Decrease In Hospitalization Rates Research Articles

A look at electric bike casualties: Do they differ from the mechanical bicycle?

ObjectiveTo evaluate and compare, at the national level, injury trends and, characteristics and to identify high risk groups of electric bike (E-bike) and mechanical bicycle (M-bike) related hospitalizations as a key message for public policy. MethodsHistoric prospective study based on data from the Israel National Trauma Registry (INTR), between 1.1.2013 and 31.12.2017. All hospitalized casualties were E-bikers and M-bikers. ResultsDuring the study period, 1733 E-bikers and 7259 M-bikers were hospitalized. Arab children (age 0–15) and young adults (age 16–29) were at higher risk for E-bike and M-bike casualties respectively. The hospitalization rate per 1000 vehicles was lower for E-bikers in comparison to M-biker. However, during the five year period a dramatic increase in E-bike related hospitalizations was reported coinciding with a decrease of M-bike related casualties. Among M-bikers, the decrease in hospitalization rate was for accidents on both inter and intra-city roads, but not on unpaved roads, which remained stationary, suggesting that the transportation mode is changing. In comparison to the M-bikers, E-bikers were at greater risk for enduring head injuries (OR 1.16 95% CI 1.00–1.25) and lower extremity injuries (OR 1.37 95% CI 1.23–1.52), to undergone surgery (OR 1.13 95% CI 1.00–1.26), having longer hospital stays (OR 1.44 95% CI 1.23–1.68) and being discharged to rehabilitation center (OR 1.43 95% CI 1.09–1.86). ConclusionDuring the last five years in Israel there is a dramatic increase in E-bike related hospitalized casualties corresponding to a substantial increase in E-bike usage. In comparison to M-bikers, there is a lower casualty rate but these casualties are more severely injured and utilize more hospital resources. It is of utmost importance to identify these high risk groups in an effort to develop culturally appropriate interventions for these road users, including training, awareness and helmet enforcement. Policy change recommendations are discussed.

Herpes Zoster Burden in Canadian Provinces: A Narrative Review and Comparison with Quebec Provincial Data.

Background The main aim of this review was to assess incidence rates and trends of medically attended and death cases of herpes zoster in Canada. Methods The search was conducted in five databases (PubMed, Cochrane, Embase, PsycNET, and Web of Science). Data on herpes zoster-related consultations and hospitalisations and deaths were also extracted from three Quebec provincial administrative databases (RAMQ, MED-ECHO, and ISQ). Results The electronic search yielded 587 publications. Seventeen publications satisfied inclusion criteria. These publications reported data from eleven studies. Ten studies used provincial databases, and one study used the Canadian Primary Care Sentinel Surveillance Network electronic database. Seven studies evaluated overall rates of medically attended cases (consultations and hospitalisations). Four of these studies reported an increase in rates of medically attended cases during the study period; one study reported stable rates, and two studies reported only an average rate. The rates varied from 316 to 450/100,000 p.y. The Quebec analysis shows similar rates with a slight decreasing trend (from 369 to 350/100,000 p.y.). Incidence rates of consultations were reported separately in three studies. Two studies reported an increase in rates (from 258 to 348/100,000 p.y. and from 324 to 366/100,000 p.y.), and the third study reported a decrease (from 525 to 479/100,000 p.y.). Hospitalization rates were reported separately in two studies, both reporting a decrease (from 12 to 8 cases/100,000 p.y. and from 9 to 4 cases/100,000 p.y.). Quebec data also showed a decrease, from 9 to 6 cases/100,000 p.y. One study reported herpes zoster-related deaths. In this study, the reported death rate was 0.7/1,000,000 p.y. in the overall population and 5.5/1,000,000 p.y. in those aged ≥65 years. Quebec analysis showed a death rate of 1.2/1,000,000 p.y. in the overall population and 8.6/1,000,000 p.y. in those aged ≥65 years. Conclusions The results of the reviewed studies and our analysis of Quebec provincial data indicate important variations in the reported overall incidence rates of medically attended herpes zoster cases in Canada. The trends in time are heterogeneous in studies in which hospitalisations and medical consultations were pooled together. We observed a decrease in hospitalization rates and a slight increase in consultation rates in studies reporting hospitalisations and consultations separately. These results consolidate the understanding of the herpes zoster burden in Canada and might be used as a tool in decision-making regarding future preventive interventions.

