Inpatient Days Research Articles

The impact of residual diabetic toe osteomyelitis at the conservative surgical resection margins on prognosis.

The study is to investigate how residual osteomyelitis at conservative surgical resection margins affects the prognosis of diabetic toe osteomyelitis. In this retrospective study, 67 participants with diabetic toe osteomyelitis who underwent conservative surgery were evaluated. The diagnosis of osteomyelitis was based on histopathology, and bone histopathology was done on the resection bone. After discharge, a 16-week follow-up was conducted, focusing on the wound healing time as the primary outcome. Cox regression analysis was employed as the primary method to analyse the risk factors that influence wound healing. Among the 67 participants, 48 (71.6%) had positive bone margins, while 19 (28.4%) had negative bone margins. Participants with positive bone margins experienced an average healing time of 60.78 ± 18.50 days, whereas those with negative bone margins had an average healing time of 55.19 ± 14.60 days (p = 0.285). Bone margins (positive vs. negative) did not have an impact on wound healing (HR, 1.195 [95% CI, 0.668-2.136]; p = 0.549). Ankle-brachial index was identified as a factor influencing wound healing (HR, 5.399 [95% CI, 1.145-25.455]; p = 0.033). There was no statistical difference between the two groups in terms of wound healing rates (40 of 48 [83.3%] vs. 16 of 19 [84.2%], p = 0.93), inpatient days (19.48 ± 5.25 vs. 18.26 ± 4.79 days, p = 0.385) and duration of antibiotics (32.33 ± 5.64 vs. 30.53 ± 6.93 days, p = 0.272). The residual osteomyelitis in diabetic toe osteomyelitis post-conservative surgery does not impact the wound healing.

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial.

The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. From 10/25/2018 to 03/29/2019, and 10/01/2019 to 11/15/2019, all adults (≥18 years of age) admitted for acute inpatient psychiatric care in Trondheim, Norway, were randomly allocated to a ward with a blue-depleted evening light environment or a ward with a standard light environment. Baseline and outcome data for individuals who provided deferred informed consent were used. The primary outcome measure was the mean duration of admission in days per individual. Secondary outcomes were estimated mean differences in key clinical outcomes: Improvement during admission (The Clinical Global Impressions Scale-Improvement, CGI-I) and illness severity at discharge (CGI-S), aggressive behaviour during admission (Broset Violence Checklist, BVC), violent incidents (Staff Observation Aggression Scale-Revised, SOAS-R), side effects and patient satisfaction, probabilities of suicidality, need for supervision due to suicidality, and change from involuntary to voluntary admission. The Intent to Treat sample comprised 476 individuals (mean age 37 (standard deviation (SD) 13.3); 193 (41%) were male, 283 (59%) were female). There were no differences in the mean duration of admission (7.1 days for inpatients exposed to the blue-depleted evening light environment versus 6.7 days for patients exposed to the standard evening light environment; estimated mean difference: 0.4 days (95% confidence interval (CI) [-0.9, 1.9]; p = 0.523). Inpatients exposed to the blue-depleted evening light showed higher improvement during admission (CGI-I difference 0.28 (95% CI [0.02, 0.54]; p = 0.035), Number Needed to Treat for clinically meaningful improvement (NNT): 12); lower illness severity at discharge (CGI-S difference -0.18 (95% CI [-0.34, -0.02]; p = 0.029), NNT for mild severity at discharge: 7); and lower levels of aggressive behaviour (difference in BVC predicted serious events per 100 days: -2.98 (95% CI [-4.98, -0.99]; p = 0.003), NNT: 9). There were no differences in other secondary outcomes. The nature of this study meant it was impossible to blind patients or clinical staff to the lighting condition. Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff. Clinicaltrials.gov NCT03788993; 2018 (CRISTIN ID 602154).

Changes in emergency healthcare use following intervention by Navigator, an emergency department social support programme: a multi-centre retrospective before-and-after study.

