Patients In Australian Hospitals Research Articles

Direct costs for treatment of venous thromboembolism complication 90-day after surgery

Study object: Describe the direct treatment costs due to venous thromboembolism complications 90 days after surgery by using national health insurance reimbursement database. Patients: 824,947 adult patients who underwent major surgeries were enrolled from January 1, 2017 to September 31, 2018. Method: Study was conducted by using cross-sectional descriptive design. Patients were considered VTE case if they had a diagnostic code up to 90 days after the first surgery, thus 1472 were diagnosed as having VTE after surgery. The study using propensity score matching method shows that there were 913 pairs of patients with the same propensity score included in analysis. Results: The rate of hospital re-admission and outpatient visit were 41.7% and 60.8% in group of VTE patient after matching, respectively. The mean 90-day postoperative cost in VTE group after matching was found to be 89.652 ± 107.928 thousand VNĐ, which is 1.5 times higher than the expenditure of non-VTE group with 61.474± 81.115 thousand VNĐ. Conclusion: The costs related to VTE treatment can be used to evaluate the potential economic benefit and cost-savings from efforts of VTE prevention.
 Keywords
 Venous thromboembolism, direct treatment costs.
 References
 [1] W.H. Geerts, G.F. Pineo, J.A. Heit, et al, Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest 126 (2004) 338-400. https:// doi.org/10.1378/chest.126.3_suppl.338S.[2] V.V. Tam, N.V. Thong, The rate of deep venous thrombosis related to hip and knee arthroplasty – A study in Cho Ray Hospital (in Vietnamese), Ho Chi Minh City Medical Journal 18(2) (2014) 250-256.[3] A.C. Spyropoulos, J.S. Hurley, G.N. Ciesla, et al, Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin, Chest 122 (2002) 108-14. https://doi.org/10.1378/chest.122.1.108.[4] D.A. Ollendorf, M. Vera-Llonch ,G. Oster., Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients, Am J Health Syst Pharm 59(18) (2002) 1750-4. https://doi.org/10.1093/ajhp/59.18.1750[5] J.Y.S. Ng, R.V. Ramadani, D. Hendrawan, et al,National Health Insurance Databases in Indonesia, Vietnam and the Philippines, Pharmacoecon Open (2019). https://doi.org/ 10.1007/s41669 -019-0127-2.[6] H. Assareh, J. Chen, L. Ou, et al, Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study, BMJ Open 4(10) (2014) 5502. https://doi.org/10.1136/bmjopen-2014-005502.[7] Agency for Healthcare Research and Quality (AHRQ), Patient safety indicator v4.5 benchmark data tables, (2013).[8] I.A. Naess, S.C. Christiansen, P. Romundstad, et al.,Incidence and mortality of venous thrombosis: a population-based study, J Thromb Haemost 5(4) (2007) 692-9. https://doi.org/10.1111/j.1538-7836.2007.02450.x.[9] D.C. Sutzko, P.E. Georgoff, A.T. Obi, et al, The Association Of Venous Thromboembolism Chemoprophylaxis Timing on Venous Thromboembolism After Major Vascular Surgery, J Vasc Surg 67(1) (2018) 262-271. https://doi.org/ 10.1016/j.jvs.2017.06.087.[10] F.A. Anderson, F.A. Spencer, Risk factors for venous thromboembolism, Circulation 107(23) (2003) 9-16. https://doi.org/ 10.1161/01.CIR.0000078 469.07362.E6[11] J. Lin, A.C. Spyropoulos, Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations, J Manag Care Pharm 13(6) (2007) 475-86. https://doi.org/10.18553/jmcp.2007.13.6.475[12] D.J. Tillman, S.L. Charland, D.M. Witt, Effectiveness and economic impact associated with a program for outpatient management of acute deep vein thrombosis in a group model health maintenance organization, Arch Intern Med, 160(19) (2000) 2926-32. https://doi.org/ 10.1001/archinte.160.19.2926.[13] M. Sakon, Y. Maehara, T. Kobayashi, et al, Economic Burden of Venous Thromboembolism in Patients Undergoing Major Abdominal Surgery, Value in Health Regional Issue 6 (2015) 73-79. https://doi.org/10.1016/j.vhri. 2015. 03.017.[14] A. Sepasso, F. Chingcuanco, E. Gordon, et al, Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study, Journal of Medical Economics 21(6) (2018) 595-602. https://doi.org/10.1080/13696998.2018.1445635.[15] Shinro Takai, Masao Akagi, Bruce Crawford, et al, Economic Impact of Venous Thromboembolism Following Major Orthopaedic Surgery in Japan, Value in Health Regional Issues 2(1) (2013) 81-86. https://doi.org/ 10.1016/j.vhri.2013.01.001.