The Global Incidence of Peptic Ulcer Disease at the Turn of the 21st Century: A Study of the Organization for Economic Co—Operation and Development (OECD)

Introduction: The incidence of peptic ulcer disease (PUD) and its complications vary worldwide and have changed over the past few decades with the identification of H. pylori and NSAIDs as major etiologic factors, as well as the marked increase in the use of PPIs. Our primary objective was to determine differences in the worldwide trends of PUD incidence starting at the turn of the 21st century. Methods: We obtained data from the Organization for Economic Co—Operation and Development (OECD) database on hospital discharges with PUD as a primary diagnosis for 35 countries from 2000 to 2015. Hospitalization rates were converted to rates per 100,000 person—years. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI) for the rate of PUD—related hospitalizations for each country from 2000 to 2015 according to 3 predefined 5—year periods: 2000—2005; 2006—2010; and 2011—2015 (Table 1). Temporal inflection points were also assessed. Choropleth maps were created to illustrate the differences in hospitalization rates over time by geographic location, stratified by terciles of hospitalization rates (Fig. 1). We additionally performed a random—effects meta—analysis of AAPCs to calculate an overall AAPC (Fig. 2).1198_A Figure 1. Hospitalization rates and temporal trends for PUD hospitalizations among 35 OECD Countries at the turn of the 21st century.1198_B Figure 2. Forest plot of pooled AAPC in the hospitalization for PUD in OECD countries.Results: PUD—related hospitalization rates from OECD countries are presented in Table 1. The overall median hospitalization rate was 45.81 with an interquartile range (IQR) of 31.49 to 63.61 per 100,000 person—years. Average hospitalization rates from 2011 to 2015 were highest in Eastern Europe (Lithuania: 135.16), Western Europe (Germany: 84.90), and Asia (Turkey: 80.05), while they were lowest in South America (Mexico 4.54 and Chile 14.48) and Asia (Israel 12.98). All countries demonstrated decreasing hospitalization rates except for Switzerland (Table 1, Fig. 2). Overall, hospitalization rates for PUD decreased significantly from 2000 to 2015 (Pooled AAPC = —3.9%; 95% CI: —3.3, —4.5) (Fig. 2). Conclusion: PUD—related hospitalizations are decreasing in the vast majority of OECD countries and likely reflect an overall decreasing incidence of PUD. That said, PUD—related complications continue to pose an important health issue with significant demands on health care systems. Detailed data collection and analysis which includes the different disease subtypes and complications would aid in developing improved strategies for accelerating the downward trend in PUD and its complications.1198_C Figure 3. PUD—related hospitalization incidence rate terciles for OECD countries in 3 time periods: A. 2000—2005, B. 2006—2010, C. 2011—2015.

Daily duration of long-term oxygen therapy and risk of hospitalization in oxygen-dependent COPD patients.

IntroductionLong-term oxygen therapy (LTOT) improves survival and may reduce hospital admissions in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia, but the impact of daily duration of LTOT on hospitalization rate is unknown. We aimed to estimate the association between the daily duration of LTOT (24 vs 15 h/d) and hospital admissions in patients with LTOT due to COPD.Materials and methodsA population-based, cohort study included patients who started LTOT due to COPD between October 1, 2005 and June 30, 2009 in the Swedish national register for respiratory failure (Swedevox). Time to first hospitalization from all causes and from respiratory or nonrespiratory disease, using the National Patient Registry, was analyzed using Fine–Gray regression, adjusting for potential confounders.ResultsA total of 2,249 patients with COPD (59% women) were included. LTOT 24 h/d was prescribed to 539 (24%) and LTOT 15–16 h/d to 1,231 (55%) patients. During a median follow-up of 1.1 years (interquartile range, 0.6–2.1 years), 1,702 (76%) patients were hospitalized. No patient was lost to follow-up. The adjusted rate of all-cause hospitalization was similar between LTOT 24 and 15–16 h/d (subdistribution hazard ratio [SHR] 0.96; [95% CI] 0.84–1.08), as was cause-specific hospitalizations analyzed for respiratory disease (SHR: 1.00; 95% CI: 0.86–1.17) and nonrespiratory disease (SHR: 0.92; 95% CI: 0.75–1.14).ConclusionLTOT prescribed for 24 h/d was not associated with decreased hospitalization rates compared with LTOT for 15–16 h/d in patients with oxygen-dependent COPD. The results should be validated in a randomized controlled trial.