Patients living with social deprivation, and those with experiences of violence, substance misuse, mental ill-health and homelessness are known to use emergency departments (EDs) more often. It is not known whether a programme of social support initiated during ED attendance may lead to a reduction in healthcare use. The objective of this study is to determine the change in emergency, inpatient and outpatient healthcare use following a social support programme, Navigator, initiated during an ED attendance. Retrospective before-and-after study. Adult patients ≥16 years, attending EDs in the West of Scotland from 14th September 2016 to 10th March 2023, with a Navigator programme encounter. The Navigator social support programme, delivered by trained support workers, initiated during ED attendance, and targeting patients affected by issues including violence, substance misuse, mental ill-health, domestic abuse and homelessness. Healthcare use rates in the 365 days following intervention, as change compared to those in the 365 days prior to the intervention. The primary outcome was the number of ED attendances in the year following intervention compared with the year prior to intervention. Secondary outcomes included inpatient admissions, inpatient bed days, outpatient appointments and outpatient appointments where the patient did not attend. Changes in use rates were analysed with negative binomial regression and reported as incidence rate ratios for interpretation as percentage change. Analysis was repeated for a subgroup of frequent attenders to the ED. Of 1421 Navigator programme encounters, 1056 were included for analysis. Median attendance in the year prior to intervention was 3 [interquartile range (IQR) 1-5], and in the year following intervention was 2 (IQR 0-4). Negative binomial regression demonstrated that in the year following Navigator intervention, there was a 29% (95% confidence interval: 24-33%) reduction in ED attendances. The Navigator programme was associated with reduced emergency and acute healthcare use in the year following intervention, with increased scheduled outpatient care. There is the potential for a social support programme, delivered from the ED, to change patterns of healthcare use, and future work should consider prospectively assessing the impact of such an intervention.

Inpatient Test Utilization and Test Volume Benchmarking: A Q-Probes Study.

Test-ordering practices vary widely between and within health care organizations, and methods used to benchmark test utilization data are unstandardized. To develop and apply standardized methodology to compare inpatient test utilization data submitted by laboratories enrolled in a College of American Pathologists Q-Probes study. Participating laboratories provided inpatient test volumes for 50 designated analytes and total inpatient days for 2019 or a recent 12-month period. Test utilization patterns were characterized by studying test volumes standardized per 1000 inpatient days. Test volume variability used the standardized median absolute deviation; standardized test volumes were evaluated by calculating comparative ranges for each analyte. Standardized test volumes falling outside their respective comparative ranges are referred to as outliers in this study. Volume data were tested for association with stewardship practices and institutional demographics. Methodology using standardized test volume data identified test groups that are commonly used in the inpatient setting and efficiently identified volume outliers. High test volume outliers included creatine kinase myocardial band, free prostate-specific antigen, myoglobin, serotonin release assay, and hepatitis B serologies; no low-volume outliers were observed. Among 33 participants, 13 (39%) had no test volume outliers, while 5 (15%) showed multiple tests (13-34) with comparatively high volumes. No statistically significant relationships were found between stewardship practices and test-ordering patterns. Our approach can be used to measure inpatient test volume data across organizations and for identifying test volumes falling outside of the standardized comparative ranges that may require interventions to change test utilization practices.

Effectiveness of geriatric rehabilitation in inpatient and day hospital settings: a systematic review and meta-analysis

