Healthcare Patients Research Articles

Experiences of clinical staff who work with patients who self-harm by ligature: An exploratory survey of inpatient mental health service staff.

Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. We explored the experiences of clinical staff who work with patients who self-harm by ligature. A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.

Pengaruh Pengetahuan Ibu dan Peran Petugas Kesehatan Terhadap Pemanfaatan Buku KIA Di Puskesmas Rawat Inap Muara Sabak Timur Kabupaten Tanjung Jabung Timur

The Maternal and Child Health Book (KIA) is a notebook owned by parents and health service providers that is used to monitor maternal health during pregnancy, assess the growth and development of children. The use of the MCH handbook can be optimal if health workers and cadres ensure that the mother and family understand the contents of the MCH handbook, increasing knowledge of the MCH handbook can be done in various ways, one of which is by providing counseling according to the needs of pregnant women.The research design used was a one group pretest-posttest design. It was carried out at the East Muara Sabak Inpatient Health Center in December 2022. The total population was as many as 30 respondents with a sample. Data analysis used the Wilcoxon test.The results showed that the mother's knowledge was quite good (40.0%) became good (76.7%) after attending counseling and the role of health workers was not good (66.7%) increased to good (100%) after attending counseling about the use of MCH book. There is an effect of mother's knowledge on the utilization of the MCH handbook. <0.05).The conclusion obtained in this study is the influence of mother's knowledge and the role of health workers on the use of the MCH handbook at the East Muara Sabak Inpatient Health Center, East Tanjung Jabung Regency. And it is suggested that socialization and ongoing counseling be carried out so that it is hoped that this research can be used as a reference for planning maternal and child health programs.

Variabel Daya Tanggap dan Empati Mempengaruhi Kepuasan Pasien Rawat Jalan pada RSUD H. Abdurrahman Sayoeti Kota Jambi

The main problem is also divided into severalsub-problems or exploration questions about service, videlicet 1) What are the service quality variables conforming of power variables? responsiveness, empathy, and patient satisfaction affect sanitarium case satisfaction. H. Abdurrahman Sayoeti Jambi City, and 2) Which service quality variable has the most dominant effect on patient satisfaction at the Sanitarium. The H. Abdurrahman Sayoeti Regional General Hospital, Jambi City, is a Type D General Hospital belonging to the Regional Government of Jambi City. This sanitarium is located at Jl.K.H Hasan AnangNo. 33Rt. 08 Ex. Olak Kemang Kec. Jambi City Bay Lake. Grounded on Mayor RegulationNo. 42 of 2017 the Jambi City Hospital officially uses the name H. Abdurrahman Sayoeti Hospital, Jambi City. This sanitarium was preliminarily the Olak Kemang Inpatient Health Center which in 2018 was converted into a sanitarium. Responsiveness and empathy variables show a tcount value lesser than table (1,663 and 5,329) or sig> a (0.000 <0.05) therefore H0 is rejected and H1 is accepted, meaning that there's a significant positive effect between responsiveness and empathy on patient satisfaction walk in H. Abdurrahman Sayoeti Hospital, Jambi City. The results of this study indicate that the quality of service conforming of responsiveness ( X1) and empathy ( X2) variables has a significant effect on patient satisfaction. Experimenters' suggestions for RSUD. H. Abdurrahman Sayoeti, Jambi City, should be a hospital nurse H. Abdurrahman Sayoeti Jambi City can maximize services according to the promised time, increase trust and responsiveness to patient complaints, maintain empathy and pay attention to the physical installations of the Sanitarium H. Abdurrahman Sayoeti Jambi City.