HIV Treatment Substantially Decreases Hospitalization Rates: Evidence From Rural South Africa.

The effect of HIV treatment on hospitalization rates for HIV-infected people has never been established. We quantified this effect in a rural South African community for the period 2009-13. We linked clinical data on HIV treatment start dates for more than 2,000 patients receiving care in the public-sector treatment program with five years of longitudinal data on self-reported hospitalizations from a community-based population cohort of more than 100,000 adults. Hospitalization rates peaked during the first year of treatment and were about five times higher, compared to hospitalization rates after four years on treatment. Earlier treatment initiation could save more than US$300,000 per 1,000 patients over the first four years of HIV treatment, freeing up scarce resources. Future studies on the cost-effectiveness of HIV treatment should include these effects.

Acute Hospital Encounters in Cancer Patients Treated With Definitive Radiation Therapy

Acute hospital encounters in patients undergoing curative-intent radiation therapy (RT) have not previously been well characterized. Understanding acute visit patterns among RT patients yields insights for risk assessments and cancer urgent care clinics that could decrease hospitalization rates and reduce health care costs. This study aims to identify patient, disease-site, and treatment characteristics associated with emergency department visits and inpatient admissions in cancer patients treated with definitive RT. A retrospective cohort study was conducted using data from a quaternary-care cancer center. The cohort was defined as all consecutive patients aged ≥ 18years who began RT between July 1, 2011, and December 31, 2013; were without metastases; and were treated with curative intent. An acute encounter was defined as an emergency department visit or inpatient admission during RT or within 30days after the conclusion of RT. Among 1852 unique RT courses, 666 RT courses (36.0%) involved at least 1 acute encounter, and a total of 1418 acute encounters were identified. RT courses with at least 1 acute encounter corresponded to patients more likely to be on their second (odds ratio [OR], 1.96; P<.001) or third (OR, 3.82; P<.05) RT course and undergoing concurrent chemotherapy (OR, 6.38; P<.001). Among the RT courses with at least 1 acute encounter, the most common disease site was thoracic (22.8%), followed by head and/or neck (22.2%) and gastrointestinal (18.3%). Central nervous system tumors had the greatest proportion of RT courses with acute encounters (77.1%). In this retrospective analysis, more than one-third of curative-intent RT courses were associated with at least 1 acute hospital encounter during or shortly after irradiation. Given that acute encounters varied by patient, disease-site, and treatment characteristics, these findings can inform targeted preventive measures to reduce cancer-related acute hospital encounters and guide improved management protocols.

Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor

AimsRemote haemodynamic monitoring (RHM) decreases hospitalization rates in patients with chronic heart failure (HF). Many patients with chronic HF develop pulmonary hypertension (PH) secondary to left heart disease with some acquiring combined pre‐capillary and post‐capillary PH (Cpc‐PH). The efficacy of RHM in achieving pulmonary pressure reductions in patients with Cpc‐PH vs. isolated post‐capillary PH (Ipc‐PH) is unknown. The purpose of this study is to evaluate whether a higher baseline diastolic pressure gradient (DPGbaseline) measured at the time of CardioMEMS™ HF sensor implantation is associated with lower reductions in pulmonary artery diastolic pressures (PADP).Methods and resultsThis was a retrospective analysis of 32 patients meeting clinical indications for CardioMEMS™ implantation. DPGbaseline categorized patients as Cpc‐PH (DPG ≥ 7 mmHg) or Ipc‐PH (DPG < 7 mmHg). Minimum achievable PADP (PADPmin) and ∆PADP (PADPbaseline − PADPmin) were determined. Pearson's correlation analysis and comparison of mean pressure changes were assessed. Median age was 69 years, and median left ventricular ejection fraction (LVEF) was 25%. Eight patients (25%) had a LVEF ≥40%. Twenty‐five patients (78%) met criteria for Ipc‐PH and seven (22%) for Cpc‐PH. Neither PADPmin (ρ = 0.27; P = 0.13) nor ΔPADP (ρ = 0.07; P = 0.72) was correlated with DPGbaseline. A trend towards higher ΔPADP was seen in Cpc‐PH vs. Ipc‐PH patients (15.2 vs. 9.88 mmHg; P = 0.12). There was a moderate positive correlation between baseline PADP and ΔPADP [ρ = 0.55 (0.26–0.76); P < 0.001].ConclusionsDecreased PADP reduction was not seen in Cpc‐PH vs. Ipc‐PH patients. Higher PADPbaseline was associated with greater ΔPADP. Larger studies are needed to elaborate our findings.

