Patterns Of Hospital Use Research Articles

Seasonal Patterns of Hospital Use in Winnipeg: Implications for Managing Winter Bed Crises

This study examined whether Winnipeg hospitals experience predictable “highvolume periods” in order to determine whether hospital overcrowding might be anticipated and, therefore, avoided. We found that highvolume periods among medical patients occurred during all but one year between 1987 and 1998. Most highvolume periods occurred during influenza seasons. Preventing such recurrent bed pressures requires a multi-faceted approach, involving preventive efforts to reduce hospital admissions (influenza vaccination) and alternatives to managing the hospital system.

Does it Matter How Small Geographic Areas are Constructed? Ward's Algorithm Versus the Plurality Rule

Objective: Illustrate Ward's clustering algorithm, an approach that creates small geographic areas based on similarity in the pattern of hospital use. Compare areas resulting from Ward's algorithm using all hospital discharges to 1) areas resulting from the plurality rule, the more widely used approach, and 2) areas resulting from Ward's algorithm using subsets of discharges.

Hospital Participation in Community Partnerships to Improve Health

The core business of hospitals now requires, for both competitiveness and quality improvement reasons, that hospitals move beyond their physical and conceptual walls to form community partnerships. THE HOSPITAL'S ROLE AS A PARTNER IN COMMUNITY-BASED HEALTH IMPROVEMENT SYSTEMS: Hospitals, as organizations that are significant health care, social, and economic institutions in their communities, should play a leading role in mobilizing resources for such community-level health improvement efforts. Three examples of extending hospital efforts into the community demonstrate that improvement of a problem involving hospital care can derive from a collaborative, community-based activity. In Boston, infection control--once a standard, strictly in-house procedure--has been forced by altered patterns of hospital use to become a largely community-based process. In Chicago, a variety of health care providers and community representatives have worked effectively to reduce mortality and morbidity in a single disease (asthma) model. In Akron, Ohio, Lifelink program hospitals, working together with community agencies and groups in a door-to-door neighborhood program, improved the effectiveness of prenatal care and the quality of birth outcomes. Efforts to work with community groups to improve health status should not be simply an optional do-good endeavor, as they have often been in the past, but rather an essential part of quality improvement and good business practice. Marketplace incentives will increasingly reward hospitals that are able to form successful community partnerships.

Patterns of hospital use, family history and co-existing conditions among urban African-American and Hispanic-American children with insulin-dependent diabetes mellitus

Patterns of hospital use, family history and co-existing conditions among urban African-American and Hispanic-American children with insulin-dependent diabetes mellitus

Patterns of hospital use, family history and co-existing conditions among urban African-American and Hispanic-American children with insulin-dependent diabetes mellitus

Little information is available about insulin-dependent diabetes mellitus (IDDM) when it occurs among US minorities. The incidence of IDDM among African-American and Hispanic children < 18 years of age was determined in the city of Chicago. Hospital records were used as the primary source of cases, and a small amount of additional data was collected from the medical charts. Cases were drawn from records at 37 hospitals in Cook County, IL. African-American and Hispanic patients using insulin, residing in the city of Chicago, and < 18-years-old at onset were registered. Three secondary sources were used and overall ascertainment was estimated at 86%. There were 413 new cases during the 6-year interval 1985 through 1990. The age-standardized incidence of IDDM was 13.2/100 000 (95% confidence interval (C.I.) 11.8 – 14.8) among African-Americans and 10.8/100 000 (95% C.I. 9.5 – 12.3) among Hispanics. Hospital use differed between African-Americans and Hispanics, presumably based on geographic, cultural and financial factors. Diabetes among the first degree relatives of children from both ethnic groups was common, and the most frequently listed co-morbid conditions were asthma and obesity. The risk for IDDM in Chicago is among the highest for both African-origin and Hispanic children worldwide. The prevalence of asthma and obesity parallels the high prevalence of these conditions among non-diabetic children in Chicago. The ongoing epidemic of non-insulin-dependent diabetes mellitus (NIDDM) among African-Americans and US Hispanics is likely to be the reason for the large number of minority IDDM patients who have a first-degree relative with diabetes.

