Lower Admission Rates Research Articles

냉매(R245fa)를 이용한 유기랭킨 사이클에 관한 연구

The organic Rankine cycle has been widely used to convert the renewable energy such as the solar energy, the geothermal energy, or the waste energy etc., to the electric power. Some previous studies focused to find what kind of refrigerant would be a best working fluid for the organic Rankine cycle. In this study, R245fa was chosen to the working fluid, and the cycle analysis was conducted for the output power of 30kW or less. In addition, properties (temperature, pressure, entropy, and enthalpy etc.) of the working fluid on the cycle were predicted when the turbine output power was controlled by adjusting the mass flowrate. The configuration of the turbine was a radial-type and the supersonic nozzles were applied as the stator. So, the turbine was operated in partial admission. The turbine efficiency and the optimum velocity ratio were considered in the cycle analysis for the low partial admission rate. The computed results show that the system efficiency is affected by the partial admission rate more than the temperature of the evaporator.

Abstract 95: Nonvalvular Atrial Fibrillation Emergency Department Encounters where Dabigatran Etexilate was Administered are Associated with Lower Admission Rate Compared to Encounters where Warfarin was Administered

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants (OAC) that reduce stroke risk among patients with nonvalvular atrial fibrillation (AF). However, DE does not require titration and INR monitoring. This study examined whether emergency department (ED) rate of admissions differed between the two therapies. Methods: Admission rate was evaluated for hospital encounters initiated in the ED, with a primary or secondary discharge diagnosis of AF between 1/1/2011-3/31/2012, with DE or warfarin administered during the encounter, and excluding encounters of valvular AF patients. Encounters were identified from a hospital Charge Detail Masters database containing 387 eligible hospitals. Samples were propensity score matched using nearest neighbor within a caliper of 0.20 standard deviations of the logit, without replacement, and a 2:1 match. Admission rates were estimated for encounters representing previously-treated patients and those representing treatment-naive patients using binominal generalized linear models, fitted by generalized estimating equations (clustered by hospital). Covariates estimating the propensity score and admission rate included age, payer type, use of bridging agents, AF as primary or secondary diagnosis, CHADS 2 and HAS-BLED scores, comorbid conditions, and hospital attributes. As a sensitivity analysis, admission rate was also estimated from the unmatched sample. Results: Matched samples included 2,688 warfarin and 1,344 DE ED encounters of previously-treated patients out of 15,053 and 1,367 ED encounters, respectively; and 2,578 warfarin and 1,289 DE ED encounters of OAC-treatment-naive patients out of 8,361 and 1,406 ED encounters, respectively. There were too few (n<5) matched encounters where the patient had prior OAC use but were new to the drug administered during the encounter, so these were excluded. No covariates used in matching had standardized mean differences > 10% after matching. Among the previously-treated sample, the estimated admission rate was 3.2% lower for DE compared to warfarin (88.3% vs. 91.5%, p=0.010) with sensitivity analysis confirming a lower admission rate for DE (91.1% vs. 93.8%, delta=2.7%, p=0.001). Among the treatment-naive sample, DE had a 1.2% lower admission rate compared to warfarin (95.2% vs. 96.3%, p=0.048). Sensitivity analysis confirmed a lower admission rate for DE (95.5% vs. 97.0%, delta=1.5%, p=0.001). Conclusions: While the vast majority of AF encounters initiated in the ED result in admission, encounters where patients were treated with DE as continuing or new therapy were less likely to be admitted compared to similar encounters where warfarin was administered.

Abstract P350: Completion of Cardiac Rehabilitation Reduces Hospital Admission Rates in Long Term Follow-up

