Decline In Hospitalization Rates Research Articles

Decline in hospitalization risk and health care cost after initiation of depot antipsychotics in the treatment of schizophrenia

Purpose:To assess change in hospitalization and cost of care from 6 months pre- to 6 months post-initiation on any depot antipsychotic among schizophrenia patients.Patients and methods:Using a large United States commercial claims and encounters database, patients younger than 65 years diagnosed with schizophrenia were identified. Patients initiated on a depot antipsychotic were studied in a mirror-image design to assess change in hospitalization rates, mean duration hospitalized, and hospitalization cost. McNemar’s test and paired t-tests compared the proportions of patients hospitalized and the mean duration. Paired t-test and bootstrapping methods compared costs.Results:In these patients (n = 147), psychiatric hospitalizations declined from 49.7% pre-initiation to 22.4% post-initiation (P < 0.001), and the mean hospitalized duration for psychiatric purposes numerically declined from 7.3 to 4.7 days (P = 0.05). Total health care costs declined from $11,111 to $7884 (P < 0.05) driven by reduction in costs for psychiatric hospitalizations from $5384 to $2538 (P < 0.05).Conclusion:Initiation of depot antipsychotic therapy appeared to be associated with a decline in hospitalization rates and costs. Current findings suggest that treatment with depot antipsychotics may be a cost-effective option for a subgroup of patients with schizophrenia who are at high risk of nonadherence with their oral antipsychotic medication regimen.

Time Trends in Hospital-Referred Stroke and Transient Ischemic Attack: Results of a 7-Year Nationwide Survey in France

Background: Nationwide evaluations of the burden of stroke are scarce. We aimed to evaluate trends in stroke and transient ischemic attack (TIA) hospitalization, in-hospital case fatality rates (CFRs) and mortality rates in France during 2000–2006. Methods: Hospitalizations for stroke and TIA were determined from National Hospital Discharge Diagnosis Records that used the International Classification of Disease, 10th revision, codes I60, I61, I63, I64, G45, G46. CFRs and mortality rates were estimated from the national death certificates database. Results: The total number of stays for stroke increased between 2000 and 2006 (88,371 vs. 92,118) contrasting with a decrease in that for TIA. The age-standardized (European population) hospitalization rates for TIA decreased in men (52.2 vs. 44.5/100,000/year, p = 0.002), whereas they remained stable in women (32.4 vs. 31.0/ 100,000/year). Concerning stroke, a decrease in hospitalization rates was observed in both men (from 135.3 to 123.4/ 100,000/year, p < 0.001) and women (from 85.1 to 80.7, p < 0.001). Whatever the age group and the sex, a sharp decrease in in-hospital stroke CFRs was noted. In addition, a 23% decrease in mortality rates was observed. This decrease was greater in patients >65 years. Conclusion: Our results demonstrate a decline in hospitalization rates for stroke, and in both stroke CFRs and mortality rates between 2000 and 2006. Improvements in stroke prevention and acute stroke care may have contributed to these results, and may have been initiated by recent advances in health policy with regard to this disease in France.

Declining US Stroke Hospitalization since 1997: National Hospital Discharge Survey, 1988–2004

