Component Of Hospital Care Research Articles

Abstract 10813: Impact of Multidisciplinary Rounds in Cardiac Patients

Introduction: A multidisciplinary care approach is the cornerstone of cardiac patient care. Multidisciplinary rounds (MDR) consisting of social workers, nutritionists, pharmacists, physical therapists, nursing and physicians systematically addressing the multifaceted components of hospital care of the cardiac patient have been implemented at many hospitals recently as an effort to increase collaboration throughout the care team and address care gaps. At this time there is little research into the impact of MDR on clinical outcomes. Hypothesis: Implementing MDR will decrease mortality, clinical complications, and length of stay (LOS) while also improving communication between ancillary staff and decreasing readmissions. Method: A single center case control study was conducted comparing Mortality Index, LOS, Clinical Complications (defined as adverse events documented during hospital stay), 30 day readmissions, and number of ancillary staff consults prior to implementation of MDR and after in patients admitted to the cardiology inpatient service at our major metropolitan academic medical center. Study duration was 34 months total with 2,695 unique hospital encounters studied. Results: Mortality Index after MDR implementation decreased from 1.179 to 0.648 and was statistically significant (p-value 0.06, CI -1.087,0.025). Average number of complications decreased by 27% (3.15 to 2.29) in response to MDR and average ancillary consults (Physical Therapy and Nutritional/Dietitian Consults) increased by 39.7% (19.75 to 27.6) and 182% (2.8 to 7.9) respectively. No significant change was observed in 30 day readmissions or LOS. Conclusion: MDR had statistically significant decrease on mortality index on cardiac patients admitted. MDR positively impacted resource utilization with appropriate consultations for ancillary services increasing. Continuation of MDR may impact LOS and readmissions over time.

Costs of inpatient and emergency department care for chronic obstructive pulmonary disease in an elderly Medicare population

Objective:Treatment in the hospital setting accounts for the largest portion of healthcare costs for COPD, but there is little information about components of hospital care that contribute most to these costs. The authors determined the costs and characteristics of COPD-related hospital-based healthcare in a Medicare population.MethodsUsing administrative data from 602 hospitals, 2008 costs of COPD-related care among Medicare beneficiaries age ≥65 years were calculated for emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, and intensive care/intubation) in a cross-sectional study. Rates of death at discharge and trends in costs, length of stay and readmission rates from 2005 to 2008 also were examined.Main results:There were 45,421 eligible healthcare encounters in 2008. Mean costs were $679 (SD, $399) for ED visits (n = 10,322), $7,544 ($8,049) for simple inpatient admissions (n = 25,560), and $21,098 ($46,160) for complex admissions (n = 2,441). Intensive care/intubation admissions (n = 460) had the highest costs ($45,607, SD $94,794) and greatest length of stay (16.3 days, SD 13.7); intubation/no ICU admissions had the highest inpatient mortality (42.1%). In 2008, 15.4% of patients with a COPD-related ED visit had a repeat ED visit and 15.5–16.5% of those with a COPD-related admission had a readmission within 60 days. From 2005 to 2008, costs of admissions involving intubation increased 10.4–23.5%. Study limitations include the absence of objective clinical data, including spirometry and smoking history, to validate administrative data and permit identification of disease severity.Conclusions:In this Medicare population, COPD exacerbations and related inpatient and emergency department care represented a substantial cost burden. Admissions involving intubation were associated with the highest costs, lengths of stay and inpatient mortality. This population needs to be managed and treated adequately in order to prevent these severe events.

Can patients evaluate the quality of hospital care?

We have found that patients have distinct opinions about many components of hospital care, but that little recent work has identified those components important to today's patients in the United States. Investigators have constructed reproducible scales to obtain evaluations. Patient evaluations of the interpersonal features of hospital care are influenced by interventions that physicians or nurses identify as "higher" quality of care. We do not know if patient reports and ratings of specific aspects of care accurately reflect the effects of hospital care on health outcomes--the quality standard that public agencies and payers may consider the most important. However, patient evaluations of nursing care and medical care are independently related to patients' overall satisfaction, overall assessments of quality, and intentions to recommend and return to the same hospital. More studies are needed to clarify whether other components of hospital care also contribute to these ratings and intentions and, if so, how much. Nonresponse bias affects patient surveys, making patient ratings of care in each sample more favorable than the population mean; we do not know how this affects conclusions of surveys that compare hospitals or treatments. Few studies have compared how different methods affect the reproducibility and accuracy of patient reports and ratings. Practical issues may be the most important obstacles for users of patient ratings, particularly regarding whether potential users will be able to interpret results and accept them. Finally, no comprehensive instrument or survey method in the published literature has been tested enough to be recommended as a reproducible, accurate, and interpretable quality measure: a few do, however, appear worthy of further testing.