Hospital Discharge Reports Research Articles

ICD-10 Coding of Spanish Electronic Discharge Summaries: An Extreme Classification Problem

Objective: Medical coding is used to identify and standardize clinical concepts in the records collected from healthcare services. The tenth revision of the International Classification of Diseases (ICD-10) is the most widely-used coding with more than 11,000 different diagnoses, affecting research, reporting, and funding. Unfortunately, ICD-10 code sets tend to follow biased, unbalanced, and scattered distributions. These distribution attributes, along with high lexical variability, severely restrict performance when coded clinical records are used to infer code sets in uncoded records. To improve that inference, we explore a combination of example-based methods optimized to capture codes with different appearance frequencies in data sets. Materials and Methods: The proposed exploration has been carried out on Spanish hospital discharge reports coded by experts, excluding all sentences without any biomedical concept. Representations based on semantic and lexical features are explored, using both global and label-specific attributes. In turn, algorithms based on binary outputs, groups of subsets and extreme classification are compared. Lists of codes together with their confidence values (certainty probabilities) are suggested by each method. Results: Diverse spectral behaviors are shown for each method. Binary classifiers seem to maximize the capture of more popular codes, while extreme classifiers promote infrequent ones. In order to exploit such differences, ensemble approaches are proposed by weighting every output code according to the method, confidence value and appearance frequency. The rule-based combination reaches a 46% Precision at 10 ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$P \text{@} 10$ </tex-math></inline-formula> ), which means a 15% improvement over the best individual proposal. Conclusion: Assembling methods based on weighting each code according to training frequency and performance can achieve better overall Precision scores on extreme distributions, such as ICD-10 coding.

Modes of dying of children in Intensive Care Units in Spain: MOMUCIP study

To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic efforts (LET). A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. A total of 337 deaths were recorded, of which 151 (50'7%) occurred after a decision of LET, while 114 (33'8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%). A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission. LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality.

Modes of dying of children in Intensive Care Units in Spain: MOMUCIP study

ObjectiveTo describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic effort (LET). MethodA multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. ResultsA total of 337 deaths were recorded, of which 151 (50.7%) occurred after a decision of LET, while 114 (33.8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%).A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission.LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). ConclusionsAt the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality.

Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain)

ObjectivesGuidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the...

Optimization of the Prediction of Arterial Hypertension Development in the Patients with Type 2 Diabetes Mellitus on the Background of Undifferentiated Connective Tissue Dysplasia

In recent years, disorders of connective tissue metabolism that are involved in the pathogenesis of many diseases have attracted increasing attention. They are of particular importance in the presence of connective tissue dysplasia. Undifferentiated forms, being a frequent component of comorbid pathology, are quite widespread among the general population. Among comorbidities, arterial hypertension, diabetes mellitus and undifferentiated connective tissue dysplasia in various combinations are more often observed.&#x0D; &#x0D; The objective of the research was to determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension in the patients with type 2 diabetes mellitus.&#x0D; Materials and methods. To determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension, there was conducted an analysis of hospital discharge reports received by the patients with type 2 diabetes mellitus duration of at least 2 years who were treated two to five years ago. The predictive significance of the factors selected for the analysis was determined through applying the regression analysis using a logistic regression model, the Wald test.&#x0D; Results. The test for coincidence of the predicted and observed values revealed that the specificity of the regression model was 87.2%, while its sensitivity was 89.7%. The overall predictability was 88.5%.&#x0D; Conclusions. These are quite high indicators that allow us to apply the proposed model to detect the patients with type 2 diabetes mellitus being at high risk of arterial hypertension.

Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period

IntroductionMultiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13 years and the subsequent impact on foetal and maternal health. Material and methodsData was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. ResultsA pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5–4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilisation showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4–11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95% CI: 1.04–1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. ConclusionMultiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality.

Predicting 1-Year Mortality in Older Hospitalized Patients: External Validation of the HOMR Model.