BackgroundGeriatric rehabilitation is a multidisciplinary intervention that promotes functional recovery in older adults. Our objective was to assess the efficacy of geriatric rehabilitation in inpatient and geriatric day hospital settings.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, PEDro and AgeLine from inception to September 30, 2022 for randomized controlled trials (RCTs) including older adults (age ≥ 65 years) undergoing geriatric rehabilitation (inpatient or day hospital) with a usual care comparator group. Primary outcome measures included mortality, long-term care home (LTCH) admission, and functional status. Secondary outcomes included discharge/remaining at home, functional improvement, length of stay, cognition, mood, and quality of life. Records were screened, abstracted and assessed for risk of bias (Cochrane Risk of Bias [RoB] 2) by two reviewers independently. We conducted a random effects meta-analysis to summarize risk ratios (RR, dichotomous outcomes) and standardized mean differences (SMD, continuous outcomes).ResultsOf the 5304 records screened, 29 studies (7999 patients) met eligibility criteria. There were 23 RCTs of inpatient geriatric rehabilitation (6428 patients) and six of geriatric day hospital (1571 patients) reporting outcomes of mortality (26 studies), LTCH admission (22 studies), functional status (19 studies), length of stay (18 studies), cognition (5 studies), mood (5 studies) and quality of life (6 studies). The primary outcome of mortality at longest follow up was lower in the rehabilitation group (RR 0.84, 95% confidence interval [CI] 0.76 to 0.93, I2 = 0%). LTCH admission was lower in the rehabilitation group at longest follow up (RR 0.86, 95% CI 0.75 to 0.98, I2 = 8%). Functional status was better in the rehabilitation group at longest follow up (SMD 0.09, 95% CI 0.02 to 0.16, I2 = 24%). Cognition was improved in the rehabilitation group (mean difference of mini-mental status exam score 0.97, 95% CI 0.35 to 1.60, I2 = 0%). No difference was found for patient length of stay, mood, or quality of life.ConclusionsGeriatric rehabilitation in inpatient and day hospital settings reduced mortality, LTCH admission, and functional impairment. Future studies should explore implementation of this intervention for older adults.Review registrationPROSPERO: CRD42022345078.

From Clinical to Non-clinical Outcomes in the Treatment of HIV: An Economic and Organizational Impact Assessment.

The aim of this study was to define the economic and organizational impacts related to a broader utilization of bictegravir/emtricitabine/alafenamide (BIC/FTC/TAF) in Italian clinical practice. A budget impact analysis-representing the evolution of the Italian National Healthcare Service (NHS) healthcare expenditure over 3years-was developed, considering the overall Italian population treated for human immunodeficiency virus (HIV). Model input variables were treatment history, therapeutic regimen, development of adverse events, achievement of an undetectable viral load and total direct healthcare costs. Besides the BIA, an organizational impact assessment was conducted to determine the impact on the use of healthcare resources, assessing the release of organizational hospital assets, focusing on the management of drug-related adverse events. Data were collected from scientific evidence, Italian national and regional legislations and healthcare professionals' reports. To verify the robustness of the economic and organizational impact assessment, sensitivity analyses were performed. Results demonstrate economic savings of about 26million euros in total health spending, assuming a higher penetration rate for BIC/FTC/TAF. This change in the current case mix would lead to a reduction in the specific costs related to adverse event management (0.9million euros; -2.09%) and in the medical management of patients (38million euros; -7.79%), with a positive impact on the achievement of virological control. From an organizational perspective, a wider use of BIC/FTC/TAF generates a reduction in the utilization of healthcare resources due to a decrease in adverse events and complications. The model estimated a 19.64% reduction in HIV-related inpatient days, which freed up healthcare professional time. Capable of improving both economic and organizational sustainability for the entire HIV care continuum, BIC/FTC/TAF is an efficient therapeutic strategy for people with HIV.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

Complications, Costs, and Health Care Resource Use with Tissue Biopsy Followed by Liquid Biopsy Versus Tissue Re-biopsy in Patients With Newly Diagnosed Metastatic Nonsmall-cell Lung Cancer.

