Outcomes In Hospitalized Patients Research Articles

Impact of pay-for-performance on hospital readmissions in Lebanon: an ARIMA-based intervention analysis using routine data

BackgroundThe objective of this paper was to estimate the impact of country-wide hospital pay-for-performance on readmissions for a set of common conditions in Lebanon.MethodsThis retrospective cohort study included all hospitalizations under the coverage of the Ministry of Public Health in Lebanon between 2011 and 2019. We calculated 30-day all-cause readmissions following general, pneumonia, cholecystectomy and stroke cases. We used an interrupted time series design, including the use of AutoRegressive Integrated Moving Average models. This nationwide study including 1,333,691 hospitalizations was undertaken in Lebanon, using hospitalizations at about 140 private and public hospitals contracted by the Ministry. The participants included citizens across all ages under the Ministry’s coverage (52% of citizens). The intervention was the engagement of hospital leaders by the Ministry, informing them of the addition of a readmissions component to the ongoing pay-for-performance initiative. Engagement participants included hospital directors and managers, and the leadership of the Syndicate of Private Hospitals. The main outcome measure was age-adjusted monthly all-cause readmission rates for each of general, pneumonia, cholecystectomy and stroke cases. We also assessed for change in readmissions for three conditions not included in the intervention (myocardial infarction, cataract surgery and appendectomy).ResultsAcross 2011–2019, the overall readmission rates were 6.00% (SD 0.24%) for general readmissions, 5.06% (SD 0.22%) for pneumonia, 2.54% (SD 0.16%) for cholecystectomy, and 6.55% (SD 0.25%) for stroke. Using ARIMA models we found a relative percentage decrease in mean monthly readmissions in the post-intervention period for cholecystectomy (5.9%; CI 0.1%-11.8%) and stroke (13.6%; CI 3.1%-24.2%). There was no evidence of intervention impact on pneumonia and general readmissions, both overall and among small, medium and large hospitals. There was also no evidence of change in non-P4P readmissions of myocardial infarction, cataract surgery and appendectomy.ConclusionsIncluding readmissions within pay-for-performance has the potential to improve hospital performance and patient outcomes, even in countries with more limited resources. Effects may vary across conditions, indicating the need for careful design and understanding of the particular context, both with respect to implementation and to evaluation of impact.

An Efficient One-Dimensional Texture Representation Approach for Lung Disease Diagnosis

The remarkable increase in published medical imaging datasets for chest X-rays has significantly improved the performance of deep learning techniques to classify lung diseases efficiently. However, large datasets require special arrangements to make them suitable, accessible, and practically usable in remote clinics and emergency rooms. Additionally, it increases the computational time and image-processing complexity. This study investigates the efficiency of converting the 2D chest X-ray into one-dimensional texture representation data using descriptive statistics and local binary patterns, enabling the use of feed-forward neural networks to efficiently classify lung diseases within a short time and with cost effectiveness. This method bridges diagnostic gaps in healthcare services and improves patient outcomes in remote hospitals and emergency rooms. It also could reinforce the crucial role of technology in advancing healthcare. Utilizing the Guangzhou and PA datasets, our one-dimensional texture representation achieved 99% accuracy with a training time of 10.85 s and 0.19 s for testing. In the PA dataset, it achieved 96% accuracy with a training time of 38.14 s and a testing time of 0.17 s, outperforming EfficientNet, EfficientNet-V2-Small, and MobileNet-V3-Small. Therefore, this study suggests that the dimensional texture representation is fast and effective for lung disease classification.

Prevalence of Metabolic Syndrome and Its Association with Cardiovascular Outcomes in Hospitalized Patients with Inflammatory Bowel Disease.