Background and Purpose: While age-adjusted stroke mortality in the United States has declined consistently during the last century, trends in stroke incidence and hospitalization are less known. This study examines trends in stroke hospitalization from 1988 to 2004. Methods: Stroke hospitalizations were estimated from the annual National Hospital Discharge Survey, 1988–2004. Stroke was defined as a first-listed diagnosis of ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) code 430–434 or 436–438. Trends in hospitalization rates were compared for groups defined by selected patient characteristics. Results: Stroke hospitalizations totaled 603,000 in 1988, peaked at 833,000 in 1997, then declined to 726,000 in 2004, a figure still higher than in 1988. Age-adjusted stroke hospitalization rates for men (per 100,000 population) increased from 287 in 1988 to 352 in 1997, but declined to 265 in 2004, and for women, rates were 252, 293 and 223 in the corresponding years. The majority of stroke hospitalizations in 2004 occurred at ages ≧65 years (69% in men and 78% in women). Decline in rates after 1997 occurred at ages 65–74 and ≧75 years. In 2004, 64% of strokes were classified as ischemic, 16% as hemorrhagic and 16% as ill-defined. Decline in hospitalization rates after 1997 were observed for ischemic and ill-defined, but not for hemorrhagic stroke. Between 1988 and 2004, the reporting of hypertension, diabetes and coronary heart disease as secondary diagnoses among stroke hospitalizations increased. Conclusions: Decline in stroke hospitalizations since 1997 was observed among men and women >65 years, who suffered ischemic or ill-defined stroke. Although long-term observation is needed to confirm this finding, the decline in stroke hospitalizations after 1997 suggests treatment of hypertension may have resulted in stroke prevention.

Police drug crackdowns and hospitalisation rates for illicit-injection-related infections in New York City

Using longitudinal data, this analysis tests the hypothesis that eight police drug crackdowns implemented in 27 New York City police precincts between 1995 and 1999 were associated with subsequent increases in monthly precinct-specific hospitalisation rates for illicit-injection-related abscesses, cellulitis, and endocarditis. Crackdowns are sustained police initiatives designed to reduce the possession and sale of illicit drugs through heightened surveillance and arrests of drug users and street-level dealers. We linked hospitalisation data (48,986 illicit-injection-related abscess or cellulitis cases and 5452 illicit-injection-related endocarditis cases) and arrest and United States Census data to police precincts to calculate hospitalisation and arrest rates. Analyses indicate that drug-related arrest rates climbed 39% in the crackdowns’ first year compared with the previous year. Contrary to our hypothesis, we found evidence of a stasis or decline in hospitalisation rates in the crackdowns’ first year, based on multivariate Poisson regression models that included sensitivity analyses that accounted for the increased incarceration of injectors after each crackdown's onset. We discuss several possible explanations for these findings and conclude that future research is warranted regarding the relationship between police strategies and drug users’ health that incorporates inmate health data and both individual-level and precinct-level data.

Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause peptic ulcer disease and upper GI bleeding. Acid suppression medications effectively treat NSAID-induced ulcers. However, it is unknown what effect the availability of proton pump inhibitors and over-the-counter preparations of NSAIDs and histamine type 2 receptor antagonists have had on population rates of hospitalization and mortality from GI toxicity. This study examines trends in hospitalization and mortality rates from GI toxicity during the 1990s. METHODS: We performed an analysis of secular trends of hospitalization and mortality rates from peptic ulcer disease, upper GI bleeding, and any GI bleeding using data from the National Hospital Discharge Survey, comparing them with sales of NSAIDs, aspirin, and acid suppression medications from 1992 to 1999. RESULTS: From 1992 to 1999, annual rates of hospitalization and mortality per 100,000 population for peptic ulcer disease declined from 205 to 165 and 7.7 to 6.0, respectively; calendar year was negatively correlated with both peptic ulcer disease hospitalization rates (ρ = −0.88, p = 0.007) and mortality rates (ρ = −0.71, p = 0.058). In contrast, these correlations did not reach statistical significance for upper or any GI bleeding ( p > 0.1 for all comparisons). Sales of acid suppression medications were negatively correlated with peptic ulcer disease hospitalization rates (ρ = −0.76, p = 0.037) and mortality rates (ρ = −0.83, p = 0.015). Sales of NSAIDs were not positively correlated with hospitalization or mortality rates from peptic ulcer disease or GI bleeding ( p > 0.2 for all comparisons). CONCLUSIONS: Despite changing patterns of use of NSAIDs and acid suppression medications during the 1990s, mortality rates from GI bleeding and peptic ulcer disease have been relatively stable, with an apparent decline in hospitalization rates and mortality from peptic ulcer disease. Changing rates of peptic ulcer disease morbidity and mortality were temporally related to increasing sales of antiulcerants but not to change in sales of NSAIDs.

Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause peptic ulcer disease and upper GI bleeding. Acid suppression medications effectively treat NSAID-induced ulcers. However, it is unknown what effect the availability of proton pump inhibitors and over-the-counter preparations of NSAIDs and histamine type 2 receptor antagonists have had on population rates of hospitalization and mortality from GI toxicity. This study examines trends in hospitalization and mortality rates from GI toxicity during the 1990s. We performed an analysis of secular trends of hospitalization and mortality rates from peptic ulcer disease, upper GI bleeding, and any GI bleeding using data from the National Hospital Discharge Survey, comparing them with sales of NSAIDs, aspirin, and acid suppression medications from 1992 to 1999. From 1992 to 1999, annual rates of hospitalization and mortality per 100,000 population for peptic ulcer disease declined from 205 to 165 and 7.7 to 6.0, respectively; calendar year was negatively correlated with both peptic ulcer disease hospitalization rates (p = -0.88, p = 0.007) and mortality rates (p = -0.71, p = 0.058). In contrast, these correlations did not reach statistical significance for upper or any GI bleeding (p > 0.1 for all comparisons). Sales of acid suppression medications were negatively correlated with peptic ulcer disease hospitalization rates (p = -0.76, p = 0.037) and mortality rates (p = -0.83, p = 0.015). Sales of NSAIDs were not positively correlated with hospitalization or mortality rates from peptic ulcer disease or GI bleeding (p > 0.2 for all comparisons). Despite changing patterns of use of NSAIDs and acid suppression medications during the 1990s, mortality rates from GI bleeding and peptic ulcer disease have been relatively stable, with an apparent decline in hospitalization rates and mortality from peptic ulcer disease. Changing rates of peptic ulcer disease morbidity and mortality were temporally related to increasing sales of antiulcerants but not to change in sales of NSAIDs.

Dissociation of hospitalization and mortality trends for myocardial infarction in the United States from 1988 to 1997

PurposeAlthough age-adjusted mortality from myocardial infarction in the United States has declined during the past few decades, changes in the incidence of myocardial infarction are less certain. To address this issue, we evaluated trends in hospitalization for, and in-hospital mortality from, myocardial infarction from 1988 to 1997. MethodsHospitalization rates were determined by age and sex using data from the National Hospital Discharge Survey and the Current Population Survey. Comorbid conditions, complications, use of cardiac procedures, and in-hospital mortality were measured. In-hospital mortality was estimated after adjusting for associated risk factors, complications, use of invasive diagnostic and therapeutic procedures, and length of stay. ResultsAge-adjusted rates of hospitalization for myocardial infarction were 525 per 100,000 in 1988 and 482 per 100,000 in 1997, with a mean annual decline of 0.8% (P = 0.32). Mortality declined from 58 per 100,000 in 1988 to 40 per 100,000 in 1997, a mean annual decline of 4.2% (P = 0.01). During these 10 years, although the median hospital stay for myocardial infarction decreased from 8 to 5 days, the intensity of hospital care increased, including use of angiography from 20% to 31% (P = 0.04) and revascularization from 16% to 31% (P = 0.004). Age-adjusted in-hospital mortality decreased by nearly half, from 7.6% in 1988 to 3.9% in 1997 (P = 0.006). ConclusionDuring the past decade, the decline in mortality from myocardial infarction in the United States has not been accompanied by a decline in hospitalization rate. At the same time, there has been a marked increased in the use of cardiac revascularization.