We compared complications, costs, and health care resource utilization (HCRU) of patients with newly diagnosed metastatic nonsmall-cell lung cancer (mNSCLC) who had a tissue biopsy followed by either liquid biopsy (TFLB) (identified with a novel algorithm) or tissue re-biopsy (TRB). This claims-based retrospective analysis included commercial and Medicare Advantage members in the Optum Research Database with mNSCLC (January 2017 to June 2021) and ≥2 tissue biopsy claims (7 to 90d apart) (TRB) or ≥1 tissue and ≥1 liquid biopsy claim within 90 days (TFLB). Patients in the TFLB group were matched 1:1 to patients in the TRB group using propensity score matching. Surgical biopsy-related complications and complication-related and all-cause medical costs and HCRU during the 6-month follow-up were compared. Both groups had 235 patients post-match. During the follow-up, the surgical biopsy-related complication rate was lower in the TFLB group than the TRB group (65.1% [153/235] vs. 84.7% [199/235], P<0.001). Mean complication-related medical costs were significantly lower with TFLB ($8494 vs. $19,741, P<0.001) during the follow-up; mean (SD) duration of complication-related inpatient stays was significantly lower with TFLB (3.5 [7.0] vs. 6.6 [13.3]d, P=0.002). Mean all-cause medical costs were not significantly different between the groups; the TFLB group had fewer all-cause inpatient stays, inpatient days, and outpatient visits. Multiple tissue biopsy procedures may be associated with significantly higher biopsy complication rates, higher complication-related medical costs, and longer complication-related inpatient stays than TFLB. All-cause medical costs were similar between groups.

Utilization of Psychiatric Hospital Services Following Intensive Home Treatment

Home treatment (HT) has been associated with fewer inpatient treatment (IT) readmission days but lacks evidence on reducing combined psychiatric hospital service use (IT, HT, day clinic). To assess the association of intensive home treatment (IHT) compared with IT regarding readmission rate, social outcomes, and clinical outcomes. This quasi-experimental, nonrandomized trial was conducted from 2020 to 2022 in 10 psychiatric hospitals in Germany. Propensity score (PS) matching was used to compare both treatment models at the 12-month follow-up using standardized instruments and routine hospital data. All patients were screened until the target sample size was reached, based on these criteria: stable residence with privacy for sessions, no child welfare risk, primary diagnosis within International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F0X to F6X, residence in the catchment area, no commitment order, no acute suicidality or severe aggression requiring hospitalization, capacity to consent, not participating in other interventional studies, sufficient German language skills, no substantial cognitive deficits or intellectual impairment, and no more than 7 days in IHT or IT before recruitment. Statistical analysis was performed from February to November 2023. IHT provided daily acute psychiatric treatment at home, while IT was psychiatric inpatient treatment as usual. The mean treatment duration of the index treatment was 37.2 days for IHT and 28.2 days for IT. The inpatient readmission rate was the primary outcome. Secondary outcomes were combined readmission rate, total inpatient days, job integration, quality of life, psychosocial functioning, symptom severity, and recovery. Of 1396 individuals, 200 patients receiving IHT and 200 patients receiving IT were included (264 female [65%]; mean [SD] age, 45.45 [15.83] years [range, 18-88 years]). Baseline sociodemographic and psychometric characteristics did not differ significantly between the groups. At 12-month follow-up, patients in the IHT group had lower inpatient readmission rate (IHT vs IT: 31.12% vs 49.74% IT; mean difference, 18% [95% CI, 9%-28%; P < .001), combined readmission rate (mean difference, 13% [95% CI, 4%-24%; P < .001), and fewer inpatient days (mean difference, 6.82 days; P < .001) than the IT group. This nonrandomized clinical trial found that patients receiving IHT had a lower likelihood of utilizing hospital-based psychiatric services and spent fewer inpatient days, suggesting that IHT is a viable alternative to IT. ClinicalTrials.gov Identifier: NCT04745507.

Evaluation of a community-based brief intervention service for youth in crisis with suicidal ideation or self-harm.