APPRENTICES TRAINING FOR INDEPENDENT WORK IN HEALTH CARE INSTITUTIONS

Background: The plan and program of apprenticeship for nurses, among other things, stipulate that the apprenticeship aims to introduce to the nurse the essence of healthcare, complement the knowledge acquired during schooling, and enable independent work after passing the professional exam. The apprenticeship program fundamentally complements the knowledge acquired in school institutions as well as the basics of the health care process. During the apprenticeship, the apprentices can determine and complement, and through practical work, train themselves for independent work with healthy and diseased people, family, and the social community, with the aim of achieving the highest possible level of health and independence in work. Aim: Perceiving of methodical approach of apprentice training for independent work in health care institutions, Methods: The observational indirect method was used in the research. The working method for data collection in this research was a survey. Two surveys were included in the research: for employed nurses and apprentices in health care institutions. The sample was 50 nurses and 50 apprentices, as random samples. In order to obtain realistic research results as much as possible, the respondents were from six different hospital institutions in Serbia. Results: Based on the goal and tasks of the research, the results of the survey showed that, on the national level, it is not specified who can train apprentices, the issue of organized training in healthcare institutions that train apprentices to do independent work, and the evaluation of acquired knowledge and apprentices’ skills. In healthcare institutions, the organized training of apprentices exists in a very small percentage. Apprenticeship training, at the largest percentage, is performed by nurses with many years of working experience. Mentors are not recognized as someone in charge of apprentices training for independent work. The satisfaction of apprentices with the training provided during the apprenticeship is not at an enviable level. Due to a lack of confidence in the quality of apprentices training, they undergo additional training after employment. Conclusion: Improving the process of apprenticeship training in the form of establishing standards, defining the conditions for apprentices training in health care institutions, evaluating training, defining the conditions for the health care institution itself that trains apprentices for independent work, recognizing the role of nurse mentors, and establishing the conditions for their mentoring are the basics for increasing the quality of the provided health care, faster independence in the work of newly employed nurses, and increased safety of patients in inpatient health care institutions.

A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours.

Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings. Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted. We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath. Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours. Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.

Sickness absence after work injuries and post-traumatic stress among white-collar workers

Abstract Background There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden. Methods A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit. Results 64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly. Conclusions About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD. Key messages • About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days. • Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.

Postpartum readmission in Maryland by race and ethnicity, 2016–2019

The majority of maternal deaths occur in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand whether there are disparities in maternal health in the postpartum period as indicated by readmission to the hospital. This study aimed to use state-wide Maryland data to identify postpartum readmission rates by race and ethnicity, as well as the major risk factors, indications, and timing of readmission. In this retrospective study (2016-2019), childbirth hospitalizations for patients of childbearing age were identified from the Maryland State Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Indication for readmission was described. Multivariable logistic regression models were employed to determine racial and ethnic differences in postpartum readmissions, adjusting for maternal and obstetrical characteristics. Among total deliveries (n=260,778), 3914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% (1306/111,325) for White patients, 2.3% (1786/79,412) for Black patients, 1.2% (485/40,862) for Hispanic patients and 1.2% (337/29,179) for patients of Other race or ethnicity (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders as compared with all other races (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio, 1.64; confidence interval, 1.52-1.77). The majority of all readmissions occurred in the first week after delivery with Black patients having higher rates of readmission in the second week relative to all other groups (P<.0001). Hypertension is a leading cause of postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race or ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.

Risk of developing psychiatric disease among adult patients with skin disease: A 9-year national register follow-up study in Norway.

The existing association between skin disease and psychiatric comorbidity has gained attention during the last decades. Stress and mental illness can directly or indirectly affect skin disease, while dermatological conditions, known to impair life quality and mental well-being, can promote psychiatric conditions. The aim of this study was to assess the risk of developing psychiatric disease among adult dermatological patients over a period of time. The secondary objective was to see which psychiatric disorders developed most commonly, and which skin diseases posed the greatest risk for later mental health issues. Adult dermatological patients were followed for 9years (2008-2016) using the Norwegian Patient Registry, for both outpatient and inpatient specialist healthcare services. Dermatological patients were identified during the first 2years and were then followed for psychiatric comorbidity prospectively for the next 7years.Cox regression models were applied to estimate the risks of psychiatric disorders among patients with skin diseases. Estimates were adjusted for age and gender differences. Hazard risk ratios (HR) with 95% CI are reported. Dermatological patients developed depressive disorders most frequently (4.1% vs. 2.3% in non-dermatological participants), followed by anxiety disorders (3.3% vs. 1.8%), and adjustment disorders (2.6% vs. 1.5%). Developing depressive disorders showed the highest HR among dermatological patients, HR (95% CI)=2.5 (2.4-2.5), followed by disorders related to alcohol use, HR (95% CI)=2.2 (2.1-2.5), and anxiety disorders, HR (95% CI)=2.1 (2.1-2.2). Papulosquamous disorders were the skin conditions with the highest HR for developing a mental health condition, with depressive disorder having HR (95% CI)=2.6 (2.5-2.9); anxiety disorders at HR (95% CI)=2.9 (2.7-3.1); and disorders related to alcohol use at HR (95% CI)=3.2 (2.8-3.6). The study demonstrates that having a skin disease doubles to triples the risk of developing a psychiatric illness within 7years, especially depression, anxiety, and alcohol use compared with the general population.