Overseas qualified nurses' communication with other nurses and health professionals: An observational study.

To understand the interprofessional and intraprofessional communication patterns of overseas qualified nurses as they coordinate care for patients in Australian hospitals. Numerous studies have informed the transitioning experiences of overseas qualified nurses with non-English-speaking backgrounds working in English-speaking workplaces. Only a few observational studies have involved examining the intercultural communication experiences of overseas qualified nurses, and none have considered their intra- and interprofessional communication patterns. A qualitative design was adopted, using participant observation and discourse analysis. This study was from January 2017 to March 2017. Thirteen overseas qualified nurses working in acute, subacute and interventional cardiology settings in a Melbourne metropolitan hospital were shadowed over a period of 12weeks to collect data that inform their communication patterns. The COREQ checklist was used. This observational study informed by genre analysis revealed that intra- and interprofessional communication occurred more commonly under the clinical communication goals of coordinating care and less commonly under facilitating intervention. Communication strategies ranged from structured interactions with use of communication tools to unstructured ad hoc interactions. Analysis of the discourse patterns demonstrated that effectiveness of interactions was affected by hesitancy, lack of assertion and few strategies to manage inadequate or aggressive communication by other team members. Poor clinical communication with peers was not always caused by the nurses from non-English-speaking backgrounds. Positive interpersonal interactions with laughter, language-switching and small talk were evident in interactions with nurses from similar cultural backgrounds but were rare with local colleagues. The linguistic evidence from this study shows variations in communication competency between participants, which emphasises the importance of not viewing overseas qualified nurses' communication training needs as homogenous. With the growing multicultural nature of healthcare teams, this study underscores the need for intercultural communication training for team integration and patient safety. Continuous professional development should incorporate intercultural communication training to ensure team effectiveness within nursing teams as well as interprofessional teams.

Quantifying the hidden healthcare cost of diabetes mellitus in Australian hospital patients.

Diabetes mellitus in hospital inpatients is most commonly present as a comorbidity rather than as the primary diagnosis. In some hospitals, the prevalence of comorbid diabetes mellitus across all inpatients exceeds 30%, which could add to complexity of care and resource utilisation. However, whether and to what extent comorbid diabetes mellitus contributes indirectly to greater hospitalisation costs is ill-defined. To determine the attributable effect of comorbid diabetes mellitus on hospital resource utilisation in a General Internal Medical service in Melbourne, Australia. We extracted data from a database of all General Internal Medical discharge episodes from July 2012 to June 2013. We fitted multivariable regression models to compare patients with diabetes mellitus to those without diabetes mellitus with respect to hospitalisation cost, length of stay, admissions per year and inpatient mortality. Of 4657 patients 1519 (33%) had diabetes mellitus, for whom average hospitalisation cost (AUD9910) was higher than those without diabetes mellitus (AUD7805). In multivariable analysis, this corresponded to a 1.22-fold (95% confidence interval (CI) 1.12-1.33, P < 0.001) higher cost. Mean length of stay for those with diabetes was 8.2 days versus 6.8 days for those without diabetes, with an adjusted 1.19-fold greater odds (95% CI 1.06-1.33, P = 0.001) of staying an additional day. Number of admissions and mortality were similar. Comorbid diabetes mellitus adds significantly to hospitalisation duration and costs in medical inpatients. Moreover, diabetes mellitus patients with chronic complications had a greater-still cost and hospitalisation duration compared to those without diabetes mellitus.