Ambulatory care for traumatic brain injuries in the US, 1995-1997

The burden of mild traumatic brain injury (TBI) is not well understood at the national level, but hospitalization rates show a decline over time. This paper describes ambulatory care for TBI patients at physician offices, hospital outpatient departments, and emergency departments (EDs) in comparison with non-TBI visits for the US during 1995-1997. An estimated 1.4 million visits for TBI were made each year for an average annual rate of 5.4/1000 population. A decline in annual visit rate was noted during 1995-1997. Visit rates were higher for those aged 0-14 and 75 and older. Falls (44%) and motor vehicles (28%) were the primary injury causes. Rural-urban differences were found, also in comparison with non-TBI. In 23% of visits to EDs, a CT scan was ordered or performed and in 33% a mental status exam was conducted. Further investigations are warranted to describe ambulatory care for TBI in more detail, particularly in light of a decline in hospitalization rates.

Hospitalization and case-fatality rates for subarachnoid hemorrhage in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations.

Subarachnoid hemorrhage (SAH) has a different epidemiological profile from other types of stroke and a different etiology. Although there has been a general decline in overall stroke incidence since the 1950s, secular trends for SAH have been modest. In contrast to other stroke types, changes in incidence over the last few decades have been less clear. The purpose of this study was to estimate hospitalization and case-fatality rates of SAH according to age, sex, calendar year, and season. Data were obtained for each of Canada's 10 provinces for the 10 fiscal years 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 430 according to the International Classification of Diseases, 9th Revision, were included. Rates of SAH per 100,000 population were calculated for men and women for 5-year age groups, by calendar year, and by season. Annual age- and sex-specific (hospital) case-fatality rates up to 30 days were also calculated. Additionally, hospital deaths from this study were related to national SAH mortality statistics. A total of 14145 women and 8995 men were discharged with a primary diagnosis of SAH during the 10-year period. In contrast to other types of stroke, the rates of SAH were higher for women than for men at all ages. The age-standardized rates of SAH in 1991-1992 were 11.2 per 100000 women and 8.0 per 100000 men. For women, there was a 6% (95% confidence interval [CI], -12% to 0%) decline in hospitalization rates over that period; for men, the decline was 15% (95% CI, -21% to -8%). The peak season for SAH among women was winter; for men the peaks were in the fall and spring. For both sexes, the lowest occurrence was in the summer. Over this period, 30-day case-fatality rates declined somewhat (statistically significant only in the age group of 35 to 44 years). The number of deaths enumerated from hospital discharges was 20% to 50% lower than the number recorded on national mortality statistics, indicating that a proportion of SAH deaths occurred before (or after) the hospital stay. Although rates of hospitalization for SAH declined over this period, SAH remains an important neurological event affecting individuals at relatively young ages. The rates were higher for women than for men at all ages. Total (in-hospital) case-fatality rate remains high.

Hospitalizations for Traumatic Injuries Among Children in Maryland:Trends in Incidence and Severity: 1979 Through 1988

Trends in incidence and severity of hospitalized injury among children aged 0 through 13 years in the state of Maryland from 1979 through 1988 (n = 35,746) were examined using routinely reported hospital discharge data. Hospital discharge rates declined over the study period from 509 per 100,000 population in 1979 to 320 in 1988. There was a decline in incidence trends for both races. However, the decrease in the nonwhite population was smaller than in whites. Analysis of incidence rates for specific Injury Severity Score groups revealed a declining trend in all Injury Severity Score groups, although the mildest group (Injury Severity Score 1 through 4) had the most notable decline of 44% compared with an average decline of 20% in the other severity groups. These data suggest a change in admission practices of mildly injured children as a major cause for the observed overall decline in hospitalization rates. The smaller decrease in the hospitalization rates of non-white children compared with white children requires further study to determine the cause.

The effects of policies and programs on reduction of mental hospitalization

A significant decline in hospitalization rates for mental patients has occured in the last 25 years, but the rate and pace of decline has varied considerably within the U.S. A comparative epidemiological study was designed to understand these variations. Specific policies and programs used in some states were found to be associated with observed patterns of decline in the resident mental hospital population rates for those states. In particular comparison of trends for California and New York in patient rates and in administrative policies provides important information about useful administrative policies and program where the stated policy goal is to reduce the resident population in state and county mental institutions.