More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients.

The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors. A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources. PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001). By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.

Barriers to penicillin allergy de-labeling in the inpatient and outpatient settings: a qualitative study

BackgroundPenicillin allergy is the most commonly reported drug allergy in the US. Despite evidence demonstrating that up to 90% of labels are incorrect, scalable interventions are not well established. As part of a larger mixed methods investigation, we conducted a qualitative study to describe the barriers to implementing a risk-based penicillin de-labeling protocol within a single site Veteran’s hospital.MethodsWe conducted individual and group interviews with multidisciplinary inpatient and outpatient healthcare teams. The interview guides were developed using the Theoretical Domains Framework (TDF) to explore workflows and contextual factors influencing identification and evaluation of patients with penicillin allergy. Three researchers iteratively developed the codebook based on TDF domains and coded the data using thematic analysis.ResultsWe interviewed 20 clinicians. Participants included three hospitalists, five inpatient pharmacists, one infectious disease physician, two anti-microbial stewardship pharmacists, four primary care providers, two outpatient pharmacists, two resident physicians, and a nurse case manager for the allergy service. The factors that contributed to barriers to penicillin allergy evaluation and de-labeling were classified under six TDF domains; knowledge, skills, beliefs about capabilities, beliefs about consequences, professional role and identity, and environmental context and resources. Participants from all groups acknowledged the importance of penicillin de-labeling. However, they lacked confidence in their skills to perform the necessary evaluations, such as test dose challenges. The fear of inducing an allergic reaction and adding further complexity to patient care exacerbated their reluctance to de-label patients. The lack of ownership of de-labeling initiative was another significant obstacle in establishing consistent clinical workflows. Additionally, heavy workloads, competing priorities, and ease of access to alternative antibiotics prevented the prioritization of tasks related to de-labeling. Space limitations and nursing staff shortages added to challenges in outpatient settings.ConclusionOur findings demonstrated that barriers to penicillin allergy de-labeling fall under multiple behavioral domains. Better role clarification, opportunities to develop necessary skills, and dedicated resources are needed to overcome these barriers. Future interventions will need to employ a systemic approach that addresses each of the behavioral domains influencing penicillin allergy de-labeling with stakeholder engagement of the inpatient and outpatient health care teams.

Studying moral distress and moral injury among inpatient and outpatient healthcare professionals during the COVID-19 pandemic.

Objective: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). The purpose of this study was to examine MD and MI among inpatient and outpatient HCPs during March of 2022.The study sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on background characteristics.Methods: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at two academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings.Results: A moderate association was found between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded eight sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability.Conclusions: While interrelated conceptually, MD and MI should be viewed as distinct constructs. Many HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by those in all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being, work satisfaction, and the quality of patient care.

Determinants of inpatient healthcare utilization in Bulgaria

Determinants of inpatient healthcare utilization in Bulgaria

Healthcare costs attributable to abnormal weight in China: evidence based on a longitudinal study