Accurate prognostic information can enable patients and physicians to make better healthcare decisions. The Hospital-patient One-year Mortality Risk (HOMR) model accurately predicted mortality risk (concordance [C] statistic = .92) in adult hospitalized patients in a recent study in North America. We evaluated the performance of the HOMR model in a population of older inpatients in a large teaching hospital in Ireland. Retrospective cohort study. Acute hospital. Patients aged 65 years or older cared for by inpatient geriatric medicine services from January 1, 2013, to March 6, 2015 (n = 1654). After excluding those who died during the index hospitalization (n = 206) and those with missing data (n = 39), the analytical sample included 1409 patients. Administrative data and information abstracted from hospital discharge reports were used to determine covariate values for each patient. One-year mortality was determined from the hospital information system, local registries, or by contacting the patient's general practitioner. The linear predictor for each patient was calculated, and performance of the model was evaluated in terms of its overall performance, discrimination, and calibration. Recalibrated and revised models were also estimated and evaluated. One-year mortality rate after hospital discharge in this patient cohort was 18.6%. The unadjusted HOMR model had good discrimination (C statistic = .78; 95% confidence interval = .76-.81) but was poorly calibrated and consistently overestimated mortality prediction. The model's performance was modestly improved by recalibration and revision (optimism corrected C statistic = .8). The superior discriminative performance of the HOMR model reported previously was substantially attenuated in its application to our cohort of older hospitalized patients, who represent a specific subset of the original derivation cohort. Updating methods improved its performance in our cohort, but further validation, refinement, and clinical impact studies are required before use in routine clinical practice. J Am Geriatr Soc 1-6, 2019.

Cost analysis for deliveries according to maternal age classes for moving to a personalized approach in the health care

Objective: In the last decades, childbearing has moved to higher ages, displaying adverse outcomes related to advanced maternal age at birth. Accordingly, the aim was to perform a cost analysis in women admitted for birth assistance and segregated by age classes (<20, 20–24, 25–29, 30–34, 35–39, 40–45, and ≥45 years). Methods: A total of 18,093 admitted for assistance at delivery in a 5-year period (2012–2016) were included in the analysis. Costs for obstetric complications in vaginal delivery (VD) and cesarean section (CS), based on hospital discharge report from the local health care system, were calculated by using the “diagnosis-related group” (DRG) approach. Results: An overall economic cost due to clinical assistance at delivery of €42.663.481 was computed. A global rate of 59.6% of vaginal deliveries (VD) and 40.4% of cesarean section (CS) was assessed. Among of all maternal age classes, women attributable to classes 30–34 and 35–39 years reached a rate of 62.8%, while values of 24.2 and 13% were observed for those under 30 and over 40 years of age, respectively. A significant increasing trend in terms of maternal stay duration was found across all age groups (from 4.7 to 5.4 days, p < .05), as well as nonspecific delivery costs (from €2.222.49 to €2.401.29, p < .05). Uncomplicated VD decreased across the groups, until to halve between two extreme maternal age groups (38.8 versus 18.6%, p < .05), while a three-fold risk of CS complications was calculated in women over 45 years-old in comparison with those under 20 years of age (4.2 versus 13.9, p < .05), although not significantly different in the cost analysis between two extreme age groups. Conclusions: Increases in maternal age at delivery are associated with higher healthcare costs, driven largely by additional complication rates, irrespective of the delivery mode.

Hospital admissions for bleeding events associated with treatment with apixaban, dabigatran and rivaroxaban

ObjectivesTo analyse the hospital admissions for bleeding events associated with treatment with direct oral anticoagulants (DOACs). To describe the characteristics and outcomes of those patients.MethodsA retrospective observational study was carried...

The Prevalence of patients with panic attacks (PAs) and panic disorder (PD) visiting Emergency Departments of the Verona Hospital.

Panic Attacks (PAs) and Panic Disorder (PD) represent a heavy burden not only because of the difficulty in distinguishing them from other pathologies and in treating them appropriately but also because of their impact on public health worldwide. In Europe, PD constitutes one of the five most common mental disorders adversely affecting quality of life. The aim of this study is to evaluate the period prevalence of visits to the Emergency Departments of the University Hospital of Verona (North East of Italy) over the period between 2012-2016 because of symptoms of PAs or PD in order to quantify the burden of the disorder. This study was carried out by retrospectively collecting data from the medical records of all the patients assessed at the Emergency Departments (EDs) of the Verona Hospital because of symptoms of PAs or PD over a 5-year period (1 January 2012 - 31 December 2016). The search words used in reviewing the medical records registered in the hospital discharge reports from the Gynecological, Pediatric and General Medicine Emergency Departments were: "Anxiety" and/or "Panic". A multiple logistic regression model was also created to evaluate the predictors of ED visits for PAs or PD over the period that was investigated. The study identified 3,771 cases of PAs or PD; 62.3% were females and 37.7% were males. The female-to-male ratio was 1.7:1. The mean age was 44 years (46 for the females and 41 for the males). The majority of the patients fell into two age categories: 30 to 39 (20.6%) and 40 to 49 (23.8%). The proportion of visits to the EDs for PAs or PD was approximately 20% per year, with an average of approximately 754 patients visiting the EDs every year. The period prevalence of accesses for PAs or PD over the five year period studied in the mean resident population (1.4%) and the mean visits to the EDs (2.5%) were calculated. Study results showed that the majority of the patients (80.9%) were referred to their general practitioner (GP) at the end of the assessment protocol at the EDs. According to the regression logistic model, the following variables were significant (p<0.05) risk factors for PAs or PD: being female vs. male (OR 1.899; 95% CI 1.785-2.020), being Italian vs. Foreigner (OR 1.292; 95% CI 1.174-1.421), having a white or green priority code at arrival (low urgency) vs. the other ones (OR 1.195; 95% CI 1.100-1.297), and being aged ≤42 years old (OR 1.091; 95% CI 1.024-1.161). The role of the GP is crucial in the management of PD and PAs. Given the difficulty of implementing primary and secondary prevention programs for these conditions, public health officials should make every effort to promote tertiary prevention in order to reduce the burden of the ailment and societal cost.