Introduction: Cardiac rehabilitation (CR) improves exercise tolerance, quality of life, and mortality among patients with heart disease in short term follow-up. Less is known regarding the sustained benefits attributable to CR after 1 year. Hypothesis: CR attendees have decreased morbidity, represented by lower admission rates. Methods: A database of patients referred to CR between May 2001 and January 2011 was constructed. Data on gender, race, age, and attendance was collected. Completion of CR was designated as 36 sessions. Participants attending 1 to 35 sessions were excluded. All cause hospitalization was recorded from the date of primary cardiac diagnosis. Data was analyzed using a t-test to compare hospitalization rates between participants and non-participants. Baseline admission rates were compared. Results: 162 participants competed CR, 84 (52%) of minority race, 98 (60%) males, 95 (59%) were 65 or older. There were 229 non-participants, 147 (64%) of minority race, 147 (64%) males, 77 (34%) were 65 or older. Mean follow up time was 6 years. Completion of CR resulted in lower mean hospitalization rates (1.19 vs. 2.93, p = 0.001) in all groups: Caucasians 0.92 vs. 2.99 (p = 0.005), minorities 1.44 vs. 2.89 (p = 0.035), males 1.32 vs. 2.89 (p = 0.011), females 1.00 vs. 3.02 (p = 0.003), age 65 or older 0.96 vs. 3.96 (p = <0.001). There was no difference in baseline mean hospitalization rates between participants and non-participants when comparing race or gender: non-participant Caucasians 2.99 vs. minorities 2.89 (p = 0.895), participant Caucasians 0.92 vs. minorities 1.44 (p = 0.246), non-participant males 2.87 vs. females 3.02 (p = 0.834), participant males 1.32 vs. females 1.00 (p=0.489). There was no difference in baseline mean hospitalization rates when comparing participants younger than 65 with 65 or older (1.52 vs. 0.96, p = 0.212). Non-participants 65 or older had significantly higher hospitalization rates than younger non-participants (3.96 vs. 2.33, p = 0.027). Conclusions: Long term follow-up of CR participants demonstrated a sustained morbidity benefit. Previous studies were limited to 1 year follow-up. Race, gender, and age did not influence morbidity, although participants older than 65 may have an additional morbidity reduction.

High-Frequency Users of Emergency Department Care

BackgroundThe heterogeneous group of patients who frequently use the Emergency Department (ED) have been of interest in public health care reform debate, but little is known about the subgroup of the highest frequency users. Study ObjectivesWe sought to describe the demographic and utilization characteristics of patients who visit the ED 20 or more times per year. MethodsWe retrospectively studied patients who visited a large, urban ED over a 1-year period, identifying all patients using the department 20 or more times. Age, gender, insurance, psychosocial factors, chief complaint, and visit disposition were described for all visits. Inferential tests assessed associations between demographic variables, insurance status, and admission rates. ResultsOf the 59,172 unique patients to visit the ED between December 1, 2009 and November 30, 2010, 31 patients were identified as high-frequency ED users, contributing 1.1% of all visits. Patients were more likely to be 30–59 years of age (52%), stably insured (81%), and have at least one significant psychosocial cofactor (65%). Their admission rate was 15%, as compared to 21% for all other patients. ConclusionsHigh-frequency users are patients with significant psychiatric and social comorbidities. Given their small proportion of visits, lower admission rates, and favorable insurance status, the impact of high-frequency users of the ED may be out of proportion to common perceptions.

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Variation in Resource Utilization Across a National Sample of Pediatric Emergency Departments

To describe variations in emergency department (ED) quality measures and determine the association between ED costs and outcomes for 3 pediatric conditions: asthma, gastroenteritis, and simple febrile seizure. This cross-sectional analysis of ED visits used the Pediatric Health Information System database. Children aged ≤ 18 years who were evaluated in an ED between July 2009 and June 2011 and had a discharge diagnosis of asthma, gastroenteritis, or simple febrile seizure were included. Two quality of care metrics were evaluated for each target condition, and Spearman correlation was applied to evaluate the relationship between ED costs (reflecting overall resource utilization) and admission and revisit rates among institutions. More than 250,000 ED visits at 21 member hospitals were analyzed. Among children with asthma, the median rate of chest radiography utilization was 35.1% (IQR, 31.3%-41.7%), and that of corticosteroid administration was 82.6% (IQR, 78.5%-86.5%). For children with gastroenteritis, the median rate of ondansetron administration was 52% (IQR, 43.2%-57.0%), and that of intravenous fluid administration was 18.1% (IQR, 15.3%-21.3%). Among children with febrile seizures, the median rate of computed tomography utilization was 3.1% (IQR, 2.7%-4.3%), and that of lumbar puncture was 4.0% (IQR, 2.3%-5.6%). Increased costs were not associated with lower admission rate or 3-day ED revisit rate for the 3 conditions. We observed variation in quality measures for patients presenting to pediatric EDs with common conditions. Higher costs were not associated with lower hospitalization or ED revisit rates.