Abstract WMP93: Trends in Stroke Hospitalizations in California: 2005-2014

Objectives: Little information is known about the recent trends of sex-, age-, race/ethnicity-, and stroke type-specific stroke hospitalizations in California. Understanding the information is important for the evaluation of regional health policies, healthcare planning and resource allocation, and stroke prevention strategies. The study reports statewide trends in hospitalization rates and mortality of stroke in California from 2005 to 2014. Methods: Adult patients admitted to California-licensed acute care hospitals for acute stroke from 2005 to 2014 were included in the study. Data were from the California patient discharge data. Sex-, age-, race/ethnicity- and stroke type-specific stroke hospitalization rates were calculated based on the California population. Results: Of 2,085,120 adult hospitalizations with stroke from 2005 to 2014, 831,236 patients were admitted for acute stroke. From 2005 to 2014, the overall stroke hospitalization rate decreased 9.7% (309.4 to 279.5 per 100,000). The decrease in hospitalization rates for women (14.0%) was significantly greater than that for men (4.8%). However, there was a significant increase of hospitalization rates in younger groups for both men and women, which was mainly driven by ischemic stroke: Men aged 18 to 34 years had the highest increase in ischemic stroke hospitalization rates (37.2%), followed by men aged 35 to 44 years (32.0%), aged 45 to 54 years (23.0%), and aged 55 to 64 years (12.1%), while men aged ≥ 65 years had a significant decrease (13.7%). Women had the similar, but less steep trend compared to men. Blacks had the highest hospitalization rates, followed by Whites and Asians. The rates decreased for Whites (12.4%), but increased for Native Americans (34.7%) over a decade. The overall in-hospital mortality rate decreased from 7.2% in 2005 to 6.1% in 2014; the decrease was not significantly different by sex, age (&lt; 55 years) or stroke type. Conclusions: Overall California stroke hospitalization rates decreased from 2005 to 2014, but hospitalization rates for ischemic stroke increased, with a significant increase in younger groups. The trends of stroke hospitalization rates over the decade varied by sex, age, race/ethnicity and stroke type.

Abstract TMP93: Early Intervention in Vascular Mild Cognitive Impairment Improves Treatment of Vascular Risk Factors and Decreases Hospitalization Rates

Hypothesis: Early intervention in VaMCI leads to improved management of vascular risk factors and decreased utilization of hospital resources. Methods: An individualized patient and family education session encouraging increased supervision of medication use, specifically for antiplatelets, statins, antihypertensives, diabetes medications and anticoagulants, was implemented at the time of diagnosis and continued at 6-month intervals. Medication adherence, treatment parameters and number of individuals with emergency room (ER) visits or hospital admissions were recorded in 72 consecutive patients for 12 months before and after the VaMCI diagnosis. Treatment parameters included average systolic (SBP) and diastolic (DBP) blood pressure, LDL, HgA1c and percentage of INR within therapeutic range. Non-adherence was defined as a lag of ≥3 months in refills over 12 months. Results: Improved adherence for antiplatelets (55% to 94%), statins (68% to 94%) and antihypertensives (59% to 93%; p’s &lt;0.0001), decreases in average SBP (-8.6 mmHg, p&lt;0.0001), DBP (-3.2 mmHg, p=0.01), LDL (-9.4, p&lt;0.0001), and HgA1c (-0.4%, p=0.001) and increased percentage of INR within therapeutic range (+21%, p=0.001) were noted after the intervention. The number of ER visits and/or hospital admissions declined after the intervention (36 vs 20, p=0.001) with a decline in one ER visit or hospital admission for every three patients receiving the intervention. Logistic regression showed that improved adherence to antiplatelets was the only significant predictor of a decline in ER visits or hospital admissions (OR=3.0, p=0.04). Conclusions: Medication adherence counselling for VaMCl patients leads to improved treatment of risk factors and decreased utilization of hospital resources. The strongest predictor of reduced ER visits and admissions in our cohort was improved adherence to antiplatelet therapy.

