Number Of Secondary Diagnoses Research Articles

ANALISIS BIAYA MEDIS LANGSUNG DAN TARIF INA-CBG’s PASIEN DIABETES MELITUS TIDAK TERGANTUNG INSULIN DI RSUD ANUTAPURA PALU

Diabetes mellitus is a long-term disease with an increasing prevalence. Diabetes mellitus is one of the main causes of human morbidity and death and has a significant impact on health financing. Indonesia itself has implemented a national health insurance program that prioritizes effectiveness and cost efficiency. This study aims to determine the average direct medical costs, INA-CBG's rates, the suitability of direct medical costs and INA-CBG's as well as the influence of treatment class, severity, number of secondary diagnoses, and length of stay on the direct medical costs of diabetes mellitus patients at Anutapura Hospital Palu. This research is a descriptive observational study with retrospective data collection from medical records and files detailing patient care costs at Anutapura Hospital Palu in 2020 from the hospital's perspective. The sample used was BPJS inpatients with a primary diagnosis of type 2 diabetes or non-insulin dependent diabetes mellitus (DMTTI) who met the inclusion and exclusion criteria, totaling 132 patients. Data were analyzed descriptively and to see the influence of variables on total costs, the Independent sample t-test and Mann-Whitney test were used. The research results show that the average direct medical costs are IDR 2,751,449, the average INA-CBG's rate is IDR 4,505,508, so there is a mismatch between direct medical costs and INA CBG's. There is a significant influence partially or simultaneously and in a positive direction from the variables treatment class, severity, number of secondary diagnoses, and length of stay on direct medical costs.

Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation

ObjectiveTo compare problems reported on EQ-5D-5L dimensions, index, and EQ visual analog scale (VAS) scores in patients receiving specialized rehabilitation in Norway with general population norms. DesignMulticenter observational study. SettingFive specialist rehabilitation facilities participating in a national rehabilitation register between March 11, 2020, and April 20, 2022. Participants1167 inpatients admitted (N=1167), with a mean age of 56.1 (range, 18-91) years; 43% were female. InterventionsNot applicable. Main Outcome MeasuresEQ-5D-5L dimension, index, and EQ VAS scores. ResultsAt admission, mean±SD EQ-5D-5L index scores were 0.48 (0.31) compared to 0.82 (0.19) for general population norms. EQ VAS scores were 51.29 (20.74) compared to 79.46 (17.53) for population norms. Together with those for the 5 dimensions, these differences were all statistically significant (P<.01). Compared to population norms, patients undergoing rehabilitation had more health states as assessed by the 5 dimensions (550 vs 156) and EQ VAS (98 vs 49). As hypothesized, EQ-5D-5L scores were associated with number of diagnoses, admission to/from secondary care, and help with completion. At discharge there were statistically significant improvements in all EQ-5D-5L scores that compare favorably with available estimates for minimal important differences. ConclusionsThe large deviations in scores at admission and score changes at discharge lend support to EQ-5D-5L application in national quality measurement. Evidence for construct validity was found through associations with number of secondary diagnoses and help with completion.

Evaluation of an approach to clinical decision support for preventing inpatient falls: a pragmatic trial.

To assess whether a fall-prevention clinical decision support (CDS) approach using electronic analytics that stimulates risk-targeted interventions is associated with reduced rates of falls and injurious falls. The CDS intervention included a machine-learning prediction algorithm, individual risk-factor identification, and guideline-based prevention recommendations. After a 5-month plan-do-study-act quality improvement initiative, the CDS intervention was implemented at an academic tertiary hospital and compared with the usual care using a pretest (lasting 24 months and involving 23498 patients) and posttest (lasting 13 months and involving 17341 patients) design in six nursing units. Primary and secondary outcomes were the rates of falls and injurious falls per 1000 hospital days, respectively. Outcome measurements were tested using a priori Poisson regression and adjusted with patient-level covariates. Subgroup analyses were conducted according to age. The age distribution, sex, hospital and unit lengths of stay, number of secondary diagnoses, fall history, condition at admission, and overall fall rate per 1000 hospital days did not differ significantly between the intervention and control periods before (1.88 vs 2.05, respectively, P = .1764) or after adjusting for demographics. The injurious-falls rate per 1000 hospital days decreased significantly before (0.68 vs 0.45, P = .0171) and after (rate difference = -0.64, P = .0212) adjusting for demographics. The differences in injury rates were greater among patients aged at least 65 years. This study suggests that a well-designed CDS intervention employing electronic analytics was associated with a decrease in fall-related injuries. The benefits from this intervention were greater in elderly patients aged at least 65 years. This study was conducted as part of a more extensive study registered with the Clinical Research Information Service (CRIS) (KCT0005378).

