General Inpatient Care Research Articles

Regional variations in primary percutaneous coronary intervention for acute myocardial infarction patients: A trajectory analysis using the national claims database in Japan.

Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-fold: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories. We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories. The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group. The trajectory of the proportion of pPCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends.

Changes in the attractiveness of medical careers and career determinants during the bachelor’s program at Zurich medical schools

BackgroundMonitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor’s studies.MethodsThe design was cross-sectional, recruiting all medical students who started a bachelor’s program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students’ perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.ResultsWe surveyed 354 medical students at the beginning and 433 at the end of the bachelor’s program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.ConclusionsDuring the bachelor’s program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.Trial registrationNot applicable.

What Factors Impact Access to General Inpatient Care in Hospice? (RP100)

What Factors Impact Access to General Inpatient Care in Hospice? (RP100)

General psychiatric inpatient care for persons with anorexia nervosa—an integrative literature review protocol

IntroductionPeople diagnosed with anorexia nervosa are offered or compelled to undergo various treatments and therapies. In Sweden, the lack of highly specialised eating disorder services means that people with anorexia...

Initiating Virtual Nursing in General Inpatient Care.

With increased demands for inpatient care and limited nursing resources, bedside RNs at one health care system were challenged to find experienced nurse colleagues to provide mentorship when they needed assistance in executing best practices. A virtual RN (ViRN) role was created to support bedside RNs and patients on designated general care inpatient units. The ViRN provided real-time virtual clinical guidance to bedside RNs and actively surveilled patients. Bedside RNs were surveyed by email to gauge the utility and their perceptions of integrating ViRNs into the nursing care team. RNs reported that they valued the consistent availability of having the ViRNs' expert nursing knowledge and virtual assistance with nursing tasks.

Hospice Capacity to Provide General Inpatient Care: Emergency Department Utilization and Live Discharge Among Cancer Patients

General inpatient (GIP) hospice care is used only minimally for hospice patients, and more than a quarter of Medicare hospice facilities do not provide GIP care. To determine the impact of hospices' capacity to provide on emergency department use during hospice enrollment and live discharge from hospice, we used Surveillance, Epidemiology, and End Results-Medicare linked data and CMS Provider of Services data from 2007 to 2013 from ten states and two metropolitan regions. Grouping hospices into three GIP care provision categories: 1) no-GIP; 2) GIP-contract; and 3) GIP-IHF where hospices directly provide GIP care in their own inpatient hospice facility (IHF), we built a multilevel logistic model that accounted for unobserved hospice characteristics. Nearly 9% of the study sample received GIP care, of which 82% received such care in the last week of discharge. GIP-IHF hospices had lower live discharge rates than no-GIP hospices (AOR: .61; 95% CI: .47-.79; P < .001) and GIP-contract hospices (AOR: .84; 95% CI: .70-1.00; P < .05). Similarly, GIP-contract hospices were also associated with a decreased risk of live discharge, compared to no-GIP hospices (AOR: .76; CI: .62-.92; P < .05). There was no difference in emergency department use between no-GIP hospices and hospices with such capacity. Our results suggest that hospices capable of providing GIP care have lower live discharge rates than their counterparts. However, the fact that GIP care tends to be provided too close to death limits its effectiveness in preventing avoidable emergency department use.

Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians.

Physicians are integral members of hospice interdisciplinary teams (IDTs). This statement delineates the core roles and responsibilities of hospice medical directors (HMDs) and hospice physicians who are designated by the hospice program to fulfill core HMD responsibilities. In addition, we describe the basic elements of hospice programs' structure and function required for hospice physicians to fulfill their roles and responsibilities. Finally, we call attention to hospice program characteristics and circumstances of the work environment that should raise a hospice physician's concerns that hospice patients and families are at risk of receiving low-quality care. Such factors include lack of a functioning IDT, minimal physician involvement in direct patient care and clinical IDT meetings, inadequate responses to symptom emergencies in patients' homes, and no or limited access to general inpatient and continuous home hospice care. We write as individual physicians who are concerned about troubling variability in access to and quality of U.S. hospice care. This statement arises from the need to protect the safety and well-being of vulnerable seriously ill people with their families from low-quality hospice care. This statement is primarily intended to be a resource to hospice physicians in negotiating employment agreements and justifying staffing and programmatic resources necessary to perform their jobs well. This statement may also serve as a resource and reference for patient advocacy groups, hospice industry leaders, health services oversight organizations, accountability agencies, and legislatures in efforts to ensure the safety, quality, and reliability of hospice care in the United States.