Implementation of a Prehospital Protocol Change For Asthmatic Children

Background: Respiratory distress due to asthma is a common reason for pediatric emergency medical services (EMS) transports. Timely initiation of asthma treatment, including glucocorticoids, improves hospital outcomes. The impact of EMS-administered glucocorticoids on hospital-based outcomes for pediatric asthma patients is unknown. Objective: The objective of this study was to evaluate the effect of an evidence-based pediatric EMS asthma protocol update, inclusive of oral glucocorticoid administration, on time to hospital discharge. Methods: This was a retrospective cohort study of children (2–18 years) with an acute asthma exacerbation transported by an urban EMS system to 10 emergency departments over 2 years. The investigators implemented an EMS protocol update one year into the study period requiring glucocorticoid administration for all patients, with the major change being inclusion of oral dexamethasone (0.6 mg/kg, max. dose = 10 mg). Protocol implementation included mandatory paramedic training. Data was abstracted from linked prehospital and hospital records. Continuous data were compared before and after the protocol change with the Mann-Whitney test, and categorical data were compared with the Pearson χ2 test. Results: During the study period, 482 asthmatic children met inclusion criteria. After the protocol change, patients were more likely to receive a prehospital glucocorticoid (11% vs. 18%, p = 0.02). Median total hospital time after the protocol change decreased from 6.1 hours (95% CI: 5.4–6.8) to 4.5 hours (95% CI: 4.2–4.8), p < 0.001. Total care time, defined as time from ambulance arrival to hospital discharge, also decreased [6.6 hours (95% CI: 5.8–7.3) vs. 5.2 hours (95% CI: 4.8–5.6), p = 0.01]. Overall, patients were less likely to be admitted to the hospital (30% vs. 21%, p = 0.02) after the change. Those with more severe exacerbations were less likely to be admitted to a critical care unit (82% vs. 44%, p = 0.02) after the change, rather than an acute care floor. Conclusions: Prehospital protocol change for asthmatic children is associated with shorter total hospital and total care times. This protocol change was also associated with decreased hospitalization rates and less need for critical care in those hospitalized. Further study is necessary to determine if other factors also contributed

An Intervention to Reduce Medication Noncompliance and Hospitalizations

Medication noncompliance is a major healthcare problem contributing to patients being rehospitalized shortly after they are discharged. In addition to financial penalties for certain diagnoses, health systems are penalized on quality measures for all rehospitalizations within 30 days, regardless of diagnosis. The purpose of this quality improvement project was to develop and implement a tool utilizing principles of the Theory of Goal Attainment to assist clinicians and patients in mutual goal setting to improve medication compliance, thus indirectly decreasing hospitalization rates. A tool that addresses mutual goal setting in the home healthcare setting was developed by a consultant and implemented at a midsized home healthcare agency. The tool stresses the patient's role in the process to attain goals and presents the clinician as a support system and educator. Effectiveness was evaluated based on data gathered from Home Health Compare. Improvement was noted in five quality indicators.

Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better?

Needle aspiration and chest tube drainages are two main treatments for primary spontaneous pneumothorax (PSP). However, the application of needle aspiration or chest tube drainages has not reached a consensus. The aim of this study is to compare the needle aspiration with chest tube drainages in patients suffering with PSP and therefore help offer suggestions for clinical practice. We searched literatures from PubMed, OVID and Web of Science from their inception to June 30, 2017. Continuous and dichotomous outcomes were expressed by weight mean difference (WMD) and risk ratio (RR) respectively, and each with 95% confidence intervals (CIs). We used the fixed effect or random effect model to perform quantitative synthesis. A total of 6 RCTs recruiting 458 participants were included in our analysis. On the basis of the six studies, our results indicated that compared with chest tube drainage applying needle aspiration shortened the hospital stay (WMD: ‒1.67 days; 95% CI: ‒2.25 to 1.08; P<0.001) and decreased hospitalization rate (RR: 0.40; 95% CI: 0.22-0.75; P=0.004). However, there was no difference regarding immediate success rate (RR: 1.01; 95% CI: 0.70-1.46; P=0.96) and one-year recurrence rate (RR: 0.89; 95% CI: 0.58-1.38; P=0.61). In the light of this present research, it is necessary to apply needle aspiration into treating PSP to reduce hospitalization rate and shorten hospital stay. However, the two treatments have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.

