Number Of Hospital Admissions Research Articles

The Association between Short-Term Exposure to PM1 and Daily Hospital Admission and Related Expenditures in Beijing.

Ambient particulate matter (PM) pollution is a leading environmental health threat worldwide. PM with an aerodynamic diameter ≤ 1.0 μm, also known as PM1, has been implicated in the morbidity and mortality of several cardiorespiratory and cerebrovascular diseases. However, previous studies have mostly focused on analyzing fine PM (PM2.5) associated with disease metrics, such as emergency department visits and mortality, rather than ultrafine PM, including PM1. This study aimed to evaluate the association between short-term PM1 exposure and hospital admissions (HAs) for all-cause diseases, chronic obstructive pulmonary disease (COPD), and respiratory infections (RIs), as well as the associated expenditures, using Beijing as a case study. Here, based on air pollution and hospital admission data in Beijing from 2015 to 2017, we performed a time-series analysis and meta-analysis. It was found that a 10 μg/m3 increase in the PM1 concentration significantly increased all-cause disease HAs by 0.07% (95% Confidence Interval (CI): [0, 0.14%]) in Beijing between 2015 and 2017, while the COPD and RI-related HAs were not significantly associated with short-term PM1 exposure. Meanwhile, we estimated the attributable number of HAs and hospital expenditures related to all-cause diseases. This study revealed that an average of 6644 (95% CI: [351, 12,917]) cases of HAs were attributable to ambient PM1, which was estimated to be associated with a 106 million CNY increase in hospital expenditure annually (95% CI: [5.6, 207]), accounting for 0.32% (95% CI: [0.02, 0.62%]) of the annual total expenses. The findings reported here highlight the underlying impact of ambient PM pollution on health risks and economic burden to society and indicate the need for further policy actions on public health.

Heat and cold-related morbidity risk in north-east of Iran: a time-stratified case crossover design

This study aimed to estimate morbidity risk/number attributed to air extreme temperatures using time-stratified case crossover study and distributed lag non-linear model in a region of Iran during 2015-2019. A time-stratified case crossover design based on aggregated exposure data was used in this study. In order to have no overlap bias in the estimations, a fixed and disjointed window by using 1-month strata was used in the design. A conditional Poisson regression model allowing for over dispersion (Quasi-Poisson) was applied into Distributed Lag Non-linear Model (DLNM). Different approaches were applied to estimate Optimum Temperature (OT). In the model, the interaction effect between temperature and humidity was assessed to see if the impact of heat or cold on Hospital Admissions (HAs) are different between different levels of humidity. The cumulative effect of heat during 21 days was not significant and it was the cold that had significant cumulative adverse effect on all groups. While the number of HAs attributed to any ranges of heat, including medium, high, extreme, and even all values were negligible, but a large number was attributable to cold values; about 10000 HAs were attributable to all values of cold temperature, of which about 9000 were attributed to medium range and about 1000 and less than 500 were attributed to high and extreme values of cold, respectively. This study highlights the need for interventions in cold seasons by policymakers. The results inform researchers as well as policy makers to address both men and women and elderly when any plan or preventive program is developed in the area under study.

Impact of COVID -19 on the children’s hospital of Rabat activities during 2020: General profile and comparison with the year 2019

The Covid-19 pandemic has put stress on the healthcare system around the world and has had an impact on people’s access to healthcare. This study aims to underline the activities at the Rabat Children’s Hospital (HER), during the year 2020 which experienced a state of health emergency due to the Covid-19 pandemic. Material and methods: We have listed the data from the admission and billing service, about the activities of the hospitalization department of the children’s hospital, Rabat. Data was entered on WPS and analyzed by Jamovi software 1.6.23. We also calculated some performance indicators: Average occupancy rate, average length of stay, and bed turnover interval (BOR, LOS, and BTOI). Results: We distinguished between services providing « urgent care » (intensive care unit ICU and emergency rooms ER) and those providing « non-urgent care » (pediatry and surgery) department. The mean number of hospital admissions (NHA) was around 8123 + /− 3942. The average BOR, LOS and BTOI were respectively 72.0 days (SD: 32.6), 66.83 days (SD: 2.68) and 3.89 days (SD: 4.34). Conclusion : The COVID-19 pandemic had an impact on our hospital activities, disturbing its normal functioning. This study tried to have an overview on the current situation and should lead to other studies in the future, allowing a better managmnt of our hospital.

