed tertiary referral medical centre and two 800-bed community hospitals, respectively, between October 2002 and December 2002 were enrolled. Prolongation of hospital stay, extra costs and complications associated with hospital-acquired infections were analysed. Patients in the medical centre had more severe underlying disease status ( P<0.001), more malignancies ( P<0.001), more multiple episodes of hospital-acquired infection ( P=0.03), and more infections with multidrug-resistant bacteria ( P<0.001) than patients in community hospitals. The additional length of hospital stay and extra costs were similar for patients with hospital-acquired infections in the community hospitals and the medical centre (mean 19.2 days vs. 20.1 days, P=0.79; mean US$ 5335 vs. US$ 5058, P=0.83; respectively). The additional length of hospital stay and extra costs in both the medical centre and the community hospitals were not related to the sites of infection or the bacterial pathogens causing hospital-acquired infections, although medical costs attributable to hospital-acquired fungal infections due to Candida spp. were much higher for patients in the medical centre. Prevalence of hospital-acquired-infection-related complications, such as adult respiratory distress syndrome, disseminated intravascular coagulation, organ failure or shock, was similar between the two groups, but patients in the medical centre had a higher mortality rate because of their underlying co-morbidities.

Effects Of Physician-Owned Limited-Service Hospitals:Evidence From Arizona

In recent years physician ownership of so-called limited-service hospitals has become commonplace in many states lacking certificate-of-need regulations. Empirical evidence documenting the effects of these facilities is sparse. This study compares practice patterns of physician-owners of limited-service cardiac hospitals and physician-nonowners who treat cardiac patients at competing full-service community hospitals. Analyses of six years of Arizona inpatient discharge data show that physician-owners treat higher volumes of profitable cardiac surgical diagnosis-related groups (DRGs), higher percentages of low-severity cases, and higher percentages of cases with generous insurance compared with physician-nonowners who treat cardiac patients in community hospitals.

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction.

To examine changes in the rate of beta-blocker (BB) use at admission, in hospital, and at discharge between 1994 and 1995 (MICH I) and 1997 (MICH II) in patients with acute myocardial infarction (AMI). Comparison of two prospectively enrolled cohorts. Five mid-Michigan community hospitals. We studied 287 MICH I patients and 121 MICH II patients with AMI who had no contraindications to BB use from cohorts of consecutively admitted cases of AMI (814 in MICH I; 500 in MICH II). Prescription of BBs to ideal patients with AMI increased in patients with previous history of myocardial infarction on arrival at the hospital (12.5% vs 36.0%; P= .01), in hospital (47.0% vs 76%; P < .01), and at discharge (34.0% vs 61.9%; P < .01). Neither race nor gender was a predictor of BB use. Younger age predicted BB prescription at discharge (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32 to 3.23). Later study cohort was the most important predictor of BB use in hospital (OR, 3.4; 95% CI, 2.09 to 5.25). BB use improved dramatically over the study period, but additional work is needed to improve use of BB after discharge and among elderly patients with AMI.

Prevalence of QRS prolongation in a community hospital cohort of patients with heart failure and its relation to left ventricular systolic dysfunction

Adverse outcomes in heart failure occur more frequently with QRS prolongation. The results of our study have shown that 1/4 of community hospital patients with heart failure of sufficient severity leading to hospitalization have a QRS duration of ≥120 ms and that this degree of QRS prolongation is associated with substantially more severe left ventricular (LV) systolic dysfunction, LV dilation, and mitral regurgitation.

Internet use by patients with prostate cancer undergoing radiotherapy

Objectives To analyze the amount of Internet use, type of Internet use, and factors that predict Internet use by patients with prostate cancer. Methods A questionnaire evaluating the use of the Internet was given to 295 patients undergoing radiotherapy for prostate cancer in three different settings: an academic center (AC), a Veterans Affairs center (VA), and a community hospital. The study included 171 AC patients (58%), 104 VA patients (35%), and 20 community hospital patients (7%). Results The response rate to the questionnaire was greater than 99%. Overall, 128 (43%) of 295 patients had a home computer. This differed among the institutions, with 64% of AC patients and only 5% of VA patients having a home computer ( P <0.0001). Overall, 94 (32%) of 295 patients used the Internet to access cancer information, with 48% of AC patients and 8% of VA patients using the Internet ( P <0.0001). Seventeen percent of black patients (n = 113) had a home computer compared with 62% of white patients (n = 175; P <0.0001). Equal access to computers did not influence Internet use because, among those patients who had access to computers, black patients used the Internet less than did white patients (32% versus 61%, P <0.0001). Men 65 years of age or younger were more likely to use the Internet (45%) than those older than 65 years (28%; P = 0.004). Patients used many sites to access different types of information. Conclusions A significant number of patients with prostate cancer access the Internet to obtain cancer information. Urologists and radiation oncologists should be familiar with this important resource to help patients access appropriate material.