Pneumococcal Conjugate Vaccine Prevents Pneumonia Hospitalizations

Research Article| September 01 2017 Pneumococcal Conjugate Vaccine Prevents Pneumonia Hospitalizations AAP Grand Rounds (2017) 38 (3): 29. https://doi.org/10.1542/gr.38-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Pneumococcal Conjugate Vaccine Prevents Pneumonia Hospitalizations. AAP Grand Rounds September 2017; 38 (3): 29. https://doi.org/10.1542/gr.38-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: 13-valent pneumococcal vaccine, pneumonia, vaccines, conjugate, serotype, invasive pneumococcal disease Source: Olarte L, Barson WJ, Barson RM, et al. Pneumococcal pneumonia requiring hospitalization in US children in the 13-valent pneumococcal conjugate vaccine era. Clin Infect Dis. 2017; 64(12): 1699– 1704; doi: https://doi.org/10.1093/cid/cix115Google Scholar Investigators at multiple institutions conducted a cross-sectional study to assess the prevalence and characteristics of pneumococcal pneumonia (PP) before and after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. Children were eligible if they were ≤18 years old and had PP managed as an inpatient at 1 of 8 participating US children’s hospitals from 2006 to 2014. PP was defined as the isolation of Streptococcus pneumoniae from blood, pleural fluid, lung abscess, or lung tissue, with clinical presentation and radiographic changes consistent with pneumonia. PP was categorized as complicated if there was pulmonary consolidation plus a large pleural effusion (>10-mm rim or ≥25% of the hemithorax opacified), loculated pleural fluid, parapneumonic empyema, necrotizing pneumonia, or lung abscess. Demographic, clinical, and S pneumoniae serotype data were obtained from the medical chart. Investigators compared annual hospitalization rates for all PP, complicated PP, and serotype-specific PP before (2006–2009) and after (2011–2014) PCV13 introduction. There were 377 patients with PP included in the analysis. The hospitalization rate for all PP decreased from 53.6 per 100,000 admissions before PCV13 to 23.3 per 100,000 admissions after PCV13 (P < .0001). Hospitalization rates for complicated PP also decreased significantly. Comorbid conditions were more common among children with uncomplicated pneumonia than complicated pneumonia (52.2% vs 22.5%, respectively; P< .001). The need for intensive care and invasive procedures did not change after the introduction of PCV13. A total of 364 of 377 isolates (96.6%) were available for serotyping and antibiotic susceptibility testing. Although there was a significant decrease in hospitalization rates for PP caused by PCV13 serotypes, they still accounted for 70% of PP cases in the post-PCV13 era (2011–2014). There was no increase in the hospitalization rate of PP caused by non-PCV13 serotypes (4.3 per 100,000 admissions before PCV13 vs 6.7 per 100,000 admissions after PCV13; P = .1). The proportion of isolates susceptible to penicillin increased from 90.8% in 2006–2009 to 97% in 2011–2014 (P = .05). A lower proportion of isolates associated with complicated (91.3%) versus uncomplicated (98.2%) PP were susceptible to penicillin (P = .015). The investigators conclude that hospitalization rates for PP have decreased since the introduction of PCV-13. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The results of the current study agree with those of previous studies, 1,2 which demonstrated a significant decline in the incidence of invasive pneumococcal disease (IPD) among children after the introduction of PCV13. These observations contrast to those for the incidence of pneumococcal meningitis, which, as of 2013, had remained unchanged among these same 8 US children’s hospitals. (See AAP Grand Rounds 2015;34[6]:65.3 )... You do not currently have access to this content.

Infection-related hospitalizations after kidney transplantation in children: incidence, risk factors, and cost.

