Increase In Inpatient Admissions Research Articles

Rapid Access From Primary Care to a Multidisciplinary Clinic at Tertiary Care Improves Clinical Outcomes for Patients With Diabetic Foot Ulcers: Results From Diabetic Foot in Primary and Tertiary (DEFINITE) Care's Lower Extremity Amputation Prevention Program (LEAPP) Clinic.

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional, multidisciplinary team (MDT) program for patients with diabetic foot ulcers (DFU) within a healthcare cluster in Singapore. This is one of our subgroup analyses within DEFINITE Care, assessing clinical outcomes of lower extremity amputation prevention program (LEAPP), a multidisciplinary diabetic foot clinic, and non-LEAPP patients within the program. From June 2020 to June 2022, 2798 patients within the DEFINITE cohort completed a minimum of 12-month follow up. Of these patients, 20.6% were managed by LEAPP, whereas 79.4% were non-LEAPP patients. Patients in the LEAPP cohort were older with co-existing metabolic conditions and complications of diabetes. Using non-LEAPP cohort as the reference group and after adjusting for age, gender, ethnicity, comorbidities, and medications, there was a significantly lower risk of death (odds ratio [OR] 0.60, P = .001) and composite major lower extremity amputation (LEA) or death (OR 0.66, P = .002) among LEAPP patients at 1 year with longer mean days from enrollment to minor LEA, major LEA, and death. The adjusted 1-year healthcare utilization outcomes for LEAPP patients demonstrated an increase in inpatient admissions, primary care polyclinic visits, hospital specialist outpatient clinic (SOC) visits and elective day surgery procedures. Despite the increased in inpatients admissions, cumulative hospital length of stay in LEAPP patients were lower. This subgroup analysis has demonstrated that the MDT approach to caring for patients with DFU in tertiary centers not only improves mortality by 40%, but also delayed the incidence of minor LEA, major LEA, and death.

Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

BackgroundFamily doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China.MethodsDifference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China.ResultsThe family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients.ConclusionsThe examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.

Stock Valuation and Business Performances of Indonesia Health Care Provider Company after Post Covid 19 Pandemics (Case Study of PT. Medikaloka Hermina, Tbk.)

The Covid-19 pandemic caused a contraction in the Indonesian economy, as evidenced by the large number of layoffs, and several companies had to declare bankruptcy, but this did not occur for companies engaged in health services, including hospitals. The large number of Indonesians infected with the Covid-19 virus caused hospitals to experience an increase in inpatient admissions, which accelerated the hospitals’ financial performance in a very short period of time. PT Mediloka Hermina, Tbk (HEAL) is a private hospital with the greatest number of branches in Indonesia, all of which are impacted by the Covid-19 pandemic. This is also a positive sentiment among stock investors, as they perceive the health industry sector to have very promising future prospects. Several listed hospital company on the IDX have seen their share prices increase significantly over the past year, including PT. Mediloka Hermina, Tbk, whose share price increased by 197 percent between 23 March 2020 and 23 March 2021. This made the author curious about PT Mediloka Hermina, Tbk’s stock valuation and whether its shares are classified as overvalued or undervalued. This study utilizes secondary data obtained from the annual report of PT. Mediloka Hermina, Tbk as well as idx.co.id and stockbit.com, among others. The data was processed with the absolute valuation method (Discounted Cash Flow) and the relative valuation method (Relative Value) in mind (EV EBITDA and Price Earnings to Ratio). Using the Discounted Cash Flow model, the company’s intrinsic value is IDR 452.80 per share. It has a safety margin of -135 percent relative to the per-share market price of IDR 1,065 as of 31 December 2021. The intrinsic value per share is 688 IDR based on the relative price-to-earnings ratio and relative valuation EV EBITDA of 7.21. Following the evaluation procedure. The author may determine the relationship between HEAL’s fundamental company and its stock price growth.

The bystander effect: Impact of rural hospital closures on the operations and financial well-being of surrounding healthcare institutions.

