Maryland Hospital Discharge Data Research Articles

Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis.

Most adults with sickle cell disease (SCD) receive care for their acute painful episodes in an emergency department (ED) setting. The purpose of this article is to describe the impact of opening a dedicated treatment center for adults with SCD [Sickle Cell Infusion Clinic (SCIC)] on patient outcomes and on hospital discharges for SCD. Descriptive data including demographics, time to first dose of narcotic, and pain scores were collected on patients presenting to the SCIC and ED. Maryland hospital discharge data were obtained from the Maryland Health Services Cost Review Commission. Analyses were conducted using T tests, χ(2) tests, and simple generalized estimating equation regression models accounting for the clustered nature of observations, as appropriate. There were 3,874 visits to the SCIC by 361 unique patients; 85% of those visits resulted in the patient being sent home. During the same time period, there were 3,408 visits to the ED by 558 unique patients with SCD. The overall admission rate from the ED for these patients was 35.9% but decreased significantly over the time period with a rate of 20% in December 2011. There was a significant decrease in readmissions over time for the entire Baltimore Metro area with the likelihood of readmission decreasing by 7% over time. The SCIC model provides adults with SCD access to high quality care that decreases the need for hospital admission. Further research needs to be done to evaluate the cost effectiveness of this model.

Potentially preventable medical hospitalizations among Maryland residents with mental illness, 2005-2010.

The goal of this study was to assess the association between mental illness and potentially preventable ambulatory care-sensitive (ACS) hospitalizations among children, adults, and older adults. This was a retrospective, cross-sectional study that used 2005-2010 Maryland hospital discharge data (N=508,142 hospitalizations). Logistic regression was used to assess the associations between mental illness and ACS hospitalizations. Any mental illness diagnosis was associated with heightened odds of ACS hospitalization in all three age groups. Any mental illness diagnosis was associated with 84% higher odds of ACS hospitalization among children, 32% higher odds of ACS hospitalization among adults, and 30% higher odds of ACS hospitalization among older adults. Mental illness was associated with increased odds of ACS hospitalization across the life span. Future research should examine the potential for integrated medical and behavioral health care models to address the poorly controlled somatic conditions that lead to ACS hospitalizations among persons with mental illness.

Effect of Hospital Setting and Volume on Clinical Outcomes in Women with Gestational and Type 2 Diabetes Mellitus

Efforts to improve health care outcomes in the United States have led some organizations to recommend specific hospital settings or case volumes for complex medical diagnoses and procedures. But there are few studies of the effect of setting and volume on maternal outcomes, particularly in complicated conditions, such as diabetes. Our objective was to estimate the effect of hospital setting and volume on childbirth morbidity and length of stay in pregnancies complicated by type 2 and gestational diabetes. We analyzed Maryland hospital discharge data during 1999-2004. The dependent variables were primary cesarean delivery, episiotomy, a composite variable for severe maternal morbidity, and hospital length of stay. The independent variables were hospital setting (community, non-teaching hospitals, community, teaching hospitals, and academic medical centers) and tertiles of annual hospital diabetes delivery volume. Multivariable regression analysis was used to assess the relation of hospital setting with each outcome, adjusting for hospital volume and maternal case mix. 5,507 deliveries with type 2 (15%) and gestational (85%) diabetes were analyzed. Primary cesarean delivery rates among women with any diabetes did not vary across settings. After adjustment for volume and patient case mix, the likelihood of severe maternal morbidity was higher among deliveries at academic centers compared to community, non-teaching hospitals (odds ratio [OR], 2.1; 95% confidence interval: 1.0, 4.2). Academic centers had a protective effect (OR, 0.3; 95% CI: 0.2, 0.7) and community teaching hospitals had a borderline protective effect (OR, 0.8; 95% CI: 0.7, 1.0) on episiotomy, compared to community, non-teaching hospitals. Length of stay was greater at academic centers and community, teaching hospitals compared to community, non-teaching hospitals (5.4 days, 3.5 days vs. 2.8 days, respectively). We did not identify an independent association between hospital diabetes volume and clinical outcomes after adjustment for case mix. Among women with type 2 and gestational diabetes, hospital setting is associated with a higher likelihood of severe maternal morbidity and length of stay, independent of volume. Patient case mix accounts for some of the variation across settings. The volume-outcome relationship found with other complex medical conditions or procedures was not found among diabetic pregnancies. Further investigations are needed to explain variations in outcomes across hospital settings and volumes.