PERBANDINGAN MODEL REGRESI WEIBULL DAN REGRESI COX PROPOSIONAL HAZARD

This study aims to determine the model of Acute Myocardial Infarction using the Weibull Regression and Cox Proportional Hazard Regression methods to determine the factors that significantly influence the length of time for recovery of acute myocardial infarction patients. The results of this study indicate that the factors that significantly influence the recovery time of acute myocardial infarction patients are age, onset, number of secondary diagnoses and duration of pain. Based on the AIC value, the Weibull regression model is the best regression model because the AIC value is smaller, namely 292.883 compared to the Cox Proportional Hazard regression model with an AIC value of 493.3971

NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality

Malnutrition is a substantial issue in hospitals, leading to prolonged length of hospital stay, increased perioperative morbidity and increased mortality. There are several validated screening tools for malnutrition, one of which is the Nutritional Risk Screening 2002 (NRS). It screens patients based on recent weight loss, reduction of recent food intake, body mass index (BMI), severity of disease and age. Higher NRS scores have been shown to be negatively associated with patients&rsquo; outcomes such as increased morbidity and mortality. The aim of the study was to evaluate how the two NRS components Nutritional Score (NS) and Severity of Disease Score (SDS) are associated with patients&rsquo; length of hospital stay and mortality. All patients admitted to the medical department of a large community hospital in Switzerland were screened for malnutrition using the nutrition screening NRS during the years 2014 to 2017. Data on patients&rsquo; NRS, primary diagnosis, number of secondary diagnoses, mortality, length of stay (LOS), discharge, sex and age were collected. The association between the NRS components and LOS/mortality was estimated using a linear mixed-effects regression model and a logistic regression model, respectively, with adjustment for confounders (age, sex, comorbidity, diagnosis group, mode of discharge and year of hospitalisation). The evaluation of the outcomes of 21,855 hospitalisations demonstrated that the NS was associated with an increment in the LOS of 5.5&ndash;12.3% per score point, depending on the diagnosis group. An increase in the SDS by one point was associated with an increase in the LOS of 2.2&ndash;11.3%. The odds for all-cause in-hospital mortality were increased by 44.1% (95% confidence interval [CI] 33.7&ndash;55.2%) per point in the NS, and by 73% (95% CI 57.5&ndash;90.1%) per point in the SDS. Increases in both components of the NRS are associated with longer LOS. The NS has a slightly stronger impact on LOS compared to the SDS and its effect is dependent on the patient&rsquo;s diagnosis group. Increases in the SDS are linked to a higher mortality than increases in the NS.

Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

BackgroundParoxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation.MethodsThe study included n = 387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge.ResultsAbout 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR = 0.94; CI = 0.91–0.97) and less severe PSH symptoms (OR = 0.79; CI = 0.69–0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only.ConclusionsPatients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent possible complications.

HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009\u20132014

BackgroundThe global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients’ length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients.MethodsData used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals’ financial situation (current ratio) was included.ResultsFor the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital’s current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables.ConclusionFollowing the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.

Accuracy of clinician-clinical coder information handover following acute medical admissions: implication for using administrative datasets in clinical outcomes management.