Patients' experiences in Australian hospitals: a systematic review of evidence.

Objective Patients are uniquely positioned to provide insightful comments about their care. Currently, a lack of comparable patient experience data prevents the emergence of a detailed picture of patients' experiences in Australian hospitals. The present study addresses this gap by identifying factors reported in primary research as relating to positive and negative experiences of patients in Australian hospitals. Methods Evidence from Australian qualitative studies of patients of all ages reporting their experiences in any hospital or day procedure centre was synthesised. A range of text words, synonyms and subject headings was developed and used to undertake a systematic search of seven electronic databases from January 1995 to July 2015 and the grey literature. Two reviewers independently screened the titles, abstracts or executive summaries and applied the inclusion criteria. Data were synthesised in a meta-narrative. Results Thirty-nine publications were included: 33 articles from database searches and six from the grey literature. Quality improvement researchers produced the dominant narrative and the nursing perspective was strong. Six themes emerged: 'Reciprocal communication and information sharing', 'Interpersonal skills and professionalism', 'The care environment', 'Emotional support', 'Discharge planning and process' and 'Correct treatment and physical outcomes'. Conclusion Tangible opportunities to enhance the patient experience are apparent. Small changes to the way that the health system operates and is resourced and the way that health professionals engage with patients could substantially improve care. Examples include inviting patients and carers to contribute to decision making and discussions about their treatment options and care preferences. What is known about the topic? Patient experience is identified as a key component of an optimal health system, along with improving the health of populations and reducing the per capita costs of care. The use of patient experience data has been associated with improved clinical effectiveness and patient safety. What does this paper add? Patient experience data are currently not routinely captured and difficulties exist as to where this information is available. These data are gathered using a variety of different methods that prohibit the development of a national picture. As a step towards overcoming this barrier, the present study identifies the common elements of healthcare experience reported by patients in Australia as being positive or negative. What are the implications for practitioners? Ensuring that patients and carers are active partners in their care is at the centre of a positive patient experience. Health professionals should provide patients with opportunities to make decisions about their care and ask questions, and to provide clear information before, during and after hospitalisation to enhance patients' experiences in Australian hospitals.

Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

ObjectivesThe UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS...

Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

ObjectivesDespite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore...

Abstract 35: Long-term Outcomes after Percutaneous Coronary Intervention in Australian Private Hospitals; Results from a National Registry

Background: Several large registries have evaluated outcomes after percutaneous coronary intervention (PCI) in the USA, however little national data exist regarding long-term outcomes of patients in Australian hospitals. The aim of this study was to report the long-term results of PCI from the Heart Care Group Registry. Methods: We prospectively enrolled consecutive patients (n=2158) undergoing PCI to 2950 lesions at 9 Australian private hospitals from November 2008 to December 2012. Baseline patient/procedural data and in-hospital, 30 day and 1 year outcomes were recorded in a secure electronic database and stored in the Department of Epidemiology at Monash University. Results: The mean age was 67 ± 12 years. Females comprised 25.1 %, diabetics 24.5%, 32% were obese (BMI&gt;30) and 37.2% had acute coronary syndromes. At least one DES was used in 64.9% of PCI. Procedural success rates were 97%. In patients not taking Warfarin, 99.0% were taking aspirin and 97.7% clopidogrel at discharge. Obese patients were more likely to be readmitted by 12 months (p=0.002) Conclusion: Australian practice and long-term outcomes after PCI are consistent with those reported in international registries. Compliance with guideline therapy is high.