Carbon footprinting for hospital care pathways based on routine diagnosis‐related group (DRG) accounting data in Germany: An application to acute decompensated heart failure

AbstractA general framework is developed using routine German diagnosis‐related group (G‐DRG) accounting data to estimate carbon footprints of hospital care pathways in the context of patients with acute decompensated heart failure (ADHF) admitted to the Red Cross Hospital Bremen in 2018. Financial activity data encompass G‐DRG material costs from hospital accounting data submitted to the Institute for the Hospital Remuneration System. A set of seven greenhouse gases (GHGs) is included. Environmentally extended input–output emission factors (EFs) compiled by Eurostat are employed. EFs of cost modules are calculated separately considering respective emissions' intensities. Total emissions reach 72,652 kg carbon dioxide equivalent (CO2e) (nonbiogenic: 85.5%; biogenic: 14.5%) for general inpatient care throughout ADHF patient care pathways in 2018. Emissions from normal wards account for the largest proportion (74.8%) of total emissions for ADHF patients. Compared to other matched industry categories, cost‐types covered by the industry category D “electricity, steam and air conditioning supply” cause the vast majority (approximately 87%) of total emissions. GHG emissions per unit of analysis, per bed day, and per euro are estimated at 263, 32, and 0.31 kg CO2e, respectively. Although this framework is currently limited to hospitals that participate in the G‐DRG calculation scheme or apply these accounting standards on a voluntary basis, it has particular advantages that render it amenable to other contexts. It enables the calculation of emissions separately for each cost module considering its specific emission intensity, which can improve the accuracy of estimates.

Impact of the epidemiological instructions due to the COVID-19 pandemic on general surgical care at the Bajcsy-Zsilinszky Hospital in Budapest

Due to the rapid spread of the coronavirus and the serious consequences of the diseases, the organization of healthcare worldwide changed in the first quarter of 2020. We show effects of restriction due to protection against the first (April 2020) wave of coronavirus in our surgery care. The aim of this study was to compare characteristics of general surgical inpatient care in April 2020 and April 2021 with April 2019 by the hospital database. We compared general surgical data of April 2021, 2020, and 2019 from the medical informatic system at the General, Vascular and Thoracal Surgery Department of the Bajcsy-Zsilinszky Hospital in Budapest. The data were analyzed with MS Excel and SPSS (version 25) programs. Study inclusion criteria met with 197 cases from April 2019, 77 cases from April 2020, and 95 cases from April 2021. Length of stay at surgical department was average 4.51 days in 2019, 6.31 days in 2020, and 6.29 days in 2021. In 2019, average 2.54 urgent and 6.2 planned operations were done, in 2020 these numbers were average 2 and 1 per day and in 2021, 2.8 urgent and 0.9 planned surgical procedures were performed. The number of co-morbidities per capita in elective cases was 1.69 in 2019, 2.97 in 2020, and 2.74 in 2021. Distribution of coded co-morbidities in the case of patients with urgent surgery was significantly different between the groups, in 2019 it was 2.5, in 2020 3.75, and in 2021 3.25 per capita. Postoperative mortality at the same care of patients after urgent surgery was 11.8% in 2019, 13.33% in 2020, and 15.66% in 2021. Due to the government instructions because of COVID-19 pandemic, less elective general surgery procedures were performed in our department. Co-morbidities of patients with urgent surgery significantly increased, probably this is responsible for the increase of postoperative mortality. Orv Hetil. 2021; 162(44): 1761-1768.