A Risk Scoring System to Identify Emergency Department Patients With Heart Failure at High Risk for Serious Adverse Events

There are no validated guidelines to guide physicians with difficult disposition decisions for emergency department (ED) patients with heart failure (HF). The authors sought to develop a risk scoring system to identify HF patients at high risk for serious adverse events (SAEs). This was a prospective cohort study at six large Canadian EDS that enrolled adult patients who presented with acute decompensated HF. Each patient was assessed for standardized clinical and laboratory variables as well as for SAEs defined as death, intubation, admission to a monitored unit, or relapse requiring admission. Adjusted odds ratios for predictors of SAEs were calculated by stepwise logistic regression. In 559 visits, 38.1% resulted in patient admission. Of 65 (11.6%) SAE cases, 31 (47.7%) occurred in patients not initially admitted. The multivariate model and resultant Ottawa Heart Failure Risk Scale consists of 10 elements, and the risk of SAEs varied from 2.8% to 89.0%, with good calibration between observed and expected probabilities. Internal validation showed the risk scores to be very accurate across 1,000 replications using the bootstrap method. A threshold of 1, 2, or 3 total scores for admission would be associated with sensitivities of 95.2, 80.6, or 64.5%, respectively, all better than current practice. Many HF patients are discharged home from the ED and then suffer SAEs or death. The authors have developed an accurate risk scoring system that could ultimately be used to stratify the risk of poor outcomes and to enable rational and safe disposition decisions.

The influence of Antonovsky’s sense of coherence on admission and psychosocial functioning

Objective  Psychosocial interventions can reduce admission rates and enhance the psychosocial functioning of patients suffering from schizophrenia. This study investigates the influence of Antonovsky’s sense of coherence on psychosocial functioning and admission rate among participants of psychoeducative multi-family groups (PG) compared to a control group (CG). Method  46 schizophrenic outpatients participated in a prospective study. They got treatment as usual in the psychiatric ambulance. Additionally they could choose participation with their relatives in the PG or join the CG. Patients were assessed with the Sense of Coherence scale (SOC-29) and the Global Assessment of Functioning scale (GAF). Admission rates (AR) were conducted from the hospitals basic documentation. Results  Before intervention PG and CG had a comparable AR, but the PG had significant lower GAF scores. After intervention the PG had a significant lower AR and higher GAF scores than the CG. In a comparison of subgroups (high vs. low SOC scores) PG participants with low SOC scores could reduce significantly their AR and enhance their GAF scores. Notably, all patients with high SOC scores had the lowest AR within all three measurement points. Conclusion  PG participants, especially those with low SOC scores, had a considerable profit in regards to AR and GAF compared to the CG. After intervention they showed the same AR and GAF scores as patients with high SOC scores. Implications for clinical practice and economic decisions are a pre-selection of patients with low SOC levels for targeted interventions and more therapeutic efforts to enhance the SOC.

Language and utilisation of emergency care in Queensland

To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home. A retrospective analysis of a Queensland statewide hospital ED dataset (ED Information System) from 1 January 2008 to 31 December 2010 was conducted. Access to ED care was measured by the proportion of the state's population attending EDs. Logistic regression analyses were performed to determine the relationships between ambulance use and language, and between hospital admission and language, both after adjusting for age, sex and triage category. The ED utilisation rate was highest in English only speakers (290 per 1000 population), followed by Arabic speakers (105), and lowest among German speakers (30). Compared with English speakers, there were lower rates of ambulance use in Chinese (odds ratio 0.50, 95% confidence interval, 0.47-0.54), Vietnamese (0.87, 0.79-0.95), Arabic (0.87, 0.78-0.97), Spanish (0.56, 0.50-0.62), Italian (0.88, 0.80-0.96), Hindi (0.61, 0.53-0.70) and German (0.87, 0.79-0.90) speakers. Compared with English speakers, German speakers had higher admission rates (odds ratio 1.17, 95% confidence interval, 1.02-1.34), whereas there were lower admission rates in Chinese (0.90, 0.86-0.99), Arabic (0.76, 0.67-0.85) and Spanish (0.83, 0.75-0.93) speakers. This study showed that there was a significant association between lower utilisation of emergency care and speaking languages other than English at home. Further researches are needed using in-depth methodology to investigate if there are language barriers in accessing emergency care in Queensland.

Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery

This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches. Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions. A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31·8 (interquartile range 13·1-35·3) months. Some 8885 (4·7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1·09, 95 per cent confidence interval (c.i.) 0·99 to 1·21; P = 0·083). Some 15 125 (8·1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3·5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6·3 per cent (692 of 11 013) for laparoscopic versus 8·2 per cent (14 433 of 176 135) for open surgery; P < 0·001) and reintervention for adhesions (2·8 per cent (305 of 11 013) versus 3·6 per cent (6325 of 176 135) respectively; P < 0·001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0·80, 95 per cent c.i. 0·71 to 0·90; P < 0·001). Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk of developing clinically significant adhesions.

De Facto regionalization of care for ST-elevation myocardial infarction in Florida, 2001–2009

ACC/AHA guidelines recommend STEMI patients receive percutaneous coronary intervention (PCI) at high volume hospitals performing ≥400 procedures/year. The objective of this study was to evaluate changes in the organization and implementation of care for STEMI patients in Florida. We assessed trends and predictors of STEMI patients first hospitalized at high PCI volume hospitals in Florida from 2001-2009. This is the first study to examine statewide trends in hospital admission for all STEMI patients. We classified Florida hospitals by PCI volume (high, medium, low, non-PCI) for each quarter from January, 2001 through June, 2009. Using hospital discharge data, we determined the percent of STEMI patients who went to each type of hospital and analyzed multiple predictors. From 2001-2009 the proportion of STEMI patients first hospitalized at high PCI volume hospitals rose from 62.4 to 89.7%, while admissions to non-PCI hospitals declined from 31% to 4.9%. Persistent barriers to high PCI volume hospital admission were age ≥85 years (OR 0.56, 95% CI 0.50-0.62), female gender (OR 0.85, 95% CI 0.79-0.91), and residence in a major metropolitan county. Through the efforts of local coalitions throughout Florida, by 2009 almost 90% of Florida STEMI patients were first admitted to high PCI volume hospitals. Greater hospital competition may explain lower admission rates to high PCI volume hospitals in major metropolitan counties. The age and gender disadvantage we observed requires further research to determine potential causes.

Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders

To explore the role of specialist outpatient eating disorders services and investigate how direct access to these affects rates of referral, admissions for inpatient treatment, and continuity of care. Services beyond primary care in Greater London retrospectively identified adolescents who presented with an eating disorder over a 2-year period. Data concerning service use were collected from clinical casenotes. In areas where specialist outpatient services were available, 2-3 times more cases were identified than in areas without such services. Where initial outpatient treatment was in specialist rather than nonspecialist services, there was a significantly lower rate of admission for inpatient treatment and considerably higher consistency of care. Developing specialist outpatient services with direct access from primary care is likely to lead to improvements in treatment and reduce overall costs.

Patient visits to the emergency department at a Norwegian university hospital: variations in patient gender and age, timing of visits, and patient acuity

BackgroundThe patient visits to Norwegian emergency departments (EDs) have increased significantly over the last few years. A national evaluation revealed a lack of systematic activity control, resource management and quality...

An Assessment of Clinical Performance Measures for Pediatric Emergency Physicians

The objectives were to evaluate clinical performance measures used for pediatric emergency medicine (PEM) physicians for reliability, correlation with one another, and relationship with clinical experience. This retrospective cohort study collected performance data for PEM physicians working at an urban children's hospital emergency department (ED) for each of 7 consecutive 6-month periods. Low correlations were seen between patients per hour or admission rate and 72-hour revisit rates. No significant association existed between level of experience and any performance measure. Physician treatment times appeared to be most reliable, and revisit rates were least reliable. Increase in number of patients seen per hour or lower admission rates in the ED are not significantly associated with an increase in revisit rates. Provider experience did not affect performance measures. Physician treatment time, patients per hour, admission rate, and charges per hour are reliable measures to assess the clinical performance of PEM physicians working at a single center.