To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12-25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm. A pragmatic, real-world evaluation was conducted on the Youth Brief Intervention Service between June 2021 (inception) and October 2022. Service users were offered four sessions over an approximate one-month period. Sessions focused on distress tolerance, safety plans and support systems. Implementation outcomes related to service uptake, retention, fidelity of the model and service user experience. Effectiveness outcomes were measured pre-post and included mental health-related hospital service utilization (primary outcome), functioning, mental health status, self-harm, suicidal ideation and quality of life. Of the 136 young people referred to the Youth Brief Intervention Service, 99 were accepted with 17 disengaging before the first session. Eighty percent of people who commenced, completed the package of care. Young persons' and parent/carers experience of service was high (97% and 88%, respectively). Mental health-related emergency department presentations and inpatient days decreased from 3 months pre-intake to 3 months post-intake (42 vs. 7 presentations, X 2 = 25.3, p < .001; 11 vs. 0 inpatient days, X 2 = 9.1, p = .01). There were significant improvements in mental health status, days engaging in self-harm, general health and functioning and quality of life. The Youth Brief Intervention Service is feasible, acceptable, subjectively beneficial and coincided with less mental health-related emergency department presentations and inpatient days, and improved mental health status and behaviour.

Preterm infant attachment is independent of breast milk intake during neonatal care

Background Following preterm birth, breast milk feeding is recommended because it confers broad health benefits to preterm infants. Breast milk has been suggested to promote secure attachment in infancy, but this is uncertain. Elucidating the relationship between breast milk intake and infant attachment is crucial for supporting parents of preterm infants to make feeding choices and providing accurate counselling when breast milk is not available. We aimed to investigate if breast milk exposure during neonatal care associates with attachment outcomes derived from infants’ responses to the Still-Face Paradigm (SFP) at nine months of age. Methods We studied 77 preterm (&lt; 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Infant responses to the SFP were videocoded at nine months corrected age. Infants’ distress, fretfulness, attentiveness to caregivers and attachment classification were compared between preterm infants who received exclusive breast milk for ≥ 75% of inpatient days, those who received exclusive breast milk for &lt; 75% of inpatient days, and term infants. Milk intake thresholds were chosen based on our previous work demonstrating positive associations between breast milk intake and MRI markers of brain maturation. Results There were no significant differences in infant distress, fretfulness, attentiveness to caregivers (p-values &gt; 0.19), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00) between preterm infants with high or low breast milk exposure, or term comparators. Conclusions Attachment outcomes at nine months were similar between term and preterm infants, and breast milk exposure did not associate with attachment in the preterm group. Although breast milk feeding has clear benefits, these findings may alleviate some of the pressures experienced by parents who are unable to provide breast milk for infants cared for in the neonatal unit.

Clinical characteristics of megaloblastic anemia with pancytopenia

ABSTRACT Objectives In this study, we aimed to explore the clinical characteristics of patients with megaloblastic anemia and pancytopenia. Methods Data on patient characteristics, laboratory examinations, clinical manifestations, and associated diseases were collected from Changzhou Hospital of Traditional Chinese Medicine. The participants were divided into two groups according to routine blood test results: megaloblastic anemia patients with pancytopenia (Group A) and megaloblastic anemia patients with simple anemia (Group B). Results The number of patients with fever and bleeding in Group A was much higher than that in Group B. Inpatient days and hospitalization costs in Group A were higher than those in Group B. White blood cell count, red blood cell count, haemoglobin level, and platelet count in Group A were lower than those in Group B. There were no significant differences in mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and serum levels of lactate dehydrogenase (LDH), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), albumin (ALB), vitamin B12, folic acid, and ferritin between the two groups. The incidence of associated diseases, particularly pulmonary infections, was significantly higher in Group A than in Group B. There was no significant difference in the degree of bone marrow hyperplasia between the two groups. Conclusion Patients with pancytopenia and megaloblastic anemia often developed infection and bleeding, which caused more severe anemia, higher hospitalization costs, and longer inpatient days. Early diagnosis and active treatment are required to reduce patient complications and costs.