Improving food services for elderly, long‐stay patients in Australian hospitals: Adding food fortification, assistance with packaging and feeding assistance

AbstractAim: The study aims to highlight barriers and feasible opportunities to enhance nutrition support of elderly, long‐stay patients in Australian hospitals.Methods: A total of 218 dietitians, nurse unit managers and food service managers from medical and rehabilitation wards of 184 hospitals completed a web‐based survey about current practices, perceived barriers and priority opportunities to enhance nutrition support in their context.Results: Cook‐fresh food was the most commonly reported food‐service system (50%). Eighty‐eight percent still used paper menus and one‐ or two‐week cycles were the most common menu cycle lengths. Lack of choice due to special diet, boredom arising from the length of stay, a lack of feeding assistance, limited variety and inadequate flexibility of food service were the key barriers identified. Food fortification, assistance with packaging, additional feeding assistance by nurses, non‐nursing feeding assistance and further nutrition assessment were key priorities for improvement.Conclusion: A ‘toolbox’ of strategies is needed as no one intervention will improve nutrition support of all patients. Further practice‐based outcomes and cost‐benefit studies are needed to enhance support and advocacy for feasible food service interventions in the future.

Adverse event rates as measures of hospital performance

ObjectivesAdverse event or complication rates are increasingly advocated as measures of hospital quality and performance. Objective of this study is to analyse patient-complexity adjusted adverse events rates to compare the performance of hospitals in Victoria, Australia. We use a unique hospital dataset that routinely records adverse events which arise during the admission. We identify hospitals with below or above average performance in comparison to their peers, and show for which types of hospitals risk adjusting makes biggest difference. MethodsWe estimate adverse event rates for 87,790 elective and 43,771 emergency episodes in 34 public hospitals over the financial year 2005/06 with a complementary log–log model, using patient level administrative hospital data and controlling for patient complexity with a range of covariates. ResultsTeaching hospitals have average risk-adjusted adverse event rates of 24.3% for elective and 19.7% for emergency surgical patients. Suburban and rural hospitals have lower rates of 17.4% and 17%, and 16.1% and 15.7%, respectively. Selected non-teaching hospitals have relatively high rates, in particular hospitals in rural and socially disadvantaged areas. Risk adjustment makes a significant difference to most hospitals. ConclusionWe find comparably high adverse events rates for surgical patients in Australian hospitals, possibly because our data allow identification of a larger number of adverse events than data used in previous studies. There are marked variations in adverse event rates across hospitals in Victoria, even after risk adjusting. We discuss how policy makers could improve quality of care in Australian hospitals.

A multilevel analysis of three randomised controlled trials of the Australian Medical Sheepskin in the prevention of sacral pressure ulcers

To assess the effectiveness of the Australian Medical Sheepskin in preventing sacral pressure ulcers (PUs), based on combined data from existing published trials. Data from two randomised controlled trials (RCTs) among Australian hospital patients and one RCT among Dutch nursing home patients were pooled, comprising a total population of 1281patients from 45nursing wards in 11institutions. These data were analysed in two ways: with conventional meta-analysis based on the published effect sizes; and with multilevel binary logistic regression based on the combined individual patient data. In the multilevel analysis, patient, nursing ward and institution were used as levels and we controlled for sex, age, PU risk and number of days of observation. Incidence of sacral PUs. Overall, the incidence of sacral PUs was 12.2% in the control group versus 5.4% in the intervention group with an Australian Medical Sheepskin. Conventional meta-analysis showed significantly reduced odds of developing a PU while using the sheepskin (odds ratio [OR], 0.37[95% CI, 0.17-0.77]). Multilevel analysis gave an OR of 0.35and narrowed the confidence interval by almost 50% (95% CI, 0.23-0.55). These analyses of pooled data confirm that the Australian Medical Sheepskin is effective in preventing sacral PUs. Multilevel analysis of individual patient data gives a more precise effect estimate than conventional meta-analysis.