Impact of the interaction between mild and mild-to-moderate cognitive impairment with chronic health problems on hospital admission among community-dwelling older adults.

This study aims to examine the effect of concurrent mild and mild-to-moderate cognitive impairment with chronic diseases on hospital admission (HA) among community-dwelling older adults. The National Health and Aging Trends Study (2011-2018), with 1225 respondents (each wave), were used. The number of HAs within 1 year was the outcome. Clock drawing test, delayed word recall test, self-reported chronic diseases and their interactions were the independent variables. The effect of cognitive impairment on the frequency of HAs varies for executive function and memory impairment. Executive function impairment concurrent with the history of heart attack or diabetes mellitus (DM) can increase the risk of HAs. Memory impairment concurrent with hypertension, DM or stroke can increase the chance of HAs. Screening to identify mild and mild-to-moderate cognitive impairment at the time of admission can help to reduce the risk of rehospitalization, particularly for patients with DM, hypertension, stroke and heart attack. Geriatr Gerontol Int 2020; 20: 1213-1220.

The Impact of Risk Factors Reduction Scenarios on Hospital Admissions, Disability-Adjusted Life Years and the Hospitalisation Cost of Cardiovascular Disease in Thailand

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year by year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model was applied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: 1) the CVD events both fatal and non-fatal; 2) the difference between the projected number of deaths and the actual number of deaths in that population; 3) the number of patients who are expected to live with CVD; 4) the DALYs from the estimated number of fatal and non-fatal events; 5) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: 1) the do-nothing scenario; 2) the optimistic scenario; 3) achieve the UN millennium development goal; and 4) the worst-case scenario. The findings showed that over the next eight years, there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal, there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results, it is expected that health care costs would save approximately ฿9000 million, ($298.3 million), for CVD and 900,000 million DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: 1) the number of CVD cases; 2) DALYs cases; and 3) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population.

Cost of hospital care for the older adults according to their level of frailty. A cohort study in the Lazio region, Italy.

BackgroundThe increasing burden of chronic diseases associated with the ageing of the European population constitutes one of the main challenges for the welfare systems in developed western countries, especially through its impact on the use of hospital services and the cost of care. This study aims at evaluating the cost of hospital care for older adults living in the Lazio Region, Italy, according to their level of frailty.MethodsSince 2014 a longitudinal randomized cohort study has been carried out on a sample consisting of 1280 older adults aged over 64 years resident in the Lazio region (Italy), with their being evaluated for multidimensional frailty. Accesses to Hospital Services (acute care and Day Hospital care admissions and Emergency Room accesses) during the first year after enrolment, as well as the related costs have been recorded through a regional database. Costs have been stratified on the basis of the state of frailty.ResultsThe analysis of hospital services and costs highlights the role played by pre-frail individuals who generated 49.3% of the hospital care cumulative costs. Hospital Admission (HA) costs arising from robust and pre-frail subjects are 70% of the total HA costs. Pre-frail individuals also showed the highest average HA cost per person/year (7062.89 Euros). The main determinant of the highest HA costs was given by the number of HAs during the follow-up (multivariate linear regression, ß coefficient = 0.319; p<0.001), which was higher among pre-frail individuals than in any other group of patients.ConclusionsPre-frail individuals generated the highest cost for hospital care in a sample of representative subjects living in an Italian Region with a low rate of community care services, as is the case in the Lazio region. Assessment of the multidimensional frailty of older adults permits a better definition of the important target of the pre-frail population as the main category within which interventions to prevent or mitigate frailty should be carried out.

Retrospective analysis of electronic medical records of Syrian immigrants admitted to a training and research hospital in Turkey