Machine-learning based prediction for high health care utilizers using a multi-institution registry

Abstract Background Rising healthcare costs worldwide have spurred interest in using machine learning to pinpoint major healthcare utilizers for population health efforts. Previous studies have focused on individuals who impose the highest financial burden, such as targeting high-need high-cost utilizers, a small group with limited potential for cost reduction. Therefore, we developed models to predict future healthcare utilization across various thresholds. Methods We leveraged data from a multi-institutional diabetes database to develop binary classification models capable of predicting healthcare utilization in the following year. The models predicted six different outcomes: patients with an annual total length of stay of ≥ 7, ≥14, and ≥30 days, and emergency department (ED) attendance of ≥ 3, ≥5, and ≥10 visits. To mitigate class imbalance, we applied random and synthetic minority oversampling techniques and compared against models trained without oversampling. Models were trained with 2019 data and tested on unseen data from 2020 and 2021. Results Models trained with random oversampling, including logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron, consistently demonstrated high AUC (&amp;gt;0.80) and sensitivity (&amp;gt;0.60) across both training-validation and test datasets. Addressing class imbalance was found to be crucial, as models without oversampling displayed satisfactory AUC (&amp;gt;0.80) but significantly lower sensitivity (&amp;lt;0.10). Key predictors identified included age, number of ED visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean HbA1c levels. Conclusions Our machine learning models successfully predict high service level utilization with strong performance, offering valuable tools for policymakers and health planners to develop targeted health initiatives based on patient utilization patterns. Key messages • Machine learning models can be leveraged to predict future healthcare utilization and facilitate interventional program development. • Annual total length of stay and total emergency department visits are useful service level indicators.

IEHT vs. Regular Treatment - Are there Differences between the Two forms of Treatment in the Retrospective Course with regard to Individual Objective and Subjective Outcome Variables?

This retrospective follow-up study over one year (after discharge from the index treatment), compares the effects of inpatient-equivalent home treatment (IEHT) and regular psychiatric treatment using subjective and objective quality indicators. Using a 1:1 matching of cohorts (diagnosis, age, gender, number of previous treatments and severity of illness), 732 IEHT patients were assigned to a comparison group. Outcome data was taken from the routine data of the clinic database and the in-house basic documentation. In the subjective quality measure, patients and practitioners in regular psychiatric treatment reported a significantly higher improvement in condition. In terms of the objective quality measure, the number of further inpatient treatment days in the observation period, the two groups did not differ significantly, which can be interpreted as encouragement for the use of this new, increasingly established form of treatment.

The influence of Muscle Wasting on Patient Outcomes among Burn Patients: A Burn Care Quality Platform Study.

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84,438 adult and pediatric burn patients injured between 2000-2018. Only 2.6% (N=2,159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P<0.001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

Machine Learning-Based Prediction for High Health Care Utilizers by Using a Multi-Institutional Diabetes Registry: Model Training and Evaluation.

The cost of health care in many countries is increasing rapidly. There is a growing interest in using machine learning for predicting high health care utilizers for population health initiatives. Previous studies have focused on individuals who contribute to the highest financial burden. However, this group is small and represents a limited opportunity for long-term cost reduction. We developed a collection of models that predict future health care utilization at various thresholds. We utilized data from a multi-institutional diabetes database from the year 2019 to develop binary classification models. These models predict health care utilization in the subsequent year across 6 different outcomes: patients having a length of stay of ≥7, ≥14, and ≥30 days and emergency department attendance of ≥3, ≥5, and ≥10 visits. To address class imbalance, random and synthetic minority oversampling techniques were employed. The models were then applied to unseen data from 2020 and 2021 to predict health care utilization in the following year. A portfolio of performance metrics, with priority on area under the receiver operating characteristic curve, sensitivity, and positive predictive value, was used for comparison. Explainability analyses were conducted on the best performing models. When trained with random oversampling, 4 models, that is, logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron consistently achieved high area under the receiver operating characteristic curve (>0.80) and sensitivity (>0.60) across training-validation and test data sets. Correcting for class imbalance proved critical for model performance. Important predictors for all outcomes included age, number of emergency department visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean hemoglobin A1c levels. Explainability analyses using partial dependence plots demonstrated that for the best performing models, the learned patterns were consistent with real-world knowledge, thereby supporting the validity of the models. We successfully developed machine learning models capable of predicting high service level utilization with strong performance and valid explainability. These models can be integrated into wider diabetes-related population health initiatives.