A Web Based Survey of Barriers and Opportunities to Support Nutrition Provision to Long Stay Patients in Australian Hospitals

A Web Based Survey of Barriers and Opportunities to Support Nutrition Provision to Long Stay Patients in Australian Hospitals

The Psychological Impact of September 11 Terrorism on Australian Inpatients

To investigate the psychological impact on Australian hospital patients of the media coverage of the September 11 (9/11) terrorist attack. Thirty psychiatry and 26 matched medical and surgical inpatients were assessed. Both reported and observed distress was common. Women reported significantly more distress than men. Individuals with psychiatric illness were significantly more varied in their attribution of cause for 9/11. Seven patients (29%) with pre-existing psychosis became delusional surrounding the events, but there were no significant differences between the psychiatry and the medical and surgical inpatients. Clinical impressions were confirmed, namely, that a large proportion of hospital inpatients were adversely affected by TV footage of the 9/11 terrorist attack. Most vulnerable were those already with a mental disorder, particularly those with a pre-existing psychotic illness.

In reply: Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous

In reply: Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous

Diagnostic and therapeutic procedures among Australian hospital patients identified as indigenous.

To determine whether hospital patients identified as Indigenous are less likely than other inpatients to have a principal procedure recorded, and the extent to which any disparity in procedure use can be explained by differences in patient, episode and hospital characteristics. Retrospective analysis of routinely collected administrative data from the National Hospital Morbidity Database (NHMD). Australian public and private hospitals. All patients included in the NHMD whose episode type was recorded as acute and whose separation occurred between 1 July 1997 and 30 June 1998. Patients admitted for routine dialysis treatment were excluded. Whether a principal procedure was recorded. In public hospitals, patients identified as Indigenous were significantly less likely than other patients to have a principal procedure recorded, even after adjusting for patient, episode and hospital characteristics (adjusted odds ratio [OR], 0.67; 95% CI, 0.66-0.68). This disparity was apparent for most diseases and conditions. In private hospitals, no significant difference was observed (adjusted OR, 0.94; 95% CI, 0.83-1.06). The disparity in procedure use after adjustment for relevant factors indicates that in Australian public hospitals there may be systematic differences in the treatment of patients identified as Indigenous.

SF-36 Health Profiles of Recently Discharged Hospital Patients in Australia

This study investigated the characteristics and validity of the SF-36 (Australian version) health profile and summary scores for recently discharged hospital patients and compared this with US and Australian community samples with minor and serious medical conditions. Adult medical, surgical, obstetric and gynaecological patients from a large teaching hospital in NSW, Australia, completed a postal survey 1 week after discharge. The SF- 36 discriminated well among patient groups and performed well on most validity tests. Scale and summary scores varied by age, gender, seriousness of condition on admission, prior health status and hospital group. The findings highlight the potential of the SF-36 in monitoring the health status of Australian hospital patients and assessing the health-related support needed on discharge.

Health outcomes by self-report: validity of the SF-36 among Australian hospital patients.

This paper examines the performance of the SF-36 as a self-reported outcome measure in a diverse sample of Australian hospital in-patients. The data derive from the Care Continuum and Health Outcomes Project with a total of 2088 randomly selected patients, yielding a response rate of 80%. Distributions, completion rates and, in particular, correlates of measures were used to investigate the validity of the SF-36 according to clinical and psychometric criteria. Physical functioning, bodily pain, role limitations-physical, general health and vitality scales better represented physical than mental health, with the relative strength decreasing in that order; while mental health, role limitations-emotional and social functioning scales better represented mental health, with the relative strength decreasing in order. A cultural dimension was a strong independent correlate of all scales. While the SF-36 performed satisfactorily, there were weaknesses: the social functioning scale was too narrow to cover social health, both role limitations scales had crude response categories and particular subgroups, the frail elderly and those with complex health conditions, required measures with finer gradings for scales such as physical functioning and bodily pain. Further testing is needed to develop self-reports for use in hospital outcomes measurement which is already proposed in Australia.

The consumption of analgesics by Australian hospital patients.

The consumption of analgesics by Australian hospital patients.