We evaluated the accuracy, limitations and potential sources of improvement in the clinical utility of the administrative dataset for acute medicine admissions. Accuracy of clinical coding in 8888 patient discharges following an emergency medical hospital admission to a teaching hospital and a district hospital over 3 years was ascertained by a coding accuracy audit team in respect of the primary and secondary diagnoses, morbidities and financial variance. There was at least one change to the original coding in 4889 admissions (55%) and to the primary diagnosis of at least one finished consultant episodes of 1496 spells (16.8%). There were significant changes in the number of secondary diagnoses and the Charlson morbidity index following the audit. Charlson score increased in 8.2% and decreased in 2.3% of patients. An income variance of £816 977 (+5.0%) or £91.92 per patient was observed. The importance and applications of coded healthcare big data within the NHS is increasing. The accuracy of coding is dependent on high-fidelity information transfer between clinicians and coders, which is prone to subjectivity, variability and error. We recommend greater involvement of clinicians as part of multidisciplinary teams to improve data accuracy, and urgent action to improve abstraction and clarity of assignment of strategic diagnoses like pneumonia and renal failure.

Medicaid inpatient costs and nested structural analysis using a hierarchical linear modeling (HLM) approach

This research investigates the factors affecting Medicaid inpatient costs using the nested relationship between hospital and patient levels. Using the 2005 Hospital Quarterly Financial and Utilization Data for the hospital level data and the 2005 Inpatient Discharge Data for the patient level data in California, we derive Medicaid inpatient costs by calculating a ratio of costs to charges at the hospital level, and then multiplying the ratio by each inpatient charge. Based on the selected factors of hospital (i.e., Hirschman–Herfindahl index, case mix index, number of BEDS, ownership, and teaching status) and patient (i.e., AGE, length of stay [LOS], diagnosis-related group weights, number of secondary diagnoses, race, and gender) levels, this study tests not only the cause and effect between factors and Medicaid inpatient costs but also the structural effects in terms of the hierarchical linear model (HLM). We confirm the theoretical arguments from previous literature but we have explored and provided more advanced causalities that the previous literature had not explored. Within the nested structure, the effects of LOS and number of secondary diagnoses are positively or negatively influenced by hospital characteristics such as hospital competition, for-profit status, and teaching hospital. We conclude that the HLM can examine both hospital and patient information and observe more accurate statistical relationships that the previous research had not investigated.