There is presently a rural hospital shortage in the United States with 180 closures since 2005 and hundreds of institutions in financial peril. Although the hospital closure phenomenon is well-established, less is known about the spillover impact on the operations and financial wellbeing of surrounding hospitals. This preliminary study quantified how discrete rural hospital closures impact institutions in their regional proximity, finding a significant increase in inpatient admissions and emergency department visits for these "bystander hospitals". Using a repository of rural hospital closures collected by the UNC Sheps Center for Health Services Research, we identified closures over the past 15 years. Criteria for inclusion were hospitals that had been fully closed between 2005-2016 and with >25-bed capacity. We then designated surrounding hospitals within a 30-mile radius of each closed hospital as "bystander hospitals." We examined the average rate-of-change for inpatient admissions and emergency department visits in surrounding hospitals both two years before and after relevant hospital closures. We identified 53 hospital closures and 93 bystander hospitals meeting our criteria during the study period. With respect to geographic distribution, 66% of closures were in the Southern US, including 21% in Appalachia. Average emergency department visits increased by 3.59% two years prior to a hospital's closure; however, at two years post-closure the average rate of increase rose to 10.22% (F (4,47) = 2.77, p = 0.0375). Average bystander hospital admissions fell by 5.73% in the two years preceding the hospital closure but increased 1.17% in the two years after (F (4,46) = 3.05, p = 0.0259). These findings predict a daunting future for rural healthcare. While previous literature has described the acute effects hospital closures have on communities, this study suggests a significant spillover effect on hospitals within the geographic region and a cyclical process at play in the rural healthcare sector. In the absence of significant public health assistance in regions affected by closures, poor health outcomes, including "diseases of despair," are likely to continue proliferating, disproportionately affecting the most vulnerable. In the COVID-19 era, it will be especially necessary to focus on hospital closures given increased risk of maintaining solvency due to delayed and deferred care atop already tight margins.

Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

BackgroundThe COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce.MethodsWe asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals.ResultsFour out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology.ConclusionsThe COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

Lower rates of endoscopy and higher mortality in end‐stage renal disease patients with gastrointestinal bleeding: A propensity matched national study

Patients with end-stage renal disease (ESRD) on hemodialysis are considered to be at higher risk of gastrointestinal bleeding (GIB) as compared with those without renal disease (NRD). We conducted a population-based study using the National Inpatient Sample (NIS) database to study the outcomes of GIB in ESRD. Patients admitted with GIB (upper and lower) from 2005 to 2013 were extracted from the NIS database using ICD-9 codes. Patients were divided into NRD and ESRD groups, and a 1:1 propensity matched analysis was performed. Various outcomes were compared in both groups, and subgroup analysis based on the timing of endoscopy was also performed. A total of 218032 patients were included in the study. There was an increase in inpatient admissions among ESRD patients with GIB with significant reduction in mortality (P<0.001). In-hospital mortality, length of stay, and total costs were significantly higher in ESRD patients as compared with NRD. ESRD patients were less likely to undergo endoscopic evaluation compared with NRD (P<0.001). Late endoscopy (>48h) was associated with increased need for transfusion and health-care utilization but without a significant difference in mortality as compared with early endoscopy. On multivariate analysis, endoscopy was associated with significantly lower rate of mortality in ESRD patients with GIB (odds ratio 0.28, P<0.0001). End-stage renal disease patients with GIB had a significantly higher rate of mortality and a higher health-care utilization with a lower rate of endoscopic evaluation. Endoscopy was associated with a lower mortality rate on multivariate analysis.

Influenza: National Trends Using the National Inpatient Sample Database from 1993 to 2015.