202 - Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study

ContextMusic therapy is frequently provided to patients at the end of life, and studies have shown a benefit in relief of symptoms and a positive impact on quality of life (QoL), but little is known regarding the effect of music therapy (MT) on caregivers. Caregivers are at risk for anxiety, emotional distress and experience anticipatory grief as the patient nears death. Caregivers are present with patients and may also benefit from MT.ObjectiveTo assess the impact of MT on caregivers for hospice patients and determine the feasibility of research in this population.MethodsTwenty caregivers of patients hospitalized for general inpatient hospice care were enrolled. MT was provided by a board-certified music therapist, and sessions included pre-MT assessment, 20-45 minutes of MT, and post-MT assessment. Caregiver stress was measured with the Pearlin Role Overload Measure (ROM), QoL was measured with the Linear Analogue Self-Assessment (LASA), and depression and anxiety were measured with the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). These three measures were taken pre-MT, post-MT and 6 months post-MT. Caregivers were also asked to complete a Music Therapy Program Survey post-MT.ResultsThe MT intervention was completed for 15/20 caregivers (75%). Of those who did not complete MT, 2 withdrew prior, 1 was not available, 1 patient passed during the MT session, and 1 patient died prior to MT. 14 caregivers completed pre-MT and post-MT assessments, and 9 caregivers completed assessments at all 3 timepoints. The MT Program Survey (post-MT assessment, n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, 78% found MT effective for stress relief, 69% for relaxation, 71% for spiritual support, 86% for emotional support, and 71% for feeling of wellness.ConclusionResearch on MT is feasible for acute hospice care caregivers with a majority of caregivers consenting to research and about half completing surveys pre-MT, post-MT, and 6-months post-MT (9/20). Future larger studies should be conducted to better assess the impact of MT on caregivers.

Generalization in Clinical Prediction Models: The Blessing and Curse of Measurement Indicator Variables.

Specific factors affecting generalizability of clinical prediction models are poorly understood. Our main objective was to investigate how measurement indicator variables affect external validity in clinical prediction models for predicting onset of vasopressor therapy. We fit logistic regressions on retrospective cohorts to predict vasopressor onset using two classes of variables: seemingly objective clinical variables (vital signs and laboratory measurements) and more subjective variables denoting recency of measurements. Three cohorts from two tertiary-care academic hospitals in geographically distinct regions, spanning general inpatient and critical care settings. Each cohort consisted of adult patients (age greater than or equal to 18 yr at time of hospitalization), with lengths of stay between 6 and 600 hours, and who did not receive vasopressors in the first 6 hours of hospitalization or ICU admission. Models were developed on each of the three derivation cohorts and validated internally on the derivation cohort and externally on the other two cohorts. None. The prevalence of vasopressors was 0.9% in the general inpatient cohort and 12.4% and 11.5% in the two critical care cohorts. Models utilizing both classes of variables performed the best in-sample, with C-statistics for predicting vasopressor onset in 4 hours of 0.862 (95% CI, 0.844-0.879), 0.822 (95% CI, 0.793-0.852), and 0.889 (95% CI, 0.880-0.898). Models solely using the subjective variables denoting measurement recency had poor external validity. However, these practice-driven variables helped adjust for differences between the two hospitals and led to more generalizable models using clinical variables. We developed and externally validated models for predicting the onset of vasopressors. We found that practice-specific features denoting measurement recency improved local performance and also led to more generalizable models if they are adjusted for during model development but discarded at validation. The role of practice-specific features such as measurement indicators in clinical prediction modeling should be carefully considered if the goal is to develop generalizable models.

General Inpatient Hospice Care #415.

General Inpatient Hospice Care #415.

General palliative care during the pandemic

HintergrundDas deutsche Gesundheitssystem steht aufgrund der SARS-CoV-2-Pandemie vor bisher nicht gekannten Herausforderungen. Auch die Palliativversorgung schwerkranker Patient*innen und deren Angehörigen war vor allem während der ersten Welle der Pandemie im stationären und ambulanten Setting stark beeinträchtigt. Das betrifft auch palliativ behandelte Krebspatient*innen.Material und MethodenDie Arbeit beschreibt – basierend auf Teilergebnissen einer Studie, die im Rahmen des Verbundprojekts „Nationale Strategie für Palliativversorgung in Pandemiezeiten“ (PallPan) durchgeführt wurde, sowie aus eigenen Erfahrungen aus der stationären Versorgung von Patient*innen, die unter einer schweren oder lebenslimitierenden Erkrankung leiden, – Best-Practice-Beispiele zur Verbesserung bzw. Aufrechterhaltung der Palliativversorgung.ErgebnisseEingeschränkte Besucherregelungen, Kommunikationsbarrieren und unzureichende Möglichkeiten zur Begleitung sterbender Patient*innen bzw. trauernder Angehöriger stellen nach wie vor große Herausforderungen in der allgemeinen wie spezialisierten stationären Palliativversorgung dar. Hier bedarf es der Schaffung von Strukturen, um z. B. innovative Kommunikationswege mittels Videotelefonie oder individuelle Ausnahmeregelungen von Besuchsverboten bei Therapiezielgesprächen oder Sterbebegleitungen möglich zu machen, um eine qualitativ hochwertige Palliativversorgung aufrechtzuerhalten.SchlussfolgerungenEine adäquate Versorgung schwerkranker und sterbender Patient*innen sowie deren Angehörigen muss auch in der Pandemie gewährleistet werden. Individuelle Maßnahmen können abgesprochen und durchgeführt werden. Eine frühzeitige Einbindung spezialisierter Palliativteams kann von Vorteil sein.