Neonatal circumcision in Maryland: A comparison of hospital discharge and maternal postpartum survey data

Objective To study circumcision rates in Maryland using hospital discharge and maternal survey data in order to provide healthcare providers, parents and policy makers with more accurate and comprehensive information about this common yet controversial procedure. Methods Secondary data analyses were performed using Maryland hospital discharge data files containing records of 96,457 male newborns, and postpartum survey data collected from 4273 mothers through the Maryland Pregnancy Risk Assessment Monitoring System. Results Hospital discharge data showed that 75.3% of male infants were circumcised, and survey data showed that 82.3% of male infants were circumcised. The circumcision rate among infants weighing <1500 g at birth was 38.9% using hospital discharge data and 74.5% using maternal survey data. Both sources revealed lower circumcision rates among Asian and Hispanic infants than among non-Hispanic white and non-Hispanic black infants. Conclusions Despite reports of decreasing circumcision rates nationally, rates remain high in Maryland. In addition to providing for the inclusion of circumcision procedures that may not have been coded properly in hospital discharge records and procedures that were performed after hospital discharge, maternal survey data provide more comprehensive information than hospital discharge data about parental characteristics and factors relevant to the circumcision decision-making process.

Estimating Alcohol and Drug Involvement in Hospitalized Adolescents with Assault Injuries

Purpose Adolescents using alcohol and drugs are at higher risk for assaultive behaviors. We examined adolescents aged 10 to 20 years who were hospitalized for assault injuries between July 1995 and December 1998 in Maryland to determine the demographic and injury-related predictors of the presence of drug/alcohol use among adolescents, and to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. Methods Patient records for adolescents were selected from 2189 discharges from the Maryland Trauma Registry and 1625 discharges from the Maryland Hospital Discharge data system. Three discrete groups of adolescents were identified: (1) those on the Trauma Registry and in the Hospital Discharge data system (N = 1197), (2) only those on the Trauma Registry (N = 992), or (3) only those in the Hospital Discharge data system (N = 428). Multiple logistic regression was performed to determine the predictors of the presence of drug/alcohol use among adolescents in the Trauma Registry. These models were then used to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. Results Age, sex, mechanism of injury, day of hospital admittance, and time of day were significant predictors of alcohol/drug use. The proportion of predicted alcohol/drug involved hospitalized cases varied from 54% to 66%. Conclusion Our methodology and findings contribute to the understanding of the epidemiology of assaultive behaviors and the role of alcohol/drug use in injury among adolescents.

Maternal Race, Procedures, and Infant Birth Weight in Type 2 and Gestational Diabetes

To examine the relation between race and cesarean delivery, episiotomy, and low birth weight infants in pregnancies with type 2 and gestational diabetes mellitus and to identify factors that might explain racial differences. Population-based, cross-sectional study of 1999-2004 Maryland hospital discharge data. Hospitalizations for delivery of pregnancies with type 2 and gestational diabetes mellitus were identified and matched to infants. The independent variable was maternal race. Dependent variables were cesarean delivery, episiotomy, and low infant birth weight. Stepwise logistic regression models were developed to estimate the independent effect of race on use of each procedure and infant birth weight, after adjusting for sociodemographic, hospital, and clinical factors. We examined 6,310 deliveries for pregnancies with type 2 (15%) and gestational (85%) diabetes. Before adjustment, black race was associated with a higher odds of cesarean delivery (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24-1.58) and low birth weight infants (OR 1.94, 95% CI 1.57-2.40) compared with white race. Adjustment for racial differences in preeclampsia and fetal heart rate abnormalities accounted for a modest degree of the racial variation in outcomes. With full adjustment, black race was still associated with a higher odds of cesarean delivery (OR 1.38, 95% CI 1.20-1.60) and low birth weight (OR 1.81, 95% CI 1.41-2.34) and a lower odds of episiotomy (OR 0.45, 95% CI 0.36-0.57). In pregnancies with diabetes, adjustment for sociodemographic, hospital, and clinical factors only partially explains racial differences in procedure use and infant low birth weight.