Background: Patients with autoimmune diseases experience a higher burden of metabolic syndrome (MetS) and cardiovascular disease (CVD). There is a paucity of data regarding MetS in patients with inflammatory bowel disease (IBD) and its impact on CVD. In this retrospective study, we aimed to evaluate the prevalence of MetS components in IBD patients, as well as their association with acute coronary syndrome (ACS), heart failure and arrhythmias. Methods: After pooling 5 years of data from the National Inpatient Sample (NIS) Database (2016-2020), we compared traditional cardiovascular risk factors between IBD and non-IBD patients. We then investigated the association between MetS (represented by a calculated metabolic score (CMS) ranging from 0 to 4, based on the presence or absence of hypertension, obesity, dyslipidemia and type II diabetes) and CVD, separately for Crohn's disease (CD) and ulcerative colitis (UC) patients. Results: The prevalence of the different MetS components was found to be lower in IBD patients compared to non-IBD patients. Comparing CD (n = 806,875) and UC (n = 575,925) identified a higher prevalence of MetS components in UC. Higher CMS was positively associated with ACS and arrhythmias in both CD and UC. This association was evident in heart failure, with the odds ratio increasing from 2.601 for CMS = 1 to 6.290 for CMS = 4 in UC patients and from 2.622 to 5.709 in CD patients. Conclusions: Our study highlights the positive association between traditional components of MetS and CVD in IBD patients. Our findings suggest that chronic inflammation explains only partially the CVD burden in hospitalized IBD patients.

Impact of Kidney Transplantation on Hospitalization Outcomes in Patients with Multiple Myeloma

Impact of Kidney Transplantation on Hospitalization Outcomes in Patients with Multiple Myeloma

In-hospital economic impact and mortality of bariatric surgery on congestive heart failure in the USA: a nationwide analysis

Abstract Background Congestive Heart Failure (CHF) remains a significant economic burden in the inpatient setting. There is a complex correlation between obesity and Congestive Heart Failure (CHF). Bariatric surgery has emerged as a critical intervention for patients with morbid obesity. However, there is limited data on how this intervention impacts hospital economic metrics and patient outcomes in the context of CHF post-bariatric surgery. Purpose The purpose of this study is to assess the in-hospital economic impact and mortality among patients with congestive heart failure who have undergone bariatric surgery. Methods We queried the National Inpatient Sample from 2016 to 2020; this retrospective observational cohort study identified CHF patients who had undergone bariatric surgery through ICD-10 codes. Univariate and multivariate logistic regression analyses were performed to determine Total Charges (TOTCH) and Length of Stay (LOS), adjusting for confounders including the Elixhauser comorbidity index, hospital region, quarterly income, and hospital location to identify the economic impact on CHF (Table 1). Results Out of 25,900,000 patients with congestive heart failure, 5,983,684 (23%) were obese, and 208,220 (0.8%) had undergone bariatric surgery. The demographic profile showed a mean age of 63 predominance of females (65%) and the White population (69.5%) (Table 1). The mean TOTCH for patients undergoing bariatric surgery was $66,235, compared to $76,046 for those who did not undergo the surgery, with a significant mean decrease in TOTCH of -$11,454 (p<0.001, 95% CI: -$12,472 to -$10,435). The mean LOS was 5 days for patients with bariatric surgery versus 6 days for those without, showing a mean decrease in LOS of 0.93 days (95% CI: -0.99 to -0.87). Additionally, there was a significant decrease in overall mortality risk among patients who had bariatric surgery (2.1%) compared to those who did not (5%), with an (OR 0.4 p<0.001, 95% CI: 0.38 to 0.43). Conclusion Our research demonstrates that bariatric surgery in obese individuals with congestive heart failure (CHF) markedly decreases in-hospital mortality, reduces hospital charges, and shortens the length of hospital stays. These findings underscore the potential of bariatric surgery as a cost-effective intervention for improving outcomes in patients with CHF and obesity, highlighting the importance of considering surgical weight loss options in the management of CHF.Table 1

CT-based sarcopenia assessment: Predicting outcomes in acute infection patients.