BackgroundThe prevalence of abnormal weight is on the rise, presenting serious health risks and socioeconomic problems. Nonetheless, there is a lack of studies on the medical cost savings that can be attained through the mitigation of abnormal weight. The aim of this study was to estimate the impact of abnormal weight on healthcare costs in China.MethodsThe study employed a 4-wave panel data from China Family Panel Studies (CFPS) between 2012 and 2018 (11,209 participants in each wave). Inpatient, non-inpatient and total healthcare costs were outcome variables. Abnormal weight is categorized based on body mass index (BMI). Initially, the two-part model was employed to investigate the impact of overweight/obesity and underweight on healthcare utilisation and costs, respectively. Subsequently, the estimated results were utilised to calculate the overweight/obesity attributable fraction (OAF) and the underweight attributable fraction (UAF).Results In 2018, healthcare costs per person for overweight and obese population were estimated to be $607.51 and $639.28, respectively, and the underweight population was $755.55. In comparison to people of normal weight, individuals who were overweight/obese (OR = 1.067, p < 0.05) was more likely to utilise healthcare services. Overweight/obesity attributable fraction (OAF) was 3.90% of total healthcare costs and 4.31% of non-inpatient costs. Overweight/obesity does not result in additional healthcare expenditures for young people but increases healthcare costs for middle-aged adults (OAF = 7.28%) and older adults (OAF = 6.48%). The non-inpatient cost of underweight population was significantly higher than that of normal weight population (β = 0.060,p < 0.1), but the non-inpatient health service utilisation was not significantly affected.ConclusionsAbnormal weight imposes a huge economic burden on individuals, households and the society. Abnormal weight in Chinese adults significantly increased healthcare utilisation and costs, particular in non-inpatient care. It is recommended that government and relevant social agencies provide a better social environment to enhance individual self-perception and promote healthy weight.

Minority and Lower Socioeconomic Status Patients Receive Ankle Fracture Care at Higher Cost Sites

Category: Ankle; Trauma Introduction/ Purpose: Socioeconomic disparities exist in the delivery of orthopedic care. Inequitable outcomes based on socioeconomic status (SES), including income, race, and geography, have been studied in association with outcomes following lower extremity trauma care. As orthopedic surgical care shifts increasingly towards providing care in hospital outpatient departments (HOPD) and freestanding ambulatory surgery centers (ASC), there is an opportunity to address socioeconomic disparities. We aimed to assess the association between patient SES and the outpatient facility type (HOPD versus ASC) where ankle fracture care was performed. We hypothesize: (1) White patients are more likely to receive care at ASCs, (2) Minority and lower income patients are more likely to receive care at HOPDs, and (3) Total charges for care are higher for minority and lower income patients. Methods: Data in patients ≥16 years old was sourced from the State Inpatient Database and Healthcare Utilization Project State Ambulatory Surgery Database (SASD) (for Florida, North Carolina, and Wisconsin) from 2016-2019. These 3 states were selected because their SASDs include a variable defining the location of service as a hospital outpatient department (HOPD) or ASC. Cases were identified using CPT codes converted to ICD-10 procedural codes for ankle fracture open reduction and internal fixation (ORIF). 85,749 cases were included: 50,411 (59%) inpatient, 28,536 (33%) HOPD, and 6,802 (8%) ASC, representing approximately 20% of inpatient and 11.5% of outpatient cases performed in the United States. Patient and facility characteristics were abstracted. Appropriate statistical analyses were conducted to describe and compare differences between facility type and patient characteristics. Results: Significant race and income disparities exist in outpatient ankle fracture care by facility type. Most patients receiving care were White (71%). Of the patients who received care at an HOPD, 32% were Black compared to 6% at ASCs (OR 0.795, CI 0.728-0.869). Of patients receiving care at an HOPD, 27% were other minorities compared to 9% at ASC (OR 1.213, CI 1.213- 1.309). More patients at HOPDs were in the lowest income level (26%) compared to ASC (18%). Factors found to associated with higher charges for surgery included patient being of minority race, patient of lower income level, and surgery performed at HOPD versus ASC. Conclusion: Ankle fractures treated at ASCs were more likely to be White and of higher income. These socioeconomic and racial/ethnic disparities are also associated with receiving care with higher total charges. These data indicate inequitable access to ankle fracture care performed at ASC facilities. More attention to social determinants of health is critical in the context of ankle fracture care to address potential inequitable outcomes and higher cost of care.

Utilization of Healthcare Resources by Vascular Anomaly Patients: An Assessment of Healthcare Burden by Lesion Complexity.