Aim: The Syrian citizens mass-migrated mostly to Turkey along with Lebanon, Jordan, and Iraq because of internal conflicts. Having access to health care is of great importance in such crisis situations. The aim of this study is to reveal the characteristics and the frequency of admission to health services of Syrian refugee patients, who have admitted to a tertiary hospital in Ankara.Material and Methods: The patients of Syrian nationality who have admitted to Ankara Numune Training and Research Hospital between 03.2014 - 02.2017 were included irrespective of their age in this descriptive retrospective study. Medical records were reviewed for available information such as the registered province, age, gender, number of patients, outpatient clinic, number of hospital admissions and emergency applications, the frequency of the diagnosis international classification of diseases (ICD) code, surgery status, surgery type, and the frequency of imaging requests. Results: The total number of Syrian citizens was 2,205. The top three ICD diagnosis codes are “Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)”, “Factors influencing health status and contact with health services (Z00-Z99)” and “Diseases of the musculoskeletal system and connective tissue (M00-M99)”. The most frequented clinic was the emergency medicine. Conclusion: Most of the applications are the problems that could be diagnosed and treated in primary care. It is thought to be more effective that Syrian patients could be followed closely by family physicians, in term of patients and cost.

Ambient concentrations of NO2 and hospital admissions for schizophrenia

ObjectivesSchizophrenia is a chronic and severe mental disorder affecting more than 21 million people worldwide. Short-term exposure to nitrogen dioxide (NO2) has been associated with hospital admissions (HAs) for mental...

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health

Rationale and objectivesWhether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health. MethodThis 18-year-long study of community-dwelling older Canadians (n = 132, 72–98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality. ResultsSupport was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic). ConclusionThese findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.

Complicações maternas e neonatais em fila de espera da Central de Regulação de Leitos na macrorregião de Maringá

with advances in the obstetrics field, maternal mortality and morbidity are still present in the pregnancy-puerperalcycle. The complications in this phase reflect the risks for the mother as well as for newborn infants. In this quantitativedescriptive study, the aim was to identify the main causes of maternal and neonatal complications to requests for ICU bedsin the Northwest of Parana. Variables related to pregnant woman (age, number of pregnancies and gestational age) andthe main problems in the pregnancy-puerperal cycle and perinatal period were analysed. From January to June 2013 therewere a total of 2215 requests for ICU beds in the Hospital Beds Regulation Center, with 221 for pregnant woman and 103for newborn infants. 9 of the cases were requests for both the mother and the baby. The women’s average age was 24.5years, 60.5% from 20 to 34 years of age; the majority (37.44%) has had no children, and 90% were in the third trimester,mostly with gestational age of 34 weeks. The main diagnosis that motivated the requests for ICU beds for pregnant women(49.76%) was preterm labor (PTL), followed by premature rupture of membranes (16.11%), and edema, proteinuria and/or hypertensive disorders (14.22%). Regarding the newborn, the prevalent diagnosis (49.5%) was prematurity and theother half was cardiorespiratory disorders (35%) and congenital malformations (15.5%). Considering the high number ofhospital admissions because of PTL and prematurity, it becomes necessary to do more studies about the causes of thesecomplications aiming to reduce maternal-infant morbidity.

Impact of ED management on hospital quality measures: the negative case of atrial fibrillation

ObjectiveEmergency department (ED) cardioversion and discharge of atrial fibrillation (AF) is an evolving treatment. Emergency department cardioversion patients have few comorbidities, and their discharge directly from the ED leads to a sicker in-patient population of AF patients. This study examines whether the quality care markers, hospital charges (HC) and length of stay (LOS), negatively reflect the practice of ED cardioversion. MethodsMedian HC and LOS were determined for 2 different quality assessment reporting models. In a standard model (SM), patients discharged from the ED were not included in any hospital statistics and only admitted, or observation patients were used to calculate the HC and LOS of AF patients. In an inclusive model (IM), patients discharged from the ED were also included in the hospital statistics but given the same LOS as observation patients. Differences across medians were analyzed using Wilcoxon rank sum tests. ResultsA total of 312 patients were evaluated for AF over an 18-month period. Of these, 197 (62%) were admitted, 21 (7%) were placed in observation status, and 95 (31%) were discharged from the ED. Median values for LOS were 3 days (interquartile range [IQR], 1-5) for the SM and 1 day (IQR, 0-4) for the IM. Median values for HC were $33062 (IQR, $19267-$60614) for the SM and $20059 (IQR, $4249-$47195) for the IM. ConclusionEmergency department cardioversion selects out a less sick cohort of patients whose removal from a hospital's admission numbers negatively skews quality performance profiles.

Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD

Pulmonary rehabilitation (PR) improves exercise capacity and health-related quality of life (HRQoL), and reduces health care utilisation. This study quantified outcomes of a PR program over a 6-year period and determined the effects of PR on hospitalisation. Patients with chronic obstructive pulmonary disesae (COPD) who entered an 8-week outpatient PR program from 1998 to 2003 were included. Functional exercise capacity (6-minute walk distance [6MWD]) and HRQoL (Chronic Respiratory Disease Questionnaire) were measured before and following PR. The number of hospital admissions and total bed-days due to a COPD exacerbation in the 12 months before and following PR were recorded. Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia. 187 (73%) of the 256 patients who entered PR completed the program. Improvements in 6MWD (404.2 +/- 114.6 m to 439.6 +/- 115.0m, P < 0.001) and HRQoL (4.1 +/- 0.9 points per item to 4.9 +/- 0.9 points per item, P < 0.001) occurred following PR. There was a 46% reduction in the number of patients admitted to hospital (71 to 38) with a COPD exacerbation and a 62% reduction in total bed-days (1131 to 432) following PR. Pulmonary rehabilitation provided in an Australian teaching hospital was associated with a reduction in COPD hospitalisation, and the resultant savings outweighed the costs of providing the program.

Asma pediátrica: o impacto das internações hospitalares

These figures arenot so different from those found in developedcountries, where asthma is seen as a significant publichealth problem.According to the Departamento de Informacaoe Informatica do Sistema Unico de Saude (DATASUS,Unified Health Care System Department ofInformation and Information Science), nearly200,000 children under 14 years of age anddiagnosed with asthma were hospitalized under theBrazilian Sistema Unico de Saude (SUS, Unified HealthCare System) in 2004, even considering that therewas probably significantly under-reporting of thedisease in various regions of the country. If weconsider that a reduction in the number of hospitaladmissions is one of the objectives to be achievedthrough the adequate control of the disease, wecan conclude, even through the use of an isolatedfinding, that the asthma management programs inBrazil are far from being adequate, which has asignificant impact on the health of children.Even more significant is the fact that asthma isresponsible for one in every 250 deaths worldwide.Many of these deaths are avoidable, since they arerelated to inappropriate medical care, lack ofadequate information, and delays in obtainingtreatment during more severe attacks. In Brazil, therewere 3000 asthma-related deaths in 2004 amongSUS patients alone.A recent study

CLINICAL IMPACT OF PULMONARY REHABILITATION USING OBJECTIVE AND SUBJECTIVE ASSESSMENTS

Introduction: Pulmonary rehabilitation (PR) is an effective, appropriate intervention in patients with chronic obstructive pulmonary disease (COPD) and other related pulmonary disorders. Objective: Determination of PR's effect on healthcare utilization and quality of life through comparison of PR vs. non-PR groups. Parameters evaluated: number of hospital admissions (NOA), length of stay (LOS), activities of daily living/social functioning (DASF), psychological functioning (PF) and sexual functioning (SF). Methodology: 66 participants (39 PR, 27 non PR) with a diagnosis of chronic stable respiratory system impairment. Participant eligibility: non-smoking, pulmonary function studies within past year showing DLCO, FVC or FEV1 values < 60% of normal, Pulmonary Function Status Scale (PFSS) completed initially and repeated at 3 and 6 month intervals. PR group participated in a 12-week/24-session pulmonary rehabilitation program. The Performance Improvement Department at Mercy Medical Center obtained and evaluated data on NOA and LOS throughout the study for both PR and non-PR groups. Hospitalizations analyzed were related to respiratory morbidity (DRG 87, DRG 88). Results: Comparison showed: In PR group DASF increased 9.68%; PF increased 4.49%; SF increased 7.7% and total score increased 6.94%. Non-PR group DASF decreased 6.34%; PF decreased 1.76%; SF decreased 11.02% and total score decreased 4.04%. Outcomes for NOA and LOS: 3 of 39 (7.7%) of PR group were hospitalized with ALOS of 3.66 days. 6 of 27 (22.3%) non-PR group were hospitalized with an ALOS of 3.92 days. Conclusion: Results showed DASF change to be the only statistically significant area when comparing groups. However, when analyzing data in terms of percent increase/decrease we find the PR group increased scores in all areas of the PFSS and had a lower NOA rate per patient. The non-PR group showed decreased scores in all areas of the PFSS and had a higher NOA rate per patient. This suggests that PR does have a positive effect on quality of life for people with COPD and other pulmonary disorders.