In this retrospective cohort study, we investigated the prognostic value of sarcopenia evaluated by Computed Tomography (CT)-based indices for adverse hospitalization outcomes in patients with acute infections. We analyzed data from 225 patients admitted to the hospital for acute infections between 2019 and 2020. Patients who had undergone an abdominal CT scan either up to 1 month before or within the first 3 days of hospitalization were included. CT image analysis was used to evaluate skeletal muscle mass (by skeletal muscle index (SMI)) and muscle quality (by psoas muscle density, pMD). Low pMD was associated with higher in-hospital mortality (31% vs 11.4% p < 0.001) as well as higher longer-term mortality rates (p = 0.008 for 30 days and <0.001 for 90- and 1-year mortality). Low pMD remained an independent poor prognostic factor after controlling for confounders, with an adjusted odds ratio (aOR) of 2.74, (95% CI 1.33-5.67, p = 0.006) for 1-year mortality, and aOR of 2.61, (95% CI 1.23-5.55) for a prolonged hospital stay. Low SMI was associated with adverse outcomes, although this association was not independent after controlling for confounders. Notably, patients with both low SMI and pMD exhibited the poorest hospitalization outcomes: aOR for 1-year mortality 5.015 (95% CI 1.767-14.23, p = 0.002), and prolonged length of stay aOR 3.197, (95% CI 1.159-8.821, p = 0.025). CT-based muscle indices serve as independent prognostic factors in medical patients admitted with acute infection. Incorporating radiological assessments of sarcopenia into routine care for hospitalized patients with acute infection may enable risk stratification and early intervention in reversible conditions.

Sarcopenia Influences Clinical Outcome in Hospitalized Patients with Peripheral Artery Disease Aged 75 Years and Older

ObjectivesSarcopenia represents a relevant comorbidity in patients with peripheral artery disease (PAD). However, only few studies exist assessing the clinical burden of sarcopenia in PAD. MethodsAll hospitalizations of patients aged ≥75 years who were admitted due to PAD within 2005-2020 in Germany were included in the study and stratified for sarcopenia. Temporal trends and the impact of sarcopenia on treatment procedures as well as adverse in-hospital events were investigated. ResultsOverall, 1,166,848 hospitalization-cases of patients admitted due to PAD (median age 81.0 [78.0-85.0] years; 49.5% female sex) were included, of which 2109 (0.2%) were coded with sarcopenia. Prevalence of sarcopenia in these patients increased during the observational period from 0.05% in 2005 to 0.34% in 2020 (β 2.61 [95%CI 2.42 to 2.80], P<0.001). Sarcopenic PAD patients were more often female (52.1% vs. 49.5%, P=0.015), obese (6.6% vs. 5.5%, P=0.021) and revealed higher prevalences of comorbidities (Charlson comorbidity index, 7.00 [6.00-9.00] vs. 6.00 [5.00-7.00], P<0.001). Sarcopenia was associated with reduced usage of reperfusion treatments (endovascular intervention: OR 0.409 [95%CI 0.358-0.466], P<0.001; surgical revascularization: OR 0.705 [95%CI 0.617-0.805],P<0.001), but higher conduction of amputation (OR 1.365 [95%CI 1.231-1.514], P<0.001) and higher rates of major adverse cardiovascular and cerebrovascular events (OR 1.313 [95%CI 1.141-1.512], P<0.001) and in-hospital death (OR 1.229 [95%CI 1.052-1.436], P=0.009). ConclusionsSarcopenia is an under-recognized condition in PAD patients of high clinical relevance causing a crucial disease burden. Awareness of the ailment needs to be increased in daily clinical practice to identify sarcopenia and improve clinical outcome of this vulnerable patient group.

Relationships Between Nursing Professional Development Department Structures in Hospital Systems and Patient Outcomes.

Although positive correlations between nursing professional development (NPD) staffing and organizational outcomes have been demonstrated, no evidence of optimal NPD department structures was found. Using an organizational participatory research method, NPD department structures in acute care hospital systems and their relationships to publicly reported patient outcomes and satisfaction were explored. Hospitals with centralized NPD departments had significantly fewer unplanned readmissions for pneumonia than hospitals with hybrid structures. No other significant differences were found.