Vascular anomalies (VAs) are heterogeneous lesions. Symptoms vary widely by lesion type and complexity. VA patients often require life-long interdisciplinary care; however, there is a paucity of data on the healthcare utilization of VA patients, and their burden on the healthcare system remains largely unquantified. We hypothesize that healthcare utilization by complex lymphatic malformation (LM) and venous malformation (VM) patients will be significantly higher compared with simple LM and VM patients. A retrospective, longitudinal study was performed of LM/VM patients seen through multidisciplinary VA clinics between January 1, 2019 and December 31, 2020. Data were collected from each patient's first presentation through December 31, 2021 and included number of office visits, imaging studies, specialists involved, procedures, hospitalization data, and approximate costs, normalized to per year utilization. Patients were divided into "simple" and "complex" LMs/VMs. Involvement of the airway, more than one anatomic area, and/or complex lymphatic anomalies were defined as "complex." In total, 28 simple and 29 complex LM patients and 51 simple and 18 complex VM patients were identified. Complex LM and VM patients had significantly higher numbers of imaging studies, specialists involved, procedures and hospitalizations, and costs incurred. Complex LM patients also had significantly higher per year office visits. VA care is chronic and costly, especially for complex LM/VM patients. LM/VM complexity was a predictor for increased inpatient and outpatient healthcare utilization and higher costs. Better awareness of the healthcare utilization trends of LM/VM patients will allow for improved counseling for these patients regarding prognosis and expectations.

Assessing the impact of recovery housing on healthcare utilization in Portland, Oregon

IntroductionCentral City Concern (CCC) operates several recovery housing sites in the Portland, Oregon metropolitan region, including the Blackburn Center (Blackburn) and the Richard L. Harris Building (Harris). This retrospective, observational study was designed to assess recovery housing's impact on inpatient detoxification readmission rates and healthcare utilization patterns. MethodsOur study population consisted of individuals discharged from CCC's Hooper Detox Stabilization Center from June 2019 to September 2020. A total of 75 clients housed at Blackburn, 63 clients housed at Harris, and 57 clients discharged as unhoused were included in the study sample. Using logistic regression for each of the two recovery housing groups relative to the unhoused group, we examined differences in readmissions to inpatient detoxification after their qualifying discharge. We then used Difference-In-Difference model to compare the per member per year (PMPY) use of different domains of health care before and after their qualifying discharge. ResultsCompared to clients discharged as unhoused, Blackburn and Harris residents had lower risk of readmissions to inpatient detoxification treatment at 90- and 180-days post-discharge. Additionally, while the mean number of PMPY emergency department visits increased for clients discharged as unhoused in the post period, the average number of emergency department visits decreased for clients who obtained recovery housing at Blackburn (DiD=-3.65 PMPY, p-value=0.02) and at Harris (DiD=-3.87 PMPY, p-value=0.01). ConclusionFindings highlight the impact and importance of recovery housing for individuals managing a substance use disorder and the value of healthcare system and public sector investment housing like Blackburn and Harris.

Health Care Professionals' Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study.

The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality.

11 Experiences of Inpatient Healthcare Services among Children with Medical Complexity: A Scoping Review

Abstract Background Children with medical complexity (CMC) have among the highest need for inpatient services in paediatrics. In addition to effectiveness and safety, experience of care (EoC) is a crucial pillar of health care quality, encompassing all interactions that shape a patient/family’s perception of care. Current evidence suggests that CMC have lower EoC compared to other populations. Collating the existing cross-disciplinary evidence will identify critical aspects of their EoC, both positive and negative, that could inform the development and evaluation of health services interventions for CMC in the hospital setting. Objectives The objectives of this scoping review were to map the existing literature related to the experience of inpatient health services for CMC and their families, describe research methods, and categorize key concepts of EoC while simultaneously identifying knowledge gaps. Design/Methods The Joanna Briggs Institute (JBI) methodology for scoping reviews was used. Articles related to CMC and the inpatient setting were identified through EMBASE, CINAHL, Web of Science, MEDLINE and PsychoInfo. Reference lists were also searched for relevant articles. Screening of titles, abstracts, and full-text articles was conducted by two independent researchers, resolving discrepancies by discussion and consensus. Data extraction and critical appraisal for included papers were likewise conducted by two separate researchers. Abstracted data included authors, participants, objectives, methodology, and key findings. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the JBI critical appraisal tool for systemic reviews. Results A total of 4463 separate articles underwent title/abstract review and 513 went on to full text review. After applying inclusion and exclusion criteria, a total of 48 articles was included in the review. There were 26 qualitative studies, 8 quantitative studies, 7 mixed methods studies, and 7 review papers. Quantitative studies used a variety of instruments to measure EoC, with the most common being the Measures of Processes of Care. The primary concepts related to EoC to be identified include partnerships (including continuity, building a therapeutic alliance), communication (particularly parent-nurse), decision-making and goal setting, and psychological distress and symptoms that occur during a hospitalization. Conclusion This review synthesizes the existing evidence on inpatient EoC for CMC. Although a diverse set of elements related to EoC are described, there are few interventional studies that include these as outcome measures. These EoC elements could be mapped to existing instruments or form the basis for the development of new tools that would allow the incorporation of EoC into evaluation of inpatient interventions.