Continuity in palliative care \u2013 analysis of intersectoral palliative care based on routine data of a statutory health insurance

BackgroundThe goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death.MethodsThe analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square.ResultsIn 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice.ConclusionsThe majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.

Effect of population inflow and outflow between rural and urban areas on regional antimicrobial use surveillance.

Regional-level measures can complement national antimicrobial stewardship programs. In Japan, sub-prefectural regions called secondary medical areas (SMAs) provide general inpatient care within their borders, and regional antimicrobial stewardship measures are frequently implemented at this level. There is therefore a need to conduct antimicrobial use (AMU) surveillance at this level to ascertain antimicrobial consumption. However, AMU estimates are generally standardized to residence-based nighttime populations, which do not account for population mobility across regional borders. We examined the impact of population in/outflow on SMA-level AMU estimates by comparing the differences between standardization using daytime and nighttime populations. We obtained AMU information from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. AMU was quantified at the prefectural and SMA levels using the number of defined daily doses (DDDs) divided by (a) 1,000 nighttime population per day or (b) 1,000 daytime population per day. We identified and characterized the discrepancies between the two types of estimates at the prefectural and SMA levels. The national AMU was 17.21 DDDs per 1,000 population per day. The mean (95% confidence interval) prefectural-level DDDs per 1,000 nighttime and daytime population per day were 17.27 (14.10, 20.44) and 17.41 (14.30, 20.53), respectively. The mean (95% confidence interval) SMA-level DDDs per 1,000 nighttime and daytime population per day were 16.12 (9.84, 22.41) and 16.41 (10.57, 22.26), respectively. The nighttime population-standardized estimates were generally higher than the daytime population-standardized estimates in urban areas, but lower in the adjacent suburbs. Large differences were observed in the main metropolitan hubs in eastern and western Japan. Regional-level AMU estimates, especially of smaller regions such as SMAs, are susceptible to the use of different populations for standardization. This finding indicates that AMU standardization based on population values is not suitable for AMU estimates in small regions.

Spatial accessibility of general inpatient care in Germany: an analysis of surgery, internal medicine and neurology

Improving spatial accessibility to hospitals is a major task for health care systems which can be facilitated using recent methodological improvements of spatial accessibility measures. We used the integrated floating catchment area (iFCA) method to analyze spatial accessibility of general inpatient care (internal medicine, surgery and neurology) on national level in Germany determining an accessibility index (AI) by integrating distances, hospital beds and morbidity data. The analysis of 358 million distances between hospitals and population locations revealed clusters of lower accessibility indices in areas in north east Germany. There was a correlation of urbanity and accessibility up to r = 0.31 (p < 0.001). Furthermore, 10% of the population lived in areas with significant clusters of low spatial accessibility for internal medicine and surgery (neurology: 20%). The analysis revealed the highest accessibility for heart failure (AI = 7.33) and the lowest accessibility for stroke (AI = 0.69). The method applied proofed to reveal important aspects of spatial accessibility i.e. geographic variations that need to be addressed. However, for the majority of the German population, accessibility of general inpatient care was either high or at least not significantly low, which suggests rather adequate allocation of hospital resources for most parts of Germany.

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

BackgroundThe adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany.MethodsWe tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%.ResultsThe analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001).ConclusionWe were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.

Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

BackgroundUK government guidelines and initiatives emphasise equity in delivery of care, shared decision-making, and patient-centred care. This includes sharing information with patients as partners in health decisions and empowering them to manage their health effectively. In the UK, general practitioners (GPs) routinely receive hospital discharge letters; while patients receiving copies of such letters is seen as “good practice” and recommended, it is not standardised. The effects and consequences of whether or not this happens remains unclear. The aim of this study (one of three forming the Discharge Communication Study) was to explore patient perspectives on receiving discharge letters and their views on how this could be improved in order to optimise patient experience and outcomes.MethodsSemi-structured interviews were conducted with a diverse sample of 50 patients recruited from 17 GP surgeries within the West Midlands, UK. All participants were adults with a recent episode of general hospital inpatient or outpatient care. Data were audio recorded, transcribed and analysed using mixed methods corpus linguistics techniques.ResultsParticipants reported inconsistent access to discharge letters. Most wanted to receive a copy of their discharge letter although some expressed reservations. Perceived benefits included: increased understanding of their condition and treatment, reduced anxiety, and increased satisfaction. Consequences where participants had not received letters included: letter inaccuracies being overlooked, missed follow up actions, failure to fully remember diagnosis, treatment, or self-management or recommendations, and confusion and anxiety at what occurred and what will happen next. Participants felt the usefulness of receiving copies of letters could be increased by: including a patient information section, avoidance of acronyms, and jargon or technical terms explained with lay language.ConclusionsMost patients value receiving copies of hospital discharge letters, and should be consistently offered them. Patients’ preferences for letter receipt could be logged in their health records. To enable positive outcomes letters should have a clear and accessible format that reflects the priorities and information needs of patients. Patients appear not to be receiving or being offered copies of letters consistently despite UK policies and guidelines supporting this practice; this suggests a need for greater standardisation of practice.

Low analysis of community interest maintenance in Central Health Center Sukmajaya Kota Depok Provinsi Jawa Barat

According to the recapitulation of the utilization of Community Health Center inpatient services in Depok in 2016-2018, it was very low. The results of an initial survey in October 2018 conducted by Community Heath Center researchers who only served inpatients in only 3 districts, while 1 sub-district had not served general inpatients since one year ago. Of the three sub-districts, only 1 sub-district has inpatients, while others sometimes do not have an in-patient visit within one month. Sukmajaya Community Health Center was appointed to serve general inpatient care, basic neonatal obstetric services and care for malnourished children. Because of the low number of inpatient visits in the city of Depok, the researchers were interested in knowing the strengths and weaknesses as well as the opportunities and threats of the Sukmajaya Community Health Center. This study used a qualitative method conducted in February 2020 with in-depth interviews using interview guidelines and voice recording devices. Interviews were conducted with the Head of the Community Health Center, Head of Administration, Responsible for Inpatients, Doctors and Nurses. As a result, Sukmajaya Community Health Center was unable to compete with Private Hospitals because private hospitals had better health personnel and infrastructure than Sukmajaya Community Health Center. Besides that, the number of private hospitals in the city of Depok is large and the location is easy to reach, so people prefer hospitals with more convenient facilities.

Outcome of Older Patients with Acute Neuropsychological Symptoms Not Fulfilling Criteria of Delirium.

Although delirium is often investigated, little is known about the outcomes of patients having acute neuropsychological changes at a single time point without fulfilling the criteria of full delirium. Our aim was to determine point prevalence, predictors, and long-term outcomes of delirium and acute neuropsychological changes in patients aged 60 years and older across different departments of a university hospital with general inpatient care. Prospective observational study. University hospital excluding psychiatric wards. At baseline, 669 patients were assessed, and follow-ups occurred at months 6, 12, 18, and 36. Measurements were obtained using the Confusion Assessment Method (CAM), comprehensive geriatric assessment, health-related quality of life, functional state (month 6), and mortality rates (months 6, 12, 18, and 36). Subjects were classified into (1) patients with delirium according to the CAM, (2) patients with only two positive CAM items (2-CAM state), and (3) patients without delirium. Delirium was present in 10.8% and the 2-CAM state in an additional 12.7% of patients. Highest prevalence of delirium was observed in medical and surgical intensive care units and neurosurgical wards. Cognitive restrictions, restricted mobility, electrolyte imbalance, the number of medications per day, any fixations, and the presence of a urinary catheter predicted the presence of delirium and 2-CAM-state. The mean Karnofsky Performance Score and EuroQol-5D were comparable between delirium and the 2-CAM state after 6 months. The 6-, 12-, 18-, and 36-month mortality rates of patients with delirium and the 2-CAM state were comparable. The nurses' evaluation of distinct patients showed high specificity (89%) but low sensitivity (53%) for the detection of delirium in wide-awake patients. Patients with an acute change or fluctuation in mental status or inattention with one additional CAM symptom (ie, disorganized thinking or an altered level of consciousness) have a similar risk for a lower quality of life and death as patients with delirium. J Am Geriatr Soc 68:1469-1475, 2020.