퇴원손상심층자료를 이용한 환자안전지표의 적용

목적: 본 연구의 목적은 국내 환자안전지표 산출 가능성을 확인하는 것이다. 조사방법: 환자안전지표의 정의는 OECD에서 AHRQ에 근거하여 작성한 보건기술문서 19의 기준을 이용하였고, 이에 따라 2004-2008년 퇴원손상심층조사 875,622건에서 환자안전지표(PSIs)를 산출하였다. 로지스틱 회귀분석을 이용하여 환자안전지표별 비율의 변이요인을 확인하였다. 분석결과: 2004-2008년간 약 80만 건의 퇴원 중에서 8개의 환자안전지표에 해당하는 위해사건은 3,084건이었다. 욕창(PSI3, 4.88), 시술 중 이물질 체내 잔류(PSI5, 0.05), 수술 후 패혈증(PSI13, 1.32), 출생손상-신생아(PSI17, 7.92), 산과적 외상-도구를 이용한 질식 분만(PSI18, 32.81)의 퇴원 1,000건당 비율은 모두 OECD 환자안전지표 비율의 최소-최대 범위 내에 포함되었다. 그러나 내과적 치료에 의한 감염(PSI7, 0.22), 수술 후 폐색전증 또는 심부정맥혈전증(PSI12, 0.90), 우발적 천공 또는 열상(PSI15, 0.71)의 퇴원 1,000건당 비율은 OECD 환자안전지표 최소값에 못 미쳤다. PSI 18을 제외한 7개의 지표값 모두 부진단명의 개수와 유의한 상관관계가 있는 것으로 나타났다. 또한 환자안전지표 비율은 환자특성을 보정했을 때, 병상규모 및 병원소재지 등 병원특성에 따른 유의한 차이를 보였다. 결론: 본 연구는 국가적인 행정자료를 이용하여 위해사고를 스크리닝 하는 환자안전지표를 산출한 최초의 실증적 연구이다. 본 연구의 결과는 자료의 질, 임상 관련 변수 등의 결과에 영향을 미치는 요소가 여전히 있지만, 환자안전에 대한 국가적인 통계를 추계하는 기초자료를 제공하였다는데 의의가 있다. 향후 본 연구결과를 바탕으로 위해사건으로 인한 사망 규모 산출 등의 결과연구가 필요하다. 【Objective: This study aims to determine whether national patient safety indicators (PSIs) can be calculated. Methods: Using PSI criteria from Organization for Economic Co-Operation and Development (OECD) Health Technical Papers 19 based on the Agency for Healthcare Research and Quality (AHRQ), PSIs were identified in the Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) database for 875,622 inpatient admissions between 2004 and 2008. Logistic regression was used to estimate factors of variations for PSIs. Results: From 2004 to 2008, 3,084 PSI events of 8 PSIs occurred for over 80 thousands discharges. Rates per 1,000 events for decubitus ulcer (PSI3, 4.88), foreign body left during procedure (PSI5, 0.05), postoperative sepsis (PSI13, 1.32), birth trauma-injury to neonate (PSI17, 7.92) and obstetric trauma-vaginal delivery (PSI18, 32.81) are all identified between ranges from maximum to minimum of OECD rates, respectively. However, rates per 1,000 events for selected infections due to medical care (PSI7, 0.22), postoperative pulmonary embolism or deep vein thrombosis (PSI12, 0.90) and accidental puncture or laceration (PSI15, 0.71) are below the minimum of OECD range. 7 PSIs except PSI 18 showed statistically significant relationship with number of secondary diagnoses. When adjusting patient characteristics, there are statistically significant different rates according to bed size or location of hospitals. Conclusion: This is the first empirical study to identify nationally number of adverse events and PSIs using administrative database. While many factors influencing these results such as quality of data, clinical data and so on are remain, the results indicate opportunities for estimate national statistics for patient safety. Furthermore outcome research such as mortality related to adverse events is needed based on results of this study.】

Long-term Impact of Physician Encoding on Detail and Number of Recorded Diagnoses

To improve the recording of diagnostic discharge data, pediatricians encoded diagnostic information as part of discharge letter writing supported by a pediatric list of ICD-9-CM-based codes. We evaluated the effect of this new policy on level of detail and number of recorded diagnoses. We compared proportions of specific principal diagnoses and numbers of secondary diagnoses of the four years before with the eight years after introduction. Immediately after introduction, half of the diagnoses for which both generic and specific codes existed was coded specific. In later years this proportion remained stable at 0.35 (p <0.05). Diagnoses that fall under the pediatrician's own subspecialty had more often a specific code than diagnoses that do not. The mean number of secondary diagnoses per admission increased from 0.7 before introduction to 1.4 in the third year after introduction (p <0.05) but gradually fell back to 0.7. This increase and decrease was mainly due to diagnoses that did not fall under the pediatrician's own subspecialty. The extra codes in individual discharge summaries had added informational value. Discharge letter-linked encoding by pediatricians supported by a pediatric list of diseases leads initially to increased detail and number of diagnoses with added informational value. When attention diminishes, especially the level of detail and number of secondary diagnoses that do not fall under one's own subspecialty decrease. The level of detail of principal diagnoses remains stable because of the advantage for pediatricians of having specific diagnostic codes falling under their own subspecialty.

Is the permanent pacemaker implant more efficient in level 1 hospital?

ObjectiveTo determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. DesignA cost-effective analysis and retrospective, cross-sectional and observational study of diagnostic related groups (DRG). SettingThe data was obtained from the national Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. PatientsThis includes the total number of patients who required treatment in all national hospitals for 5 DRG: 115 - bradyarrhythmic complication during the acute coronary syndrome, heart failure or shock; 116 - symptomatic isolated conduction defects; 117 - revisions, but without changing the battery, 118 - application of a new one, 549 - implementation or revision but with serious complications. Principal variables of interestDemographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortality) and management (total and preoperative length of stay (LOS), access, discharge, hospital size), defining inefficient stays as those exceeding 2 days on the average. Results23,154 episodes, 5.3% small hospitals. The comparative bivariate study between small hospitals and the rest, not discriminated by DRG, showed a mean LOS of 7.87±8.78 days vs 11.01±12.95 (p=0.005, 95% CI for mean difference [0.17, 1.65]) and also lower than preoperatively (3.62±6.14 vs. 4.22±6.68 days [p=0.015]) without greater comorbidity, as measured by proxy through the NSD (5.23±2.88 vs 5.42±3.28 [p=0.055]) and NP as proxy of diagnostic and therapeutic effort (3.79±2.50 vs 3.55±2.69 [p=0.002]). A total of 24.1% were inefficient, there being an association with preoperative stay, NDS, NP and emergency access. ConclusionPacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.

¿Es más eficiente el implante de marcapasos permanentes en hospitales de nivel I?

Objective To determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. Design A cost-effective analysis and retrospective, cross-sectional and observational study of diagnostic related groups (DRG). Setting The data was obtained from the national Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. Patients This includes the total number of patients who required treatment in all national hospitals for 5 DRG: 115 - bradyarrhythmic complication during the acute coronary syndrome, heart failure or shock; 116 -symptomatic isolated conduction defects; 117 -revisions, but without changing the battery, 118- application of a new one, 549 - implementation or revision but with serious complications. Principal variables of interest demographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortality) and management (total and preoperative length of stay (LOS), access, discharge, hospital size), defining inefficient stays as those exceeding 2 days on the average. Results 23,154 episodes, 5.3% small hospitals. The comparative bivariate study between small hospitals and the rest, not discriminated by DRG, showed a mean LOS of 7.87±8.78 days vs 11.01±12.95 (p=0.005, 95% CI for mean difference [0.17, 1.65]) and also lower than preoperatively (3.62±6.14 vs. 4.22±6.68 days (p=0.015)) without greater comorbidity, as measured by proxy through the NSD (5.23±2.88 vs 5.42±3.28 (p=0.055)) and NP as proxy of diagnostic and therapeutic effort (3.79±2.50 vs 3.55±2.69 (p=0.002)). A total of 24.1% were inefficient, there being an association with preoperative stay, NDS, NP and emergency access. Conclusion Pacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.

The impact of fragmentation of hospitalist care on length of stay

Different hospitalist staffing models provide different levels of inpatient continuity of care, which may impact length of stay (LOS). To determine if fragmentation of care (FOC) by hospitalist physicians is associated with LOS. Concurrent control study. Hospitalist practices managed by IPC The Hospitalist Company. A total of 10,977 patients admitted for diagnosis-related group (DRG) of 89 pneumonia with complications or comorbidities (PNA) or a DRG of 127 heart failure and shock (HF) between December 2006 and November 2007. FOC was defined as the percentage of care given by hospitalists other than the hospitalist who saw the patient the majority of the stay. Negative binomial regression was performed on DRG 89 and DRG 127 patients with LOS as the dependent variable. We adjusted for gender, age, severity of illness (SOI) scores, risk of mortality (ROM) scores, and number of secondary diagnoses, and admission day of the week. A 10% increase in fragmentation was associated with an increase of 0.39 days (P < 0.0001) in the LOS for pneumonia, and an increase of 0.30 days (P < 0.0001) in LOS for heart failure. As FOC increased for pneumonia and heart failure, the LOS increased significantly. Methods to reduce fragmentation should be explored, while more research is needed to identify the source of the relationship between FOC and LOS.

Variación de la estancia preoperatoria en España según grupos de edad, sexo y modo de acceso hospitalario (urgente o programado)

IntroductionThe increase in health care expenditure threatens the financial sustainability of health systems, and is leading to reforms in hospital use. The length of preoperative stay (POS) depends on the number of interventions and cancellations, but also possibly related to the care process itself (complexity, severity) and the patient (age, sex, comorbidity) with repercussions on the total stay and direct costs. There have been investigations on the length of POS in Spain and its possible relationships with these variables, hospital access (urgent or scheduled) and clinical type (originally medical or surgical). Materials and methodsDescriptive and comparative analysis with ANOVA and linear regression of the episodes of the Minimal Data Set 2005 which have resulted in surgery, through variables (relative weight, cost, number of secondary diagnoses and procedures, mortality, stay, age and sex) using SPSS version 15 for Windows, a p<0.05 being established as statistically significant. ResultsThe POS averaged 2.92 days, higher in urgent in-patient surgical (5.80) and medical (5.44) procedures, and by age groups and gender was higher in men (7.51) and women (6.31) of 70-74 years with surgical emergencies, but there is a direct link with age in scheduled medical inpatients. There was statistically significant relationship of POS with the length of stay, the relative weight, cost and other variables, all dependent on the severity and complexity. ConclusionsThe POS depends on determining factors such as hospital planning and organization, but also depends on some factors of the process and the patient. Ageing should not cause problems in the emergency surgical in-patient, but must be best managed in the scheduled ones. Adequate management of preoperative studies is essential to reduce the POS, the length of stay and the direct costs of hospitalization.

Analysis of an Integrated Clinical Decision Support System in Nursing Home Clinical Information Systems

This descriptive study evaluated a clinical decision support system (CDSS) in three nursing homes. The CDSS included alerts for decline in condition, improvement in condition, constipation, dehydration, loss of skin integrity, weight loss, and weight gain. Frequencies of alerts and their triggers were counted, and Spearman's rank correlations were determined between active alert frequency and number of secondary diagnoses. The most frequent alerts were for dehydration and improvement in condition. One significant positive correlation existed between number of secondary diagnoses and weight gain alert frequencies in residents with cerebral vascular accident. Health care leaders face challenges constructing an implementation strategy that addresses usability, ensures accuracy, and guides users to critical information about residents.

B-type natriuretic peptide testing is associated with reduced cost in patients with secondary diagnosis of heart failure

BackgroundThis study was designed to examine the effect of BNP use on resource utilization and clinical outcome in hospitalized patients with heart failure (HF). MethodsDetails of all (1788) hospital discharges over 12 months with ICD-9 code 428.x diagnosis were matched to the laboratory and echocardiography databases. Multiple linear regression and logistic regression analysis were performed using use of BNP testing, number of secondary diagnoses, sex, age, financial status, cardiology care, performance of echocardiography as dependent variables to predict length of stay, payable amount and discharge status in separate HF as primary and HF as secondary diagnosis groups. ResultsUse of BNP measurement was associated with an average $ Singapore 1305 (p=0.007) decrease in payable amount in patients with secondary diagnosis of HF when controlled for other variables. Its use was associated with reduced use of echocardiography in both primary (odds ratio: 0.04) and secondary (OR: 0.08) diagnosis groups. ConclusionsUse of BNP measurement was associated with reduced cost of hospitalization in patients with a secondary diagnosis of HF and with reduced use of echocardiography in heart failure patients. This suggests the potential of BNP measurement to reduce costs for the many patients whose multiple problems include HF.

Hospital use in the treatment of sleep apnea.

Evaluate hospital use for treatment of sleep apnea. Retrospective database review. The 1998 to 2000 National Inpatient Sample (NIS) was searched for admissions with a diagnosis of sleep apnea. Records were examined for demographics, diagnoses, procedures, and complications. Data were analyzed to identify factors affecting length of stay (LOS) and charges. There were 5864 (0.03% NIS) admissions for sleep apnea. The sleep apnea group had lower mean age (43.1 vs. 47.2 years), higher percentages of males (71.6% vs. 41.0%) and African Americans (18.7% vs. 13.7%), and higher rates of obesity, hypertension, and anatomic airway diagnoses than the NIS population. Of sleep apnea group adults, 77.1% underwent a mean 2.3 procedures, whereas of those patients under 18 years of age, 60.8% underwent a mean of 1.2 procedures. Tracheotomy and procedures for hypopharyngeal airway compromise were used infrequently. Within the sleep apnea group, there were significant differences in LOS and charges on the basis of age, sex, race, payment method, procedures, and number of secondary diagnoses (all P <.05). Patients over 18 admitted for other diagnoses, but with secondary diagnosis of sleep apnea, had longer LOS (5.38 vs. 4.95 days) and higher charges (US dollars 16562 vs. US dollars 13928) than patients without sleep apnea. Hospital use for sleep apnea remains largely for surgical treatment of the disease. Procedures directed at hypopharyngeal obstruction are seldom used. Multiple factors including patient age, number of secondary diagnoses, and procedures affect LOS and charges. The presence of sleep apnea also increases charges and LOS in patients admitted for other diagnoses.

Association of hospital ownership with patient transfers to outpatient care under a prospective payment system in Taiwan

Case payment, a prospective payment system akin to diagnosis-related groups (DRGs) has in-built incentives for hospitals to transfer inpatients to their own ambulatory care units following early discharge. This study used nation-wide inpatient claims data on a total of 100,730 patients treated in 2000 in (Taiwan): cesarean section (59,364 cases), femoral/inguinal hernia operation (18,675 cases), and hemorrhoidectomy (22,691 cases), all reimbursed by case payment, to explore the relationship between hospital ownership and patient transfers to outpatient treatment. For all three diagnoses, for-profit (FP) hospitals not only had lower lengths of stay (LOS) compared to public hospitals, but also showed very high odds of patient transfer to their own outpatient units, after controlling for institutional variables, (hospital level, teaching status, and geographic location), hospital competitive environment (the Herfindal–Hirschman index), and patient variables (gender, age, length of stay, and number of secondary diagnoses, a proxy for severity of illness). Similar, though slightly lower odds were observed with not-for-profit (NFP) hospitals relative to public hospitals. The findings support the property rights theory, suggesting that in Taiwan, institutional profit maximization motives may be driving patient transfers under the case payment diagnoses, rather than medical care needs. In NFP hospitals, their physician compensation mechanism, driven largely by care volumes provided by each physician, appears to be driving the disproportionately greater likelihood of patient transfer to outpatient care.

Estimating the costs associated with nosocomial urinary tract infection. A case-control study

Nosocomial infection (NI) is associated with increased resource use. The current study addressed the cost excess attributable to nosocomial urinary tract infection (NUTI). Case-control study conducted in a cohort population. For matching, the Diagnostic Related Group (DRG) to which the episode of case patient was ascribed was used. Then, a further search was conducted in the hospital discharge database with the following parameters: DRG, gender, age, admission date, department, comparison of length of stays, main diagnosis, co-morbidities, number of secondary diagnoses and procedures. Matching was achieved for 64 episodes (71%), and upon them an estimation of costs was performed. The mean length of stay for cases were 15.3 (median: 12) and 12.3 (median: 11) days for cases and controls, respectively (p = 0.0001). The excess of length of stay attributable to NUTI was 3 days (95% CI 1.6-4.7), longer for patients admitted to Medical Departments (5.3 days) than for patients admitted to Surgical Departments (2 days) (p = 0,03). The use of diagnostic resources was significantly higher for bacteriological testing only. The use of antibiotics and fluid therapy was higher among infected patients. Out of the total excess of the estimated costs per episode, 132,047 ptas, 93% corresponded to the increase in hospital stay. Ten patients (15.6%) were responsible for 68% of the total of extra-costs. In 17 occasions (26.6%), the control patient used more resources than the infected patient. Nosocomial urinary tract infection is associated with a resource use directly related to its presence. For the most part, it is related to the prolongation of hospital stay.