A Quality Improvement Initiative for Inpatient Advance Care Planning

The Centers for Medicare & Medicaid Services (CMS) implemented advance care planning (ACP) billing codes in 2016 to encourage practitioners to conduct and document ACP conversations, and included ACP as a quality metric in the CMS Bundled Payments for Care Improvement Initiative in 2018. Use of this billing code in the inpatient setting has not been studied. To determine whether a quality improvement intervention to increase inpatient ACP is effective in increasing ACP billing rates or changing hospital treatment plans or patient outcomes. This nationwide cohort study and difference-in-differences analyses compared changes in ACP billing, treatment, and outcomes in Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized and cared for by 3 different groups: practitioners employed by a national acute care staffing organization who underwent an ACP quality improvement intervention, nonintervention practitioners at the same hospital, and control group practitioners from other hospitals. Using data from the Master Beneficiary Summary File, acute care hospital stays for nonsurgical conditions were linked to Medicare enrollment, claims, and vital status data from 1-year preadmission to 1-year postadmission from 2015 to 2019. The ACP billing rates for each group were assessed for associations with 6 inpatient treatments and 4 outcomes. Data analyses were performed from January 2022 to December 2024. Billed ACP conversations, receipt of intensive care and life support (intensive care unit admission, gastrostomy tube placement, mechanical ventilation, tracheostomy), treatment limitations (newly initiated do-not-resuscitate orders) and outcomes (discharge to hospice, inpatient death, 30-day postadmission death, and 1-year postadmission death). The total study sample included 109 intervention hospitals, 1691 control hospitals, nearly 12 million Medicare fee-for-service beneficiaries aged 65 years and older, and 738 309 practitioners associated with admissions from 2016 to 2018. ACP billing rates increased more for the intervention (1.3% in preintervention to 14.0% in postintervention; P < .001) than for the nonintervention (same hospitals) and control groups (odds ratio [OR], 2.6; 95% CI, 1.7-4.1 intervention vs control). Increased ACP billing rates were significantly associated with decreased rates of inpatient death in the intervention group (OR, 0.95; 95% CI, 0.90-1.00) compared to the nonintervention (OR, 1.10; 95% CI, 1.04-1.17) and control groups (reference). All other associations were nonsignificant. This nationwide cohort study suggests that while the ACP quality initiative increased ACP billing, changes in clinical outcomes were inconsistent with the hypotheses. Further study is needed to address questions regarding confounding by unobserved measures of care quality.

S573 Predictive Artificial Intelligence Analysis of Determinants of Health Outcomes in Hospitalized Patients with Eosinophilic Esophagitis

S573 Predictive Artificial Intelligence Analysis of Determinants of Health Outcomes in Hospitalized Patients with Eosinophilic Esophagitis

188 Temporal Impact of Hospice and Palliative Medicine Consults on End-of-Life Outcomes in Emergency Department and Hospitalized Patients

188 Temporal Impact of Hospice and Palliative Medicine Consults on End-of-Life Outcomes in Emergency Department and Hospitalized Patients

Practice Patterns for Acute Asthma Exacerbation in Adult Patients Admitted to U.S. Intensive Care Units.

Rationale: Guidelines recommend systemic corticosteroids and inhaled β-agonists for patients with severe asthma exacerbation who are admitted to intensive care units. The benefits and utilization of adjunct treatments after guideline-recommended first-line treatments have been initiated are unclear. Objectives: Examine practice patterns of adjunct interventions in US intensive care units (ICUs) and their associations with outcomes for adults with severe asthma exacerbations. Methods: Using the multicenter PINC AI Healthcare Database of Premier Inc. (2016-2022), we sought to explore the use of adjunct interventions (medications [e.g., magnesium, leukotriene inhibitors, terbutaline, heliox] and procedures [e.g., invasive and noninvasive mechanical ventilation]) for adult patients admitted to U.S. ICUs with acute asthma exacerbations. We used hierarchical generalized linear models to calculate risk-adjusted rates of adjunct interventions and quantified between-hospital variation in adjunct interventions using the intraclass correlation coefficient (ICC; higher values correspond to higher between-hospital variation). We then used K-means clustering to identify groups of hospitals with similar risk-adjusted practice profiles of all adjunct treatments and examined associations between identified hospital clusters and patient outcomes. Results: We identified 62,392 patients from 961 hospitals for inclusion. Adjunct interventions with the highest between-hospital variation after risk adjustment were heliox (ICC, 91%), inhaled steroids (ICC, 23%), invasive mechanical ventilation (ICC, 21%), terbutaline (ICC, 22%), paralytics (ICC, 16%), and noninvasive ventilation (ICC, 15%). K-means clustering identified two distinct hospital clusters: Patients who were admitted to Cluster 1 hospitals (399 hospitals) had higher risk-adjusted rates of noninvasive ventilation (51% vs. 33%), compared with patients who were admitted to Cluster 2 hospitals (234 hospitals), which had higher risk-adjusted rates of invasive mechanical ventilation (63% vs. 30%). Cluster 2 was associated with fewer hospital-free days (β = -0.75 d; 95% confidence interval [CI] = -0.95, -0.55) and increased in-hospital mortality (adjusted odds ratio, 1.28; 95% CI = 1.17, 1.40). Conclusions: The use of adjunct interventions for patients with severe asthma exacerbations vary widely across U.S. hospitals; however, hospitals generally fall into two clusters differentiated primarily by the use of invasive or noninvasive mechanical ventilation. The cluster favoring noninvasive mechanical ventilation was associated with improved outcomes. Our results help to inform usual-care arms of future comparative effectiveness studies and efforts to standardize asthma practice.