The Relative Cost of Inpatient Care in Manitoba's Largest Hospitals

Comparative information from 1991/92 to 1997/98 regarding an indicator of the relative financial performance of teaching, urban community and major rural hospitals in Manitoba is presented. Results suggest that the acuity and complexity of patients in teaching and urban community hospitals was similar in 1997/98, and that teaching facilities had higher inpatient care costs in all time periods, even after accounting for differences in case-mix, physician remuneration, capital expenditures and the direct costs of teaching programs.

PHP17: PATIENT OUTCOMES IN THE SEDATED ICU PATIENT

OBJECTIVE: This study compares patient outcomes in the mechanically ventilated ICU patient by patient demographics, hospital characteristics and drug therapy. METHODS: Data collected from 42 hospitals included patient demographics, disease severity, sedatives/analgesics administered, hospital type/size, days hospitalized and discharge status. RESULTS: 622 patients were studied (48% female, mean APACHE score = 21.7, 31% with care plans). Only 50% of patient episodes for ICU sedation greater than 24 hours were treated with lorazepam (guideline recommended drug for long-term sedation). 94% of patients received recommended analgesics. Patients in community hospitals had fewer ICU days (9.31 versus 11.05) and total hospital days (14.14 versus 16.96) compared to teaching hospitals. Patients receiving midazolam or orazepam had shorter hospital stays (13.7 and 15.5 days respectively) compared to propofol patients. Patients receiving midazolam had higher mortality rates (31.7%) compared to patients on lorazepam (29.2%). However, these results were not confirmed when controlling for disease severity and other factors. Multivariate regression analysis revealed that type of sedative/analgesic drug treatment and whether the hospital had a care plan were not associated with shorter ICU and total hospital stays when controlling for patient demographics and disease severity. In fact, patients admitted to hospitals with care plans had longer total hospital stays. More severe patients had shorter total hospital stays, probably due to higher mortality. Higher mortality was associated with older patients and higher disease severity. CONCLUSION: There is much discussion about treatment guidelines and use of care plans to improve quality of care and reduce hospitalization costs. In this study, the type of sedation and analgesia treatment in mechanically ventilated ICU patients and whether the patient had a care plan did not influence days in ICU or mortality. Whether following treatment guidelines and care plans reduces total costs, needs further evaluation.

Review: evidence of the effectiveness of discharge planning is equivocal

(2000) Cochrane Database Syst Rev. (4) CD000313. Parkes J, Shepperd S. . Discharge planning from hospital to home. . ; . : . (latest version 17 Aug 2000). . [OpenUrl][1][PubMed][2]...

A System of Credentialing Physicians in Advanced Gynecologic Endoscopy

Study Objective To develop criteria for credentialing physicians in advanced gynecologic endoscopy. Design Descriptive study (Canadian Task Force classification III). Setting University-affiliated community hospital Patients None. Intervention Criteria for credentialing physicians were tested. Measurements and Main Results Physicians were granted universal privileges in advanced gynecologic laparoscopy or hysteroscopy when they were certified by the Accreditation Council for Gynecologic Endoscopy (ACGE). Alternatively, they received category-specific privileges in any one of six categories when they provided documentation of having satisfactorily performed 10 cases in four categories or 5 cases in the remaining two. Required cases included those performed during residency or with a proctor. Completion of an approved residency, board certification or eligibility, and good standing were other requirements. Proof of continuing medical education in endoscopy was also considered. Of 31 physicians in the department, 3 had ACGE certification: 1 in laparoscopy, 2 in laparoscopy and hysteroscopy. Three physicians gained privileges under the alternative system. One received category 1, one received categories 1 and 2, and the third received categories 1, 2, and 6 privileges. Twenty-five physicians were granted standard endoscopy privileges, including six who applied for advanced endoscopy privileges. These applications are pending case documentation and proctorship. Conclusion A system for credentialing physicians in advanced gynecologic endoscopy, using two alternative pathways, was implemented.