BackgroundThere is a significant impact of influenza on individuals, families, and societies both economically and clinically. This significant impact is a result of hospital admissions, medication expenses, side effects, secondary bacterial infections, and more days off from work or other forms of reduced productivity for the patients or their caretakers. Our objective is to present the trends in the rate of hospital discharges per 100,000 population from the years 1993 through 2015, the mean age, and the inpatient mortality rate.MethodsThis is a retrospective study utilizing the National Inpatient Sample (NIS) from 1993 through 2015. Discharges due to influenza from 1993 to 2015 were identified, and the rate of discharges per 100,000 population, inpatient mortality, and mean age of discharged patients were trended. Linear regression was used to assess if the deviation from horizontal was statistically significant for the trends of the rate of discharges per 100,000 population, mean age, and percentage of the inpatient mortality.ResultThe mean age and inpatient mortality vary from year to year. The linear regression analysis for the trends was not statistically significant, and for the percentage of the inpatient mortality, the deviation from horizontal was not significant, P-value 0.75 and F-value: 0.09. Similarly, for the mean age, the deviation from horizontal was not significant with a P-value of 0.97 and an F-value of 0.001. However, the linear regression analysis for the rate of discharges per 100,000 population was remarkable for a statistically significant deviation from the horizontal with a P-value of 0.0002 and an F value of 19.5.ConclusionRecent advancements in influenza detection have made the detection feasible, quick, and cost-effective. However, the role of these advanced modalities on the outcome is still controversial. Our analysis revealed a significant increase in the rate of discharges due to influenza, but there was no significant change in the parentage of the inpatient mortality over the years between 1993 - 2015. Advanced influenza virus detection tests are now recommended in both outpatient (including emergency department) and inpatient admissions. The recent increase in inpatient admissions could be due to better detection modalities. However, no change in the percentage of inpatient mortality makes the impact of these detection tests on the outcome questionable. A further prospective study is warranted to assess the impact of these tests on the outcome.

Assessment of health care resource utilization (HRU) in patients with castration-resistant prostate cancer (CRPC).

89 Background: Although patients with CRPC frequently develop metastasis within 3 years following castration resistance, the impact of metastasis on HRU in these patients is not well understood. Methods: The Optum de-identified electronic health record database (1/1/2007 – 4/30/2016) was used in this single cohort observational study comparing HRU after metastasis with HRU before metastasis. The cohort included only non-metastatic CRPC (nmCRPC) patients who later developed metastasis. The pre-metastasis period spanned from nmCRPC identification to development of metastasis; the post-metastasis period spanned from metastasis until death or end of data availability. Per-patient per-month (PPPM) HRU was estimated during both pre- and post-metastasis periods by a generalized linear mixed model adjusted for log-transformed baseline PSA, age, testosterone levels, and Charlson Comorbidity Index. Results: With a mean time of 11 and 17 months of pre- and post-metastasis periods, respectively, 540 CRPC men were included, with a mean age at nmCRPC identification of 75 years. Higher HRU was seen across all service types during the post-metastasis period. There was a 2.5-fold increase in inpatient admissions and a 6.4-fold increase in inpatient length-of-stay in the post-metastasis period compared to the pre-metastasis period (p &lt; 0.01). For emergency department (ED) visits, there was a 2.0-fold increase from the pre- to post-metastasis periods (p &lt; 0.01). For observation unit visits, a 2.7-fold increase was seen in the post-metastasis period (p &lt; 0.01). Finally, patients were 40% more likely to have an office visit after developing metastasis (p &lt; 0.01). The PPPM use of intensive care unit, hospice or skilled nursing facility were too low for meaningful comparison between the pre- and post-metastasis periods. Conclusions: Shorter time to metastasis was observed in this cohort vs. other nmCRPC studies, likely due to delayed disease identification. CRPC patients incurred substantially higher HRU after developing metastasis, attributable to inpatient, ED, observation unit as well as office visits, suggesting that delaying metastasis may reduce or delay the increased HRU in patients with nmCRPC.