Infection is the leading cause of death and hospitalization in renal transplant recipients. We describe posttransplant infections requiring hospitalization, their risk factors and cost in a national pediatric kidney transplantation cohort. Data on renal transplant recipients <20years were extracted from the French National Medicoadministrative Hospital Discharge database between 2008 and 2013 and matched with the Renal Transplant Database. We used Cox regression to study risk factors of hospitalization and calculated the instantaneous risk of hospitalization per month for all infections and by infection type. Five hundred and ninety-three patients were included, and 660 infection-related hospitalizations were identified in 260 patients. The leading cause of hospitalization was urinary tract infection (UTI), followed by viral infection (16.6 and 15.6 per 100 person-years, respectively). Risk factors were younger age at transplantation, high number of HLA mismatches, and use cyclosporine rather than tacrolimus as first anticalcineurin treatment. Risk factors varied by infection type. Female gender, uropathy, cold ischemia time, and cyclosporine were associated with increased risk of UTI, while only age at transplantation inversely correlated with virus-related hospitalizations. Instantaneous risk of all infections decreased with time, except for cytomegalovirus (CMV) infection that displayed a peak at 6months posttransplantation after prophylaxis withdrawal. Total cost of infection-related hospitalizations was 1600 kilo-euro (k€) (933 €/person-years). This study highlights the high burden of infection in transplanted pediatric patients, especially the youngest. This should be considered both for pretransplantation information and designing procedures aiming to decrease hospitalization rate and duration.

Cost analysis of pulmonary lobectomy procedure: comparison of stapler versus precision dissection and sealant.

ObjectiveWe aimed to evaluate the direct costs of pulmonary lobectomy hospitalization, comparing surgical techniques for the division of interlobar fissures: stapler (ST) versus electrocautery and hemostatic sealant patch (ES).MethodsThe cost comparison analysis was based on the clinical pathway and drawn up by collecting the information available from the Thoracic Surgery Division medical team at Mantova Hospital. Direct resource consumption was derived from a previous randomized controlled trial including 40 patients. Use and maintenance of technology, equipment and operating room; administrative plus general costs; and 30-day use of postsurgery hospital resources were considered. The analysis was conducted from the hospital perspective.ResultsOn the average, a patient submitted to pulmonary lobectomy costs €9,744.29. This sum could vary from €9,027 (using ES) to €10,460 (using ST). The overall lower incidence (50% vs 95%, P=0.0001) and duration of air leakage (1.7 days vs 4.5 days, P=0.0001) in the ES group significantly affects the mean time of hospital stay (11.0 days vs 14.3 days) and costs. Cost saving in the ES group was also driven by the lower incidence of complications. The main key cost driver was staff employment (42%), then consumables (34%) and operating room costs (12%).ConclusionThere is an overall saving of around €1,432.90 when using ES patch for each pulmonary lobectomy. Among patients undergoing this surgical procedure, ES can significantly reduce air leakage incidence and duration, as well as decrease hospitalization rates. However, further multicenter research should be developed considering different clinical and managerial settings.

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

BackgroundAround 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system.MethodsAdministrative healthcare data collected over the period of April 1st 1997 to March 31st 2014 were analyzed to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care, and hospitalizations within each year.ResultsThe incidence of HZ increased by 49.5% from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14.Drug costs rose significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to $127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p <0.0001) from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI; $74.08, $83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95% CI; $284, $511) to $195/episode (95% CI; $129, $260).Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7% lower than the 1997/98 costs of $2,095,633.ConclusionA significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21% increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts.The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3% in the last 4 study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population.

The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity

The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease.Conclusions: We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases.What is known?• Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally• Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumoniaWhat is new?• We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization• We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.

REmote SUpervision to Decrease HospitaLization RaTe. Unified and integrated platform for data collected from devices manufactured by different companies: Design and rationale of the RESULT study.

The number of patients with heart failure implantable cardiac electronic devices (CIEDs) is growing. Hospitalization rate in this group is very high and generates enormous costs. To avoid the need for hospital treatment, optimized monitoring and follow-up is crucial. Remote monitoring (RM) has been widely put into practice in the management of CIEDs but it may be difficult due to the presence of differences in systems provided by device manufacturers and loss of gathered data in case of device reimplantation. Additionally, conclusions derived from studies about usefulness of RM in clinical practice apply to devices coming only from a single company. An integrated monitoring platform allows for more comprehensive data analysis and interpretation. Therefore, the primary objective of Remote Supervision to Decrease Hospitalization Rate (RESULT) study is to evaluate the impact of RM on the clinical status of patients with ICDs or CRT-Ds using an integrated platform. Six hundred consecutive patients with ICDs or CRT-Ds implanted will be prospectively randomized to either a traditional or RM-based follow-up model. The primary clinical endpoint will be a composite of all-cause mortality or hospitalization for cardiovascular reasons within 12 months after randomization. The primary technical endpoint will be to construct and evaluate a unified and integrated platform for the data collected from RM devices manufactured by different companies. This manuscript describes the design and methodology of the prospective, randomized trial designed to determine whether remote monitoring using an integrated platform for different companies is safe, feasible, and efficacious (ClinicalTrials.gov Identifier: NCT02409225).