Comparison of Maryland Hospital Discharge and Trauma Registry Data

This study aimed to examine the validity of using Maryland hospital discharge data to characterize injuries sustained by trauma patients. Maryland hospital discharge and Maryland trauma registry data for 1999 were merged, and the extent of agreement regarding the presence and severity of injuries sustained was evaluated. The mean Injury Severity Score was 8.4 according to the Maryland hospital discharge data and 10 according to the Maryland trauma registry data (p < 0.0001). The Maryland hospital discharge data identified 95% or more of all moderate to severe injuries (Abbreviated Injury Score, > or =2) for all body regions except the head. There was substantial agreement between the two data sets for mechanism of injury (weighted kappa, 0.62), the number of preexisting conditions present (weighted kappa, 0.45) and final disposition (weighted kappa, 0.78). The Maryland hospital discharge data are a valid source for documenting the nature and severity of injuries sustained by trauma patients, except for those with a relatively minor head injury.

The Direct Cost and Incidence of Systemic Fungal Infections

Objectives In this study we determined the incidence and direct inpatient and outpatient costs of systemic fungal infections (candidiasis, aspergillosis, cryptococcosis, histoplasmosis) in 1998. Methods Using primarily the National Hospital Discharge Survey (NHDS) for incidence and the Maryland Hospital Discharge Data Set (MDHDDS) for costs, we surveyed four systemic fungal infections in patients who also had HIV/AIDS, neoplasia, transplant, and all other concomitant diagnoses. Using a case-control method, we compared the cases with controls (those without fungal infections with the same underlying comorbidity) to obtain the incremental hospitalization costs. We used the Student's t-test to determine significance of incremental hospital costs. We modeled outpatient costs on the basis of discharge status to calculate the total annual cost for systemic fungal infections in 1998. Results For 1998, the projected average incidence was 306 per million US population, with candidiasis accounting for 75% of cases. The estimated total direct cost was $2.6 billion and the average per-patient attributable cost was $31,200. The most commonly reported comorbid diagnoses with fungal infections (HIV/AIDS, neoplasms, transplants) accounted for only 45% of all infections. Conclusion The cost burden is high for systemic fungal infections. Additional attention should be given to the 55% with fungal disease and other comorbid diagnoses.

Case-fatality rates by body part affected and trends in hospitalized burns in Maryland, 1981-90

This study was undertaken (i) to determine in-hospital case-fatality rates (CFRs) by severity using body part(s) affected as a proxy, and (ii) to examine the trends in hospitalized burns regarding CFRs. The study used the Health Service Cost Review Commission non-confidential Maryland hospital discharge data for the years 1981-90. CFRs were computed as percentages of hospitalized burns that died. Chi-square tests were used to assess homogeneity for categorical variables and to examine linear trends. The CFR for hospitalized burns was 2.9 per cent. CFR was highest among the elderly (13.1 per cent) and for burns affecting multiple specified sites (7.4 per cent), and lowest among children (1.1 per cent) and for upper limb burns (0.22 per cent). Burn CFR increased overall by 59 per cent for 1981-90, with a decreasing rate only in children. However, after controlling for age and degree of burn no significant change in trend in CFRs over the 10-year period was evident. The findings demonstrate that while child burn fatality seems to have declined, the elderly continue to have high CFR for burns regardless of the body part affected, and that the CFRs for hospitalized burns remained constant between 1981 and 1990 in Maryland despite considerable advances in treatment.

Poverty, race, and hospitalization for childhood asthma.

This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty. The average annual asthma discharge rate was 1.95/1000 children aged 1-19; 3.75/1000 for Black children, and 1.25/1000 for White. Medicaid-enrolled children of both races had increased discharge rates for asthma compared to those whose care was paid for by other sources: 5.68/1000 vs 2.99/1000 for Blacks, and 3.10/1000 vs 1.11/1000 for Whites. When ecologic analyses were performed, populations of Black and White children had nearly equal asthma discharge rates after adjustment for poverty. The statewide adjusted rate was 2.70/1000 (95% CL = 1.93, 3.78) for Black children and 2.10/1000 (1.66, 2.66) for White children. Among Maryland counties and health planning districts, variation in asthma discharge rates was not associated with the supply of hospital beds or the population to primary-care physician ratio. We conclude that Black children are at increased risk of hospitalization for asthma, but that some or all of this increase is related to poverty rather than to race.