Cardiovascular risk factors as potential biomarkers of length of hospital stay and rehospitalization in mood disorders – a retrospective study

ObjectiveCardiovascular diseases are often comorbid with mood disorders, increasing the burden on patients. Few studies explore the role of cardiovascular disease on psychiatric inpatient stays. This retrospective study investigated the association of cardiovascular risk factors during an index stay on psychiatric length of stays and rehospitalization in the subsequent 10 years in patients with mood disorders. MethodsPatients with a first inpatient stay in two German psychiatric hospitals, diagnosed with F31 (bipolar affective disorder), F32 (depressive episode) or F33 (recurrent depressive disorder) were investigated (n=930). The association of hypertension, hypercholesterolemia, and type 2 diabetes mellitus at the index stay with total length of stays, average length of stay and rehospitalization in the next 10 years was investigated in bivariate, and multivariate regression analyses, adjusting for sex, age, BMI, smoking, taking antidepressants and antipsychotics. ResultsPatients averaged 99.27 (± 134.94) inpatient days within 10 years, patients with hypertension 138.09 (± 162.85) days. Controlling for confounders, hypertension associated with longer total length of stays (β=0.105, p=0.044), hypertension (β=0.146, p=0.004), hypercholesterolemia (β=0.104, p=0.034) and diabetes (β=0.103, p=0.015) linked to more rehospitalizations and not having hypercholesterolemia (β=0.101, p=0.041) related to longer average stays. Sex mediated the relationship between hypercholesterolemia and both rehospitalization (F=11.60, p<0.001) and total length of stays (F=7.21, p=0.007), with males with hypercholesterolemia showing more rehospitalization and longer total length of stays than females. ConclusionCardiovascular risk factors were associated with duration and frequency of psychiatric inpatient stays in patients with mood disorders. Cardiovascular risk factors as potential predictive biomarkers for the course of disease of mood disorders should be monitored and managed.

First Pregnancy Abortion or Natural Pregnancy Loss: A Cohort Study of Mental Health Services Utilization.

While both induced abortion and natural pregnancy loss have been associated with subsequent mental health problems, population-based studies directly comparing these two pregnancy outcomes are rare. We sought to compare mental health morbidity after an induced abortion or natural loss. Continuously eligible Medicaid beneficiaries age 16 in 1999 were assigned to two cohorts based upon the first pregnancy outcome: abortion (n = 1,331) or natural loss (n = 605). Outcomes were mental health outpatient visits, inpatient hospital admissions and hospital days of stay per patient per year. Average exposure periods before and after the first pregnancy outcome for each cohort were used to adjust the mental health service rates. Prior to the first pregnancy outcome, all three utilization rates were significantly higher for the natural loss cohort compared to the abortion cohort. For the abortion cohort, the per-patient per-year increase from the pre- to post-pregnancy periods was significant for all three rates: 2.04 times for outpatient visits (p < 0.0001), 3.04 times for inpatient admissions (p = 0.0003), and 3.01 times for hospital days of stay (p = 0.0112). None of the pre-to-post rate increases were significant for the natural loss cohort. Higher pre-pregnancy use rates for women who experience a natural pregnancy loss indicate that increased mental health services use following abortion cannot be solely attributed to pre-existing mental illness. Only the abortion cohort, but not the natural loss cohort, experienced significant increases in mental health services use following the first pregnancy outcome.

Technical efficiency analysis of advanced medical centers in Burkina Faso

IntroductionBurkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures.MethodWe first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered.ResultsWe found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency.ConclusionOur results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder

BackgroundOnly 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes. MethodsThirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured. ResultsCompared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05). ConclusionsWe identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.