A large 15 - year database analysis on the influence of age, gender, race, obesity and income on hospitalization rates due to stone disease.

ABSTRACTPurpose:To assess the public hospitalization rate due to stone disease in a large developing nation for a 15-year period and its association with socio-demographic data.Materials and Methods:A retrospective database analysis of hospitalization rates in the Brazilian public health system was performed, searching for records with a diagnosis code of renal/ureteral calculi at admission between 1998–2012. Patients managed in an outpatient basis or private care were excluded. Socio-demographic data was attained and a temporal trend analysis was performed.Results:The number of stone-related hospitalizations increased from 15.7%, although the population-adjusted hospitalization rate remained constant in 0.04%. Male:female proportion among hospitalized patients was stable (49.3%:50.7% in 1998; 49.2%:50.8% in 2012), though there was a significant reduction in the prevalence of male hospitalizations (−3.8%;p=0.041). In 2012, 38% of hospitalized patients due to stone disease had 40–59 years-old. The ≥80 years-old strata showed the most significant decrease (−43.44%;p=0.022), followed by the 20–39 (−23.17%;p<0.001) and 0–19 years-old cohorts (−16.73%;p=0.012). Overall, the lowest relative hospitalization rates were found for yellow and indigenous individuals. The number of overweight/obese individuals increased significantly (+20.6%), accompanied by a +43.6% augment in the per capita income. A significant correlation was found only between income and obesity (R=0.64;p=0.017).Conclusions:The prevalence of stone disease requiring hospitalization in Brazil remains stable, with a balanced proportion between males and females. There is trend for decreased hospitalization rates of male, <40 and ≥80 years-old individuals. Obesity and income have a more pronounced correlation with each other than with stone disease.

Pneumonia hospitalisations in Scotland following the introduction of pneumococcal conjugate vaccination in young children.

BackgroundScotland introduced PCV7 and PCV13 immunisation in young children in 2006 and 2010 respectively. One recent study from the United States reported a decrease in hospitalisation rates for all-cause pneumonia most notably in adults older than 75 years of age following PCV7 introduction in the US child population. We aimed to examine the effect of PCV7 and PCV13 on hospitalisation rates for all-cause pneumonia across all age groups in Scotland.MethodsWe linked hospital records and death certification datasets for the entire Scottish population for the period 2000 to 2012. We included all cases where the primary / secondary diagnosis was pneumonia. Differences in hospital admission rates for pneumonia by age group were calculated using the difference in average annual rates for each period.ResultsWe estimated that all-cause pneumonia hospitalisation rates in children <2 years decreased by about 30 % in the post-PCV-13 period compared with the pre-PCV period. However, in adults aged 75–84 years and ≥85 years, all-cause pneumonia hospitalisation rates increased by 63 and 46 % respectively in the post-PCV 13 period compared to the pre-PCV period. This resulted in an additional 7000 hospitalisations across all age groups in Scotland in 2012 about half of which were in adults >75 years. At the same time, the median length of hospital stay decreased by a third in children <2 years and by about 20 % in adults >75 years in the post-PCV13 period compared to the pre-PCV period. Additionally, there was an 11 % reduction in deaths due to all-cause pneumonia, and 30 % reduction in pneumococcal hospitalisations across all age groups in the post-PCV13 period compared with pre-PCV period.DiscussionThe modest and sustained decline in the rates of hospitalisation for all-cause pneumonia in children and the reduction in proportion of pneumonia hospitalisations in children coded as pneumococcal disease in the post-PCV period should alleviate concerns that pneumococcal serotype replacement may have resulted in an increased pneumonia burden in this age group. The indirect impact of child PCV immunisation in those not vaccinated (in terms of reduction in all-cause pneumonia hospitalisations in the elderly) has not been seen in Scotland. Our results are likely to be confounded by changes in clinical coding and healthcare practices over the same period.ConclusionsOur results illustrate that health care planners cannot, with confidence, predict indirect PCV vaccine impacts on hospitalisations. IPD surveillance across all age groups is needed to assess the indirect effects of PCV in the community.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1693-x) contains supplementary material, which is available to authorized users.