TCT-617 Hospital Dispersion and Patient Outcomes of Transcatheter Mitral Valve Repair

TCT-617 Hospital Dispersion and Patient Outcomes of Transcatheter Mitral Valve Repair

Assessment of the Effectiveness of the E-Government System in Camarines Norte Provincial Hospital

The research focuses on evaluating the effectiveness of the e-government system at Camarines Norte Provincial Hospital. It assesses the system's performance using the System Evaluation Questionnaire aligned with the ISO 25010-2011 system/software quality model indicators, which include functionality, reliability, usability, performance efficiency, compatibility, portability, and security. The study's findings indicate that iHOMIS performs exceptionally well at Camarines Norte Provincial Hospital, particularly excelling in functionality, reliability, usability, and security. This suggests that the system is robust, user-friendly, and meets users' needs effectively, with users expressing confidence in the system's data protection and privacy measures.However, the results for performance efficiency, compatibility, maintainability, and portability are satisfactory but suggest areas for improvement. Overall, the findings point to a positive user experience at Camarines Norte Provincial Hospital, although there is potential for further enhancements to achieve consistent excellence across all evaluated criteria. The study concludes that iHOMIS is well-suited to meet the e-governance needs of government facilities like Camarines Norte Provincial Hospital. The successful implementation of iHOMIS at CNPH demonstrates the significant impact of the Department of Health's initiative in improving hospital operational efficiency and patient outcomes. CNPH's digital transformation journey serves as a model for other government healthcare facilities aiming to enhance patient outcomes through digital means. The insights from this study are expected to be pivotal in advancing e-government initiatives nationwide.

Impact of hospital pharmacy interventions on length of stay in hospitals: a protocol for a systematic review and meta-analysis

Background Length of stay (LOS) is an essential metric for hospital efficiency, patient outcomes and satisfaction. Studies indicate hospital pharmacy interventions positively affect LOS and other outcomes, yet results vary due to study differences. No systematic review or meta-analysis has been conducted on this topic; thus, the aim of this study is to systematically assess the effect of interventions on LOS. Methods This review will conduct a systematic search across MEDLINE, EMBASE, Cochrane Trials, Cochrane Reviews and the Cumulative Index to Nursing and Allied Health Literature to identify pertinent studies. An expert librarian will craft the search strategy, ensuring our review adheres to standard guidelines. We will use Covidence, a specialized systematic review management software, to optimize data management, the selection process and data extraction. A dedicated team of reviewers will independently evaluate titles and abstracts in duplicate, progressing to full-text examination of articles, to determine inclusion in our review and analysis. Data will be extracted by one reviewer, with independent data extraction by a second reviewer in a proportion of papers, and checking for consistency by a third. A template in Covidence will guide extraction of study, setting, participant, intervention and outcome characteristics and findings. The findings will be described narratively, and if possible given the methodological and statistical heterogeneity, meta-analysis will be undertaken. Discussion Considering the inconsistency of previous studies, this systematic review aims to clarify the potential impact of hospital pharmacy interventions on LOS. It will expand and reinforce existing knowledge, and provide detail about which intervention types have the most impact on LOS.