Cocaine‐Using Patients With a Normal or Nondiagnostic Electrocardiogram: Single‐Photon Emission Computed Tomography Myocardial Perfusion Imaging and Outcome

Few trials have examined the outcomes of patients who use cocaine with chest pain and who have a normal or nondiagnostic electrocardiogram (ECG) and the use of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). We sought to compare the characteristics and overall outcomes in cocaine users vs non-cocaine users presenting to the emergency department with a normal/nondiagnostic ECG and to assess the value of rest MPI in both of these populations. Patients with symptoms compatible with myocardial ischemia, suspected acute coronary syndrome (ACS), and a normal/nondiagnostic ECG were enrolled in the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial, a randomized controlled trial designed to evaluate the impact of rest MPI on triage decisions. Cocaine users (n = 294) were compared to non-cocaine users (n = 2180). Cocaine users were younger than non-cocaine users, and 72% were male. Among the cocaine users, 2.4% had a myocardial infarction, 1.4% required percutaneous coronary intervention, and none of the patients underwent coronary artery bypass graft surgery. Among cocaine users with a final diagnosis of not ACS, randomization of patients to rest SPECT MPI resulted in an appropriate reduction in hospital admissions in both the cocaine users (P = 0.011) and the non-cocaine users (P < 0.001), suggesting improved triage when MPI was used. Cocaine users with a normal/nondiagnostic ECG are at low risk of cardiac events. Even though cocaine users are at low risk of cardiac events, SPECT MPI remains effective in the risk stratification and improves triage management decisions resulting in lower admission rates and more discharges to home.

Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: A 3-year follow-up study

The aim of the current study was to investigate the rates and predictors of symptomatic remission and recovery in patients presenting with first-episode psychosis 3 years after treatment initiation. Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide early intervention programme in Hong Kong from July 2001 to August 2003 fulfilled study inclusion criteria, with 539 completing 3-year follow-up. Baseline and follow-up variables were collected via systematic medical file review. The operational criteria for recovery were based on clinical definition incorporating both symptom and functional dimensions. By the end of 3-year follow-up, 58.8% (n = 317) and 17.4% (n = 94) of participants met criteria for symptomatic remission and recovery, respectively. Around half (51.2%, n = 276) were not remitted either symptomatically or functionally in the last 12 months of follow-up. Of those who achieved sustained symptomatic remission, only 43.1% were also in functional remission. Patients in symptomatic remission had lower rate of admissions, shorter duration of hospitalisations and more favourable psychosocial functioning than non-remitted counterparts. Logistic regression analysis revealed that female sex, older age of onset of psychosis, shorter duration of untreated psychosis (DUP) and early symptom resolution predicted symptomatic remission at the end of follow-up. Higher educational attainment, superior baseline occupational status and shorter DUP were found to be predictive of recovery. In a large representative cohort of Chinese young people presenting with first-episode psychosis, although more than half achieved symptomatic remission 3 years after service entry, the rates of functional remission and recovery were low. More intensive psychosocial interventions may be required to further improve patients' functional outcome.

Abstract 3930: Differences in Admitting Hospital Characteristics for African American and White Patients with Acute Ischemic Stroke Patients in United States

Background_ Racial disparities in acute ischemic stroke treatment may be due to differences in characteristics of admitting hospitals. Recent studies have found a significantly lower rate of admission for African-American patients with acute myocardial infarction to revascularization centers. Objective_ To ascertain if there are racial disparities in admitting hospital characteristics in regards to hospital based outcomes and availability of revascularization among patients with ischemic stroke. Methods_ We identified African-American and white acute ischemic stroke patients from the Nationwide Inpatient Sample-2009. We categorized hospitals based on availability of intravenous thrombolysis (&gt;10 patients per year) and/or endovascular treatment (&gt;1 patient per year). We assessed hospital’s quality using a score based on in-hospital stroke mortality. Hospitals with a score in the top 20% were categorized as high quality, and those in the lowest 20% as low quality. The odds of admission to high or low quality hospitals for white and African American patients was determined after adjusting for risk factors in multivariate analysis. Results- Of the 110,511 patients admitted with ischemic stroke including 16,334 (14.8%) African-American patients. African-American patients lower mean age (64.7 versus 72.7 years), higher percentage of females (56.5% versus 52.5%) and increased incidence of hypertension (86.6% versus 77.7%) p&lt;0.0001. African American patients were relatively less likely ( P &lt;0.001) to be admitted to a high-quality hospitals (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.84 to 0.95) and more likely ( P &lt;0.001) to be admitted to low-quality hospitals (OR, 1.16; 95% CI, 1.05 to 1.28). There was no difference in the rates of admission to hospitals with availability of revascularization according to race (OR, 1.026; 95% CI, 0.978 to 1.077). Conclusions_ There appears to be higher odds for African-American stroke patients to be admitted to low quality hospitals in United States warranting a better understanding of associated factors.