The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis

Background: The accuracy of noncontrast helical computed tomography (CT) for appendicitis has recently been demonstrated. What is its clinical utility? Methods: This was a retrospective review of 443 consecutive community hospital patients evaluated for acute appendicitis over an 18-month period using limited pelvic CT scan or clinical acumen alone. Results: Appendicitis was pathologically proven in 158 patients. The negative appendectomy rate was 5.4%. The best radiological indicators for a positive CT for appendicitis were pericecal inflammation (88%) and appendicolith(57%). Appendiceal CT was found to have a 92% sensitivity, 99.6% specificity, and a 97.5% accuracy. There were 260 patients who had a negative CT; 243 of these were sent home. Alternative diagnoses were identified in 22% of patients. Conclusions: The liberal use of noncontrast helical CT results in a low negative appendectomy rate and a high degree of confidence that a negative CT will allow patients to be sent home safely.

Low Prevalence of VRE Gastrointestinal Colonization of Hospitalized Patients in Manitoba Tertiary Care and Community Hospitals

To determine the prevalence of vancomycin-resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing. Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin-nalidixic acid-vancomycin (6 microg/mL) (CNAV) agar plates. The study was divided into six, eight-week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE. A total of 1408 stool specimens were submitted over the 48-week study period. Sixty-seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin-resistant E faecium -VREF- (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and LY333328. VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).

Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: A study of 143 patients

Study Objective: To study the epidemiology of Stenotrophomonas maltophilia infections in the intensive care units (ICUs) of community general hospitals. Design: Retrospective chart review of 143 patients with cultures positive for S. maltophilia over a 2-year period. Setting: Intensive care units of 2 community general hospitals. Results: Patients with S. maltophilia infection or colonization were elderly (mean age 62.4 years), intubated for a mean of 11.8 days, and had a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16.6. A tracheostomy was present in 22.4%, and underlying chronic respiratory disease and malignancy were found in 25.9% and 15.4%, respectively. Only 2 patients (1.4%) were neutropenic. Most isolates (89.5%) were from the respiratory tract and were part of a polymicrobial culture in 52.5% of patients. Only a slightly higher APACHE II score (mean = 18.0, SD 7.8 vs mean = 15.6, SD 6.2, P = 0.052) differentiated patients with infection from those with colonization. All but 2 patients were exposed to antibiotics before their positive culture. Crude mortality rate was 41.3% overall and was significantly higher in those with an APACHE II score of 15 or more (48.8% vs 30.5%, P = 0.028). Conclusion:S. maltophilia is emerging as an important cause of nosocomial infection, especially pneumonia, in ICUs of community general hospitals. Patients tend to be elderly, intubated for a mean of about 12 days, have high APACHE II scores, and frequently have a tracheostomy or underlying chronic respiratory disease. In contrast to earlier reports, neutropenia and underlying malignancy are uncommon in our ICU population. We found prior antibiotic exposure was almost universal and similar to previous reports, but use of imipenem was much less common in our community hospital patients. Patients with a high APACHE II score should be considered infected rather than colonized, but differentiation of infection from colonization remains problematic. Isolation of S. maltophilia from a patient carries a crude mortality rate of 41.3%, and patients with an APACHE II score of 15 or more have a significantly higher mortality rate than those with lesser scores, approaching 50%. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for infections caused by S. maltophilia. (Heart Lung® 1999;28:134-41)

Depressive Symptoms in Elderly Medical-Surgical Patients Hospitalized in Community Settings

The authors examined the rates and correlates of depressive symptoms in adults over age 60 admitted to community hospital settings and compared them with patients admitted to a tertiary-care medical center. Rates of depressive symptoms in patients admitted to five different community hospitals in North Carolina were compared with each other and with a sample of 542 elderly medical patients admitted to Duke University Medical Center (DUMC). Compared with patients at DUMC, community-hospital patients were older and had more cognitive impairment, but had less severe medical illness and shorter hospital stays. The proportion of depressed community patients was significantly higher than among patients admitted to DUMC. In four of the five community hospitals, rates of significant depressive symptoms exceeded 50%. Health correlates of depression were admitting diagnoses other than cardiovascular disease, poor cognitive functioning, and severe medical illness.

Depressive Symptoms in Elderly Medical-Surgical Patients Hospitalized in Community Settings

The authors examined the rates and correlates of depressive symptoms in adults over age 60 admitted to community hospital settings and compared them with patients admitted to a tertiary-care medical center. Rates of depressive symptoms in patients admitted to five different community hospitals in North Carolina were compared with each other and with a sample of 542 elderly medical patients admitted to Duke University Medical Center (DUMC). Compared with patients at DUMC, community-hospital patients were older and had more cognitive impairment, but had less severe medical illness and shorter hospital stays. The proportion of depressed community patients was significantly higher than among patients admitted to DUMC. In four of the five community hospitals, rates of significant depressive symptoms exceeded 50%. Health correlates of depression were admitting diagnoses other than cardiovascular disease, poor cognitive functioning, and severe medical illness.