Enhancing Hospital Efficiency and Patient Outcomes Through Flexible Resident Scheduling: A Meta-Analysis

Enhancing Hospital Efficiency and Patient Outcomes Through Flexible Resident Scheduling: A Meta-Analysis

MM-038 Beyond the Remission: How Does Beating Cancer Affect Your Heart Attack Outcomes? Impact of Multiple Myeloma in Remission on Hospitalization Outcomes in Patients with Acute Myocardial Infarction: Insights From a Retrospective Analysis of the 2021 National Inpatient Sample Database

MM-038 Beyond the Remission: How Does Beating Cancer Affect Your Heart Attack Outcomes? Impact of Multiple Myeloma in Remission on Hospitalization Outcomes in Patients with Acute Myocardial Infarction: Insights From a Retrospective Analysis of the 2021 National Inpatient Sample Database

Characteristics of Patients Hospitalized to Community Hospitals With Malignant Brain Tumors and Factors Associated With Discharge Destination.

Our main objective was to compare the characteristics and hospital outcomes of patients with primary and metastatic brain malignancies and to investigate the associated factors related to hospital outcomes. We conducted a retrospective, cross-sectional study of 1628 patients with brain malignancies from 8 community hospitals between 2017 and 2022 who were identified using International Classification of Disease codes. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge. The median age was 65 years old, with 72.5% of patients having metastatic brain malignancies. After 7.2 days of hospital stay, 49.2% were discharged home, and 102 patients expired during hospitalization. Increased age, medical coverage by Medicare, hemiplegia or paraplegia, lower initial hemoglobin level, increased length of stay, and the use of electrolyte replacement, antibiotics, laxatives, heparin, and anticonvulsants were associated with a decreased likelihood of discharge to home. No medical insurance, Medicaid insurance coverage, comorbidities of cerebrovascular disorder, the need to stay in the intensive care unit, patient safety indicator events, and the use of antibiotics, oral analgesics, and ipratropium-albuterol were associated with increased odds of in-hospital mortality. We identified several predictor variables that delineate differences between both mortality risk and home discharge in patients with primary and metastatic brain tumors. Understanding these predictor variables can be helpful in improving the acute and post-acute care of this population.

Comparative assessment of venous congestion severity and hospitalization outcomes in patients with acute decompensated heart failure with preserved ejection fraction

Aim. To characterize the potental of additional paraclinical research methods (ultrasound, determination of body composition) for assessing the congestion severity in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) in the intensive care unit.Material and methods. We examined 82 patients with ADHFpEF aged from 50 to 85 years, who were hospitalized in the intensive care unit of the Veresaev City Clinical Hospital (Moscow). All patients underwent a standard clinical and laboratory examination, including determination of NT-proBNP, as well as echocardiography, chest radiography, bioimpedance analysis, Venous Excess Ultrasound (VExUS), lung ultrasound. Depending on the congestion degree visualized by VExUS, patients were divided into three groups.Results. The median levels of NT-proBNP, E/A and E/e', number of B-lines in one lung segment, ECW and TBW, and the diuretics' dose used in the hospital in pa tients with ADHFpEF and severe congestion were significantly higher. Signs of congestion obtained as a result of X-ray examination did not differ significantly between groups. In-hospital death was associated with higher values of NT-proBNP, E/A ratio, IVC diameter, number of B-lines in one lung segment, ECW and TBW. The odds of death in patients with VExUS Grade 3 increased 20,9 times compared to Grade 1 (95% CI: 1,125-387,688).Conclusion. Higher levels of NT-proBNP, the dose of diuretics used in the hospital, and ECW and TBW were associated with congestion severity. The severity of congestion assessed by VExUS and ECW/TBW are positively associated with inhospital mortality

MPN-092 Association Between Major Depressive Disorder and Hospitalization Outcomes in Patients With Lymphoid and Hematopoietic Malignancies: A Population-Based Study

MPN-092 Association Between Major Depressive Disorder and Hospitalization Outcomes in Patients With Lymphoid and Hematopoietic Malignancies: A Population-Based Study