Indicator performance after the implementation of the Spanish Consensus Document for the control of hyperglycemia in the hospital and at discharge

Background and aimsInformation for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. MethodsObservational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes/hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. Results199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (p<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (p<.005) and ≥7.5% (p<.001) in the prospective group and in patients with HbA 1c ≥7.5% (p<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (p<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (p<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. ConclusionsImplementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge.

Malnutrition, is it an habitual diagnosis in hospital discharge reports?

Malnutrition, is it an habitual diagnosis in hospital discharge reports?

Rendimiento de los indicadores tras la implementación del Documento de consenso español para el control de la hiperglucemia en el hospital y al alta

Background and aimsInformation for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. MethodsObservational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. Results199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. ConclusionsImplementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge.

Quelles sont les attentes de coordination et d’accompagnement des patients français atteints de cancer vis-à-vis de leur pharmacien de ville ?

Analyze the relationship and expectations of cancer patients towards the community pharmacist in a pharmaceutical care coordination project. In November 2014, a questionnaire was distributed to ambulatory patients of a university hospital specialized in oncology. Thirteen questions explored the consumption habits and the usage of the pharmacy (typology of consumers, use of goods and benefits consumed), and collected their expectations for pharmaceutical benefits in the context of the management of their cancer. One thousand two hundred and seventy two patients were included for a final response rate of 78%. Characteristics of the respondents: 64% were women, 63% lived in Île-de-France and 49% took cancer-related treatments (anticancer drugs, supportive care medications). More than 84% of respondents went to pharmacies at least once a month and 95% reported resorting to a single pharmacy. 36% to be ready to share their hospital discharge report with their pharmacist and 61% to have their hospitalization order sent to their "referral" pharmacy to anticipate treatments. Discussion Community pharmacists were perceived positively by the respondents. Patients were willing to share information and be accompanied by this health professional in their cancer care. Their expectations were first and foremost the management of drug-related iatrogenic effects with a report of adverse effects to the hospital, and validated solutions for their management.

Percepción de los médicos de atención primaria sobre la integración con cardiología mediante programas de continuidad asistencial en prevención secundaria

ObjectiveTo determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. Material and methodsA cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. ResultsThe integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; p<.001). Almost all PC physicians received the hospital discharge report. The majority of the hospital discharge reports included recommendations about the CA and PC follow-up, control of risk factors, as well as the duration of secondary prevention treatment, with not significant differences according to the level of integration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). ConclusionsThe level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction.

Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults.