Impact of Physicians’ Characteristics on the Admission Risk Among Children Visiting a Pediatric Emergency Department

This study aimed to assess the impact of physicians' gender, work experience, and training on hospitalization among children visiting a pediatric emergency department (ED). This retrospective cohort study used the computerized database of a tertiary care pediatric ED staffed by pediatric emergency physicians, general pediatricians, and general emergency physicians. Participants were all children evaluated in the ED between April 1, 2008, and March 31, 2009. The primary outcome was hospitalization, and secondary outcome was unscheduled return in the 48 hours after discharge from the ED. Determinants of outcomes were physician's gender, experience, and specialty training. Multivariate logistic regression was used to evaluate associations between physicians' characteristics and the risk of admission, adjusting for referral status, triage level, chief complaints, and other potential risk factors. Forty-five physicians evaluated 49,146 patients during the study period. Physicians' individual admission and return rates varied from 1% to 24% and 0% to 11%, respectively. On multiple logistic regression, physician's gender was not a predictor of admission but the physician's years of experience was slightly associated with both admission rates and unscheduled return visits. As a group, pediatric emergency physicians demonstrated a lower admission rate than physicians trained in general pediatric or general emergency medicine. Individual physician's admissions proportions vary widely. Providers' experience and specialization in pediatric emergency medicine are weak predictors of admission, whereas gender was not associated.

Abstract 2: Impact of Race and Hospital Racial Makeup on Readmissions for Heart Failure

Reducing racial/ethnic disparities in health care is a policy priority, and heart failure (HF) is a particularly important area of focus, not only because HF is the most common cause of hospitalizations and readmissions in the Medicare program, but because black patients suffer a disproportionate burden of this disease. Prior studies have shown that black patients may have higher readmission rates than white patients, but the reasons for these differences are unclear. We sought to determine whether racial disparities in readmission rates for HF were due to the site where black and white patients received care. We used national Medicare data from 2006-2007 to categorize hospitals based on the proportion of black patients they cared for, designating those in the top decile as “minority-serving.” We created risk-adjusted generalized linear regression models, with patient race and hospital racial makeup as our primary predictors, and 30-day readmission as our primary outcome. Forty percent of all black patients and five percent of all white patients were cared for at minority-serving hospitals. In risk-adjusted analyses, black patients had higher 30-day readmission rates than white patients (24.1% vs. 23.3%, p&lt;0.0001). However, in stratified analyses, we found that there were no disparities in readmission rates at non-minority-serving hospitals (Table), and black patients at non-minority-serving hospitals had significantly lower admission rates than white patients at minority-serving hospitals. These results were unchanged after controlling for length of stay, hospital characteristics, and proportion of Medicaid coverage in a hospital. Our findings suggest that racial disparities in readmissions are largely due to the site at which care is provided. Focusing quality improvement efforts at poor-performing, minority-serving hospitals has the potential to improve quality of care for all HF patients while simultaneously reducing disparities in HF care. Minority-serving hospitals Non-minority-serving hospitals Black patients White patients P value for comparison, black v. white Black patients White patients P value for comparison, black v. white Model 1 (Patient characteristics only) 26.2% 25.1% 0.006 23.3% 23.1% 0.33 Model 2 (Model 1 plus length of stay) 26.0% 25.1% 0.014 23.3% 23.2% 0.75 Model 3 (Model 2 plus hospital characteristics) 25.4% 24.3% 0.005 23.0% 22.8% 0.49 Model 4 (Model 3 plus percent Medicaid) 25.0% 24.0% 0.008 22.8% 23.0% 0.51

A physiotherapy service to an emergency extended care unit does not decrease admission rates to hospital: a randomised trial

BackgroundOne of the reasons physiotherapy services are provided to emergency departments (EDs) and emergency extended care units (EECUs) is to review patients' mobility to ensure they are safe to be...