PCV24 - Multifaceted Interventions Improve Medication Adherence In Medicaid Patients Prescribed Hypoglycemics, Statins, And/Or Antihypertensives

To measure the effectiveness of adherence interventions for oral hypoglycemics, antihypertensives, and statins on medication adherence and acute hospitalization (emergency room [ER] and inpatient) in three Medicaid managed care organizations (MCOs) in Southeastern Pennsylvania (SEPA) and Lehigh/Capital-New West Pennsylvania (LCNWPA). One-year follow-up analysis of prescription and hospitalization member data with prescription fills for hypoglycemics, statins, and/or antihypertensives from January 1 to December 31, 2012. Thirty interventions— categorized as general interventions (GI) for all subjects and personalized interventions (PI) for higher-risk care-managed subjects—were implemented to improve 2013 adherence. Medication adherence (proportion of days covered [PDC]; baseline inclusion criterion: 20%–67%) and acute hospitalization rates (utilization per thousand members per year) were calculated at baseline and at one-year post-intervention. Of 6,382 participants (1,607 LCNWPA; 4,775 SEPA), 1,044 were PI subjects (579 LCNWPA; 465 SEPA). SEPA and LCWPA member profiles were demographically similar to one another, except regarding race and ethnicity. The PDC rate improvements for all three medication classes were 13.14% for LCNWPA and 14.15% for SEPA (P<0.01 for both), accompanied by significant increases in inpatient admissions (+11.0% and +1.9%, respectively; P<0.01 for both); the SEPA cohort also experienced an increase in inpatient admissions—small in magnitude, but statistically significant (+0.3%; P<0.01). Improvements in mean PDC were significantly greater in PI than GI subjects (LCNWPA: 16.12% vs. 11.46%, P<0.01; SEPA: 20.95% vs. 13.42%, P<0.01), but increases in acute hospitalization were also significantly greater (P<0.01 for all, except ER-[LCNWPA]) due to selection bias. Subjects demonstrating improvements in 2013 PDC rates displayed comparable changes in acute hospitalization rates as their non-improving counterparts. Multifaceted MCO-implemented adherence interventions significantly improved medication adherence in Medicaid participants, especially in higher-risk subjects. However, these PDC improvements were not necessarily translated into measurable reductions in acute hospitalization over the one-year post-intervention timeframe.

Diverticular disease in Scotland: 2000-2010.

Symptomatic diverticular disease (DD) may be increasing in incidence in western society particularly in younger age groups. This study aimed to describe hospital admission rates and management for DD in Scotland between 2000 and 2010. Data were obtained from the Scottish Morbidity Records (SMR01). The study cohort included all patients with a hospital admission and a primary diagnosis of DD of the large intestine (ICD-10 primary code K57). Scottish NHS hospitals reported 90990 admissions for DD (in 87314 patients) from 2000 to 2010. The annual number of admissions increased by 55.2% from 6591 in 2000 to 10,228 in 2010, an average annual increase per year of 4.5%. Most of the increase attributable to DD was due to elective day cases (3618 in 2000; 6925 in 2010) a likely consequence of a greater proportion of the population accessing colonoscopy over that time period. There was an 11% increase in inpatient admissions (2973-3303), 60% of these patients being women. Admissions in younger age groups increased proportionally in the later years of the study, and there was an association between DD admissions and greater deprivation. Despite an increase in complicated DD from 22.9% in 2000 to 27.1% in 2010 and a 16.8% increase in emergency inpatient admissions, the rate of surgery fell during the period of study. This report supports findings of other population-based studies of western countries indicating that DD is an increasing burden on health service resources, particularly in younger age groups.

ACA Dependent-Coverage Extension Showing Positive Results

Increases in inpatient admissions were significant for both men and women, but were larger for men. Also, the probability of uninsured emergency department visits dropped by 3.9 percent.

The effect of urban hospital closure on markets

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2–4% for all patients and about 6–8% for patients who would have been treated at the closed hospital.

Indian people and community psychiatry in Saskatchewan.

A discrepancy is identified between the increase in inpatient admissions and of outpatient contacts of Treaty Indians in Saskatchewan from 1967 to 1976. This is the reverse of the trend in the non-Treaty Indian population, and represents a contradictory effect to the intention of the Community Psychiatry Program of the province's government. No major diagnostic differences were at statistically significant levels, which might have accounted for the higher inpatient admission rates and the relatively lower outpatient contact rates of Treaty Indians. This is an interesting example of the use of governmental statistics and a promising one for the identification and solution of problems in health care delivery.