Regional differences in the utilization and outcomes of cerebral embolic protection during transcatheter aortic valve replacement: an analysis of the National Inpatient Sample from 2017 through 2019.

Aim: To evaluate the utilization and outcomes of cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) by USA region, using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Patients & methods: All TAVR discharge encounters from June 2017-2019 were included in the analysis. Discharge encounters with bicuspid anatomy were excluded. Regional CEP utilization rates were reported. For TAVR cases performed with the Sentinel CEP device (Boston Scientific, MA, USA), multivariable logistic regression was performed to model regional differences in TAVR outcomes including: stroke, transient ischemic attack (TIA), stroke/TIA combined, and in-hospital all-cause mortality. Generalized linear regression models were used to assess regional differences in length of stay (LOS) and hospital charges. Results: The Northeast had the greatest overall CEP utilization rate (11.3%), followed by the Midwest (11.1%), West (8.7%), then South (3.1%). Compared with the Northeast, the South was associated with a lower risk of stroke (OR: 0.267, 95% CI: 0.106-0.673; p= 0.005), and the West a higher risk of stroke (OR: 1.583, 95% CI: 1.044-2.401; p= 0.031). Compared with the Northeast, the West was associated with a higher risk of stroke/TIA combined (OR: 1.618, 95% CI: 1.107-2.364; p= 0.013). Compared with the Northeast, the Midwest (OR: 4.501, 95% CI: 2.229-9.089; p< 0.001) and West (OR: 5.316, 95% CI: 2.611-10.824; p< 0.001) were associated with a higher risk of in-hospital all-cause mortality. Adjusted charges and LOS were highest in the West. Conclusion: Within the USA, there are regional differences in the utilization and outcomes of CEP use during TAVR. To prevent regional disparities and ensure consistent quality of care in the USA, further research is needed to determine what variable(s) may be responsible for regional differences in TAVR outcomes, with or without CEP.

Efektifitas Senam Hipertensi terhadap Tekanan Darah Lansia di Puskesmas Rawat Inap Muaro Kumpeh

Elderly (elderly), is a process of the final stages of a human life. One of the problems that often occurs in the elderly is hypertension. Hypertension is a condition where the elderly have blood pressure above 14/90 mmHg. One way that can be done to lower blood pressure is hypertension exercise. In Muaro Jambi Regency, based on data from the Muaro Jambi District health office, the health center with the highest number of elderly people with hypertension was the Muara Kumpeh inpatient health center with a total of 2190 cases of hypertension. The purpose of this study was to determine the effect of hypertension exercise on elderly blood pressure at the Muara Kumpeh Inpatient Health Center in 2021. This research is a quantitative study using the pre-experimental method with one group pre-test post-test design. This research was conducted in September 2021 – August 2022 at the Muara Kumpeh Inpatient Health Center. The total population is 2190 people with a sample of 10 people taken by purposive sampling technique. Data collection was done by observing blood pressure before and after the intervention, which was carried out once a week for three weeks. Blood pressure data were analyzed using paired sample t-test with α &lt; 0.05. The results of research conducted at the Muaro Kumpeh Inpatient Health Center found that hypertension exercise had an effect on elderly blood pressure (p-value = 0.000). Where the average systolic blood pressure decreased by 40 mmHg and the average diastolic blood pressure decreased by 20 mmHg. Suggestions that elderly hypertension exercise can be an alternative exercise that can be given to the elderly to lower blood pressure and for further research can add insight to researchers on the relationship between the level of influence of hypertension exercise on elderly blood pressure.