BackgroundMitral regurgitation in people without prior cardiac disease is considered a degenerative disease with no established risk factors for its prevention. We aimed to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation.Methods and findingsWe used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) from 1 January 1990 to 31 December 2015. CPRD covers approximately 7% of the current UK population and is broadly representative of the population by age, sex, and ethnicity. About 5.5 million UK patients with no known cardiovascular or valve disease at baseline were included in this cohort study. We investigated the relationship between blood pressure (BP) and risk of mitral regurgitation using Cox regression models. Our primary exposure variable was SBP and our primary outcome was incident reports of mitral regurgitation, which were identified from hospital discharge reports or primary care records.Of the 5,553,984 patients in the CPRD that met our inclusion criteria, during the 10-year follow-up period, 28,655 (0.52%) were diagnosed with mitral regurgitation and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation with no evidence of a nadir down to 115 mmHg (p < 0.001). Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation (hazard ratio [HR] 1.26; CI 1.23, 1.29). The observed association was partially mediated by diseases affecting the left ventricle during follow-up (myocardial infarction [MI], ischaemic heart disease [IHD], cardiomyopathy, and heart failure). However, the percentage of excess risk mediated (PERM) by these proximate causes of secondary mitral regurgitation was only 13% (CI 6.1%, 20%), and accounting for them had little effect on the long-term association between SBP and mitral regurgitation (mediator-adjusted HR 1.22; CI 1.20, 1.25; p < 0.001). Associations were similar for each 10 mmHg increment in diastolic blood pressure (DBP) (p < 0.001) or each 15 mmHg increment in pulse pressure (PP) (p < 0.001). By contrast, there was no association between SBP and risk of mitral stenosis (HR per 20 mmHg higher SBP 1.03; CI 0.93, 1.14; p = 0.58). These analyses are based on routinely collected data from health records which may be sensitive to measurement errors, and the observed associations may not be generalizable to less severe and subclinical cases of mitral regurgitation.ConclusionsLong-term exposure to elevated BP across its whole spectrum is associated with an increased risk of primary and secondary mitral regurgitation. These findings suggest that BP control may be of importance in the prevention of mitral regurgitation.

Integrated Care Pathway and personalised care at the heart of Lombardy Region’s strategy for tackling chronic care: lessons learnt from the CreG (Chronic Related Group) model

Lombardy Region launched a three years’ plan (2016-2018) for tackling chronic care and frailty through a redesign of the health and social care delivery system that hinges on a population health management (PHM) perspective for programme planning interventions and resources and Integrated Care Pathways (ICPs) for organising the provision of personalised care. The reform strategy relies on the Regional piloting experience with the CReG (Chronic Related Group) model that started in 2011. The latter represents a prospective payment system based on a clinical-risk adjustment model. The model is built on three steps: the classification of diseases, a grouping system, and a bundle tariff accounting for a one-year period of care (including pharmacy and outpatient services). The pilot programme has been managed in the Primary Care setting, through GP-cooperatives with several tools and services (Service Centre) to support care planning activities and the actual implementation of ICPs, based on prospective and flexible Personalized Care Plans (PCP). The paper presents the most significant results of the CReG model, comparing data from the patients’ enrolled in 2012 (first year) and in 2015 (latest available), at the population level (chronic cohorts) and at individual one (impacts of PCP and GPs’ behaviors). A statistical analysis is performed on quantitative data retrieved from different administrative databases (diagnostic and outpatient services, hospital discharge report, pharmaceutical consumption, PCP register, GP patients’ register, Service Centres’ activities). The discussion highlights the lessons learnt and the challenges to exploit the CReG model yet to the overall Regional population yet to other settings, like intermediate and acute care, broadening the mean of PCPs, as foreseen by the Regional policy.

Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study

IntroductionThe aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. MethodsWe performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). ResultsWe included 965 patients with a median stay of 8 days (IQR 6–13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42–13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07–2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07–2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85–3.48) when oral anticoagulation (OAC) was initiated 2–3 days after admission, and 2.43 (95% CI: 1.16–5.07) when initiated at 4–5 days, compared to OAC initiation at 0–1 days. ConclusionssPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay.

Possible Uses of Data from Hospital Discharge Reports

Abstract Almost all countries in the world keep some form of hospital discharge report (HDR). Although there are many variations, every report contains such data as patient demographics, the main cause of hospitalization, comorbidities, the length of stay in hospital and outcome. The advantages of using data obtained from HDRs are numerous: The data from HDRs are already collected in a designated centre and thus easily available and relatively cheap; HDRs contain information for many previous years; they are sometimes more reliable than data obtained through any other method; and finally, they provide a large and representative database. HDRs databases can be connected with other databases using a unified patient identification number. The limitations of using data obtained through HDRs are as follows: inconsistencies in defining and coding diagnoses and applied procedures, common underestimations of comorbidity, limited possible applications in specific studies and partial coverage of inpatient institutions. The prediction that in the future, a growing number of diagnostic and treatment procedures will be performed on an outpatient basis will also limit the use of HDRs. When electronic recordkeeping becomes a practice, we may assume that these data will no longer be needed. There is no perfect model for collection and processing data regarding hospitalized patients. HDRs, with their advantages and disadvantages, currently represent the best way to perceive the size, type, quality and efficiency of the health care services provided to patients at the secondary and tertiary level.

Factores que influyen en la estancia hospitalaria por embolia pulmonar. Un estudio de cohortes

IntroductionThe aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. MethodsWe performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). ResultsWe included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. ConclusionssPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay.