Outcomes Of Hospital Care Research Articles

Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature.

Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.

Comparison of the Predictive Performance of Medical Coding Diagnosis Classification Systems

Health analytics frequently involve tasks to predict outcomes of care. A foundational predictor of clinical outcomes is the medical diagnosis (Dx). The most used expression of medical Dx is the International Classification of Diseases (ICD-10-CM). Since ICD-10-CM includes >70,000 codes, it is computationally expensive and slow to train models with. Alternative lower-dimensionality alternatives include clinical classification software (CCS) and diagnosis-related groups (MS-DRGs). This study compared the predictive power of these alternatives against ICD-10-CM for two outcomes of hospital care: inpatient mortality and length of stay (LOS). Naïve Bayes (NB) and Random Forests models were created for each Dx system to examine their predictive performance for inpatient mortality, and Multiple Linear Regression models for the continuous LOS variable. The MS-DRGs performed highest for both outcomes, even outperforming ICD-10-CM. The admitting ICD-10-CM codes were, surprisingly, not underperformed by the primary ICD-10-CM Dxs. The CCS system, although having a much lower dimensionality than ICD-10-CM, has only slightly lower performance while the refined version of CCS only slightly outperformed the old CCS. Random Forests outperformed NB for MS-DRG, and ICD-10-CM, by a large margin. Results can provide insights to understand the compromise from using lower-dimensionality representations in clinical outcome studies.

Improving in-patient neonatal data quality as a pre-requisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya.

The objectives of this study were to (1)explore the quality of clinical data generated from hospitals providing in-patient neonatal care participating in a clinical information network (CIN) and whether data improved over time, and if data are adequate, (2)characterise accuracy of prescribing for basic treatments provided to neonatal in-patients over time. This was a retrospective cohort study involving neonates ≤28 days admitted between January 2018 and December 2021 in 20 government hospitals with an interquartile range of annual neonatal inpatient admissions between 550 and 1640 in Kenya. These hospitals participated in routine audit and feedback processes on quality of documentation and care over the study period. The study's outcomes were the number of patients as a proportion of all eligible patients over time with (1)complete domain-specific documentation scores, and (2)accurate domain-specific treatment prescription scores at admission, reported as incidence rate ratios. 80,060 neonatal admissions were eligible for inclusion. Upon joining CIN, documentation scores in the monitoring, other physical examination and bedside testing, discharge information, and maternal history domains demonstrated a statistically significant month-to-month relative improvement in number of patients with complete documentation of 7.6%, 2.9%, 2.4%, and 2.0% respectively. There was also statistically significant month-to-month improvement in prescribing accuracy after joining the CIN of 2.8% and 1.4% for feeds and fluids but not for Antibiotic prescriptions. Findings suggest that much of the variation observed is due to hospital-level factors. It is possible to introduce tools that capture important clinical data at least 80% of the time in routine African hospital settings but analyses of such data will need to account for missingness using appropriate statistical techniques. These data allow exploration of trends in performance and could support better impact evaluation, exploration of links between health system inputs and outcomes and scrutiny of variation in quality and outcomes of hospital care.

Association between hospital accrediting agencies and hospital outcomes of care in the United States

Background: Hospital accreditation standards function as the structure to which hospitals must meet to receive reimbursement. There are four independent hospital accrediting organizations in the United States: The Joint Commission, Det Norske Veritas Healthcare (DNV), the Center for Improvement in Healthcare Quality (CIHQ), and the Healthcare Facilities Accreditation Program (HFAP).

Relationship between hospital volumes and health outcomes: epidemiological evidence supporting the revision process of the Ministry of Health Decree no. 70 of 2 April 2015.

In this perspective, this work intends to establish whether statistical correlations exist between volumes of activity and outcomes of hospital care. The scope is limited to several clinical conditions and therapeutic procedures for which specific indicators are provided by the National Healthcare Outcomes Programme (Programma Nazionale Esiti - PNE). For each condition or procedure, the analysis shows the volume-outcome relationship by hospital centre by means of the Levenberg-Marquardt algorithm (software: XLSTAT). The existence of breakpoints is assessed through the use of segmented models (software: "segmented" R-Package). The results show a statistical correlation for the following: acute myocardial infarction (breakpoint: 91 hospitalizations per year; 95% CI: 81-101; p<0.0001); repair of an unruptured abdominal aortic aneurysm (breakpoint: 69 procedures per year; 95% CI: 52-86; p=0.146); lung cancer (breakpoint: 96 procedures per year; 95% CI: 60-132; p<0.01); knee arthroplasty (breakpoint: 91 procedures per year; 95% CI: 51-131; p=0.484). Conversely, the statistical analysis did not allow to accurately highlight a breakpoint for the isolated aorto-coronary bypass, percutaneous transluminal coronary angioplasty and hip arthroplasty. These results represent a useful knowledge contribution to support the revision process of the above-mentioned Decree. As regards the procedures that may not be currently assessed through this statistical analysis method, literature data is referred to that confirm that the current regulatory thresholds are in the safe range.

Brazil's response to COVID-19: commercial determinants of health and regional inequities matter

The study by Rudy Rocha and colleagues in The Lancet Global Health1 provides important evidence of the relationship between inequity and socioeconomic vulnerability in the outcomes of hospital care in the context of COVID-19. However, it is necessary to highlight elements that have previously determined the current health scenario in Brazil.

Antimicrobial Herbal Soap Formulation

Nosocomial infection has been recognized as a crucial issue in the outcome of hospital care, with significant morbidity and mortality results. The primary routes of infection transmission to patients are the hands of health-care workers. This also evokes utilization of antiseptics for hand-washing purposes. Many of the antiseptics commercially available are sanitizers dependent on alcohol that have certain shortcomings or harmful effects. The regular use can cause dermal irritation. The aim of the present study was to formulate an herbal hand-wash using leave extracts of Terminalia catappa, fruits of Curcuma longa, and rinds of Garcinia indica. Using the Disc diffusion process, the antibiotic activity against skin pathogens was evaluated, and results were compared with commercial antimicrobial hand-wash. The results showed that the herbal hand-wash was more effective against Bacillus subtilis and Escherichia coli than the commercially available antiseptic hand-wash. The effectiveness of herbal hand-wash was analysed using the Glove Juice method, which revealed that herbal hand-wash is effective in reducing pathogenic microbes present on the hands better than commercial hand-wash. These plant extracts can therefore be used for formulating herbal hand-wash to prevent hand borne microbial infections.

A Bayesian Study of the Dynamic Effect of Comorbidities on Hospital Outcomes of Care for Congestive Heart Failure Patients

Comorbidities can have a cumulative effect on hospital outcomes of care, such as the length of stay (LOS), and hospital mortality. This study examines patients hospitalized with congestive heart failure (CHF), a life-threatening condition, which, when it coexists with a burdened disease profile, the risk for negative hospital outcomes increases. Since coexisting conditions co-interact, with a variable effect on outcomes, clinicians should be able to recognize these joint effects. In order to study CHF comorbidities, we used medical claims data from the Centers for Medicare and Medicaid Services (CMS). After extracting the most frequent cluster of CHF comorbidities, we: (i) Calculated, step-by-step, the conditional probabilities for each disease combination inside this cluster; (ii) estimated the cumulative effect of each comorbidity combination on the LOS and hospital mortality; and (iii) constructed (a) Bayesian, scenario-based graphs, and (b) Bayes-networks to visualize results. Results show that, for CHF patients, different comorbidity constructs have a variable effect on the LOS and hospital mortality. Therefore, dynamic comorbidity risk assessment methods should be implemented for informed clinical decision making in an ongoing effort for quality of care improvements.

Hospital quality indicators are not unidimensional: Areanalysisof Lieberthal and Comer.

To evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. Pooled cross-sectional 2010-2011 Hospital Compare data (10/1/10 and 10/1/11 archives) and the 2012 American Hospital Association Annual Survey. We used 71 indicators of structure, process, and outcomes of hospital care in a principal component analysis of Ridit scores to evaluate the dimensionality of the indicators. We conducted an exploratory factor analysis using only the indicators in the Centers for Medicare & Medicaid Services' Hospital Value-Based Purchasing. There were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. Hospital quality should be measured using a variety of indicators reflecting different dimensions of quality. Treating hospital quality as unidimensional leads to erroneous conclusions about the performance of different hospitals.

PTU-277 Coding errors lead to high financial penalties in surgical readmissions:

Introduction Readmission rates in general surgery are now used as an indicator of outcome of hospital care. Financial penalties for high levels of readmissions were introduced in 2011. Aims of this study were to assess the accuracy of general surgical readmission and cost implications of erroneous coding. Method 174 patients were readmitted over a four month period (April – June 2014). Electronic patient records were reviewed for both the primary admission and readmission. Results During this time frame, the trust was fined £85,320 in penalties, of which £36,851 could have been avoided if coding errors were excluded. Conclusion Robust systems need to be instituted to avoid excessive charges as a result of inaccurate coding. Collaboration with clinical commissioning groups (CCGs) to reduce the penalty for readmissions with an unrelated primary complaint should be carried out. Disclosure of interest None Declared.

Is there a relationship between transparency and outcome in hospital care? An analysis on the Italian public hospitals

Is there a relationship between transparency and outcome in hospital care? An analysis on the Italian public hospitals

Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards

BackgroundPoor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care.MethodsQualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofesional contexts.ResultsPhysicians in GIM wards communicated with other professions mainly in structured rounds. Physicians’ communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians.ConclusionWithout interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care.Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions.

The impact of organizational culture on the outcome of hospital care: After the implementation of person-centred care

To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. The regression analysis showed that; 16% (R(2) = 0.02) of a decreased health status, 22% (R(2) = 0.05) of pain/discomfort and 13% (R(2) = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.

Pediatric Hospitalists: A Systematic Review of the Literature

Systematic reviews have demonstrated consistently decreased length of stay and costs in internal medicine hospitalist systems. Systematic reviews of pediatric hospitalist systems have not been conducted. Our aim was to determine the effects of pediatric hospitalist systems on length of stay, costs, quality of care, and provider satisfaction and experience. We searched PubMed, Medline, Cochrane Library databases, and the Pediatric Academic Societies National Meeting research abstracts for all primary-data studies published or presented on pediatric hospitalist systems. Studies presenting primary data on efficiency, financial performance, clinical outcomes, or family, referring provider, and housestaff experience in hospitalist systems were included; review articles and case studies were excluded. To minimize publication bias, we contacted all primary authors to obtain information about unpublished studies. Of 47 publications reviewed, 20 were primary-data studies that met criteria for inclusion. Six of 7 studies that compared traditional and hospitalist systems of care demonstrated improvements in costs and/or length of stay in pediatric hospitalist systems. The average decrease in cost was 10%; average decrease in length of stay was 10%. Three of 3 economic analyses, however, demonstrate that efficiency gains do not generally translate into revenues for the hospitalist programs themselves; most hospitalist programs are currently losing money. Surveys of families, referring providers, and pediatric residents demonstrate neutral or improved experiences in hospitalist systems, although these data are less comprehensive. Data on quality of care are insufficient to draw conclusions. Emerging research suggests that pediatric hospitalist systems decrease hospital costs and length of stay without adversely affecting provider, parent, or housestaff experiences. The quality of care in pediatric hospitalist systems is unclear, because rigorous metrics to evaluate quality are lacking. Studies of the processes and outcomes of hospital care are needed.

Hospital care of patients with ST-elevation myocardial infarction in four different European regions

National surveys as well as European comparative studies suggest that differences in treatment of patients with ST-elevation myocardial infarction (STEMI) exist. The extent to which these variations influence the outcome of hospital care delivered to STE-MI patients in everyday routine is mostly unknown. In this study data representative of hospital care received by STEMI patients in four European regions (Berlin, Dijon, Florence and Tartu) were compared. The four registries are population based. The percentage of women and the mean age of the patients differed among the registries. Risk factors such as hypertension and hypercholesterolaemia also differed among the different regions, whereas a history of diabetes mellitus was similar among the registries. The percentage of patients receiving reperfusion therapy ranged from 47 to 81%. An appreciable difference also resulted after breaking down reperfusion therapy into thrombolysis and primary percutaneous coronary intervention (PCI). Hospital mortality as an outcome measure was very similar among the regions. After adjustment for age, the comparative magnitude of hospital mortality proportion was also very similar among three registries. Only the patients from Florence demonstrated a comparatively lower death rate, with a ratio of 0.81. In summary, there are important differences among baseline characteristics and hospital care of STE-Ml patients in the four study regions. Nevertheless, it was interesting to ascertain that the outcome measured in hospital mortality was very similar among the four registries compared.

Hospitalists and the Costs and Outcomes of Hospital Care

Hospitalists and the Costs and Outcomes of Hospital Care

Hospitalists and the Costs and Outcomes of Hospital Care

Summaries for Patients3 December 2002Hospitalists and the Costs and Outcomes of Hospital CareSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-11-200212030-00002 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the problem and what is known about it so far?American doctors have traditionally spent part of their day seeing patients in their offices and part of their day seeing patients in the hospital. However, many hospitals have begun to use doctors called hospitalists. Hospitalists spend a large portion of their time taking care of hospitalized patients. The concept of hospitalists was developed to improve quality and reduce costs. Because of increases in the hospital patients' level of illness and the specialized nature of hospital care, it is difficult for doctors to split their time between the outpatient ... Author, Article, and Disclosure InformationAffiliations: The summary below is from the full report titled “Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists.” It is in the 3 December 2002 issue of Annals of Internal Medicine (volume 137, pages 866-874). The authors are D Meltzer, WG Manning, J Morrison, MN Shah, L Jin, T Guth, and W Levinson.Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists David Meltzer , Willard G. Manning , Jeanette Morrison , Manish N. Shah , Lei Jin , Todd Guth , and Wendy Levinson Metrics 3 December 2002Volume 137, Issue 11Page: I-25KeywordsAcademic medicineHospital medicineHospitalistsLearning curvesOutpatient clinicsPatients ePublished: 3 December 2002 Issue Published: 3 December 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Chronic Comorbidity and Outcomes of Hospital Care: Length of Stay, Mortality, and Readmission at 30 and 365 Days

This article evaluates the behavior of an adaptation of the Charlson Index (CHI) applied to administrative databases to measure the relationship between chronic comorbidity and the hospital care outcomes of length of stay (LOS), in-hospital mortality, and emergency readmissions at 30 and 365 days. These outcomes were analyzed in 106,673 hospitalization episodes whose records are registered in a minimum basic data set maintained by the public health authorities of the community of Valencia, Spain. The highest comorbidity measured by the CHI was associated with greater LOS and in-hospital mortality and increased readmission at 30 and 365 days. The rate of readmissions at 1 year dropped, however, in the group with the greatest comorbidity, probably owing to an increase in mortality after hospitalization. While comorbidity does appear to increase the risk of adverse outcomes in general and mortality and readmission specifically, the second outcome is only possible if the first has not occurred. For this reason, information and selection biases derived from administrative databases, or from the CHI itself, should be taken into account when using and interpreting the index.

The Effectiveness of Inpatient Case Management

Production processes and service delivery in acute care hospitals can be fragmented. Inpatient case management has the potential to improve both processes and outcomes of hospital care. The author reports on 18 research studies that used inpatient case management as the treatment variable. These outcome studies, using case management, did not provide the evidence needed to address deficiencies in inpatient settings. However, these studies do provide clear direction for nurse administrators and nurse researchers to take concerning the next steps needed to address this critical issue.

Issues of recruitment and maintaining high response rates in a longitudinal study of older hospital patients in England--pathways through care study.

STUDY OBJECTIVES: To describe and discuss the methods used to recruit and maintain an unbiased sample of older discharged hospital patients in a study of the process and outcomes of...