Epidemiology and patterns of hospital use after parasuicide in the south west of England.

To describe the epidemiology, management, and outcome of parasuicide in the south west of England. Descriptive analysis using routine information systems. The former South Western Regional Health Authority, population aged 10 and over: 2.9 million. These comprised 5080 residents of the South Western Health Region, admitted on 5770 occasions for parasuicide between April 1992 and March 1993 to hospitals in the south west. Person based age and sex standardised admission ratios for parasuicide; readmission for parasuicide in the subsequent 12 months; admission to psychiatric hospital after parasuicide; in-hospital mortality for those admitted after attempted suicide. The overall rate of parasuicide admission was 174 per 100,000 per year. Rates were highest in males aged 20-24 (381 per 100,000) and in females aged 15-19 (625 per 100,000). Parasuicide is the third most frequent cause of acute medical admission in the south west. A total of 10.0% of admissions received psychiatric inpatient care as a direct result of their parasuicide admission and 10.1% were readmitted in the following 12 months with a repeat episode of parasuicide. Significant variations in standardised admission ratios for parasuicide were observed between the districts. Some of this variation is related to socioeconomic differences between districts, the rest is probably due to differences in practice between districts. There is no clear evidence that these variations result in differences in readmission rates. Districts where psychiatric inpatient facilities were located on the same site as the general hospital tended to admit a greater percentage of parasuicide patients for psychiatric inpatient care. A quarter of all suicide deaths from overdose occurred in hospital. It is estimated that there are 87,000 parasuicide admissions in England and Wales annually. Parasuicide is a common cause of acute hospital admission and there is evidence that hospital admission practices for parasuicide vary across the south west. Randomised controlled trials are needed to evaluate the most appropriate form of management for those patients who do not require admission on medical grounds.

Impact of socioeconomic status on hospital use in New York City.

This DataWatch examines the potential impact of socioeconomic differences on rates of hospitalization, based on patterns of hospital use in New York City in 1988. The research suggests that lack of timely and effective outpatient care may lead to higher hospitalization rates in low-income areas. For certain conditions identified as ambulatory care sensitive, hospitalization rates were higher in low-income areas than they were in higher-income areas where appropriate outpatient care was more readily available. Further study is needed to determine the relative impact of various economic, structural, and cultural factors that affect access to care.

Changing patterns of hospital use for patients with musculoskeletal disease in Michigan, 1980 to 1987.

Over the past 10 years there have been dramatic changes in health care financing in the United States, such as Medicare's Prospective Payment System for hospitalized Medicare beneficiaries, and in health services delivery, such as the growth in health maintenance organizations and other forms of managed care. These changes have occurred largely in response to payors' concerns about the rising cost of health care. A study of such changes in financing and delivery, and how specific groups of patients are affected is necessary so that the effects of these changes on patients' health can be determined. We examined the hospitalization rates for patients with musculoskeletal diseases in Michigan from 1980 through 1987. During this period, the overall age-adjusted hospitalization rates decreased 7.0% per year (p = 0.001). The decrease occurred less for surgical discharges (6.0% per year) than for medical discharges (8.6% per year) (p < 0.001). While these overall trends are of interest, they obscure disease-specific trends that vary significantly from both the overall, and the medical and surgical trends. For example, while surgical discharges, in general declined, procedures related to major joint and limb reattachment (DRG #209) increased at a rate of 6.3% per year. And while medical discharges in general decreased over this period, discharges for osteomyelitis increased 5.4% per year. The patterns of disease-specific trends offers insight into the possible causes for these changes. Finally, it is important to understand the epidemiology of hospital use to evaluate the effects of new medical care delivery and payment systems on the care of subsets of patients.

The natural history of alcohol abuse: implications for definitions of alcohol use disorders

Is the DSM-III-R category of alcohol abuse validly differentiated from the DSM-III-R category of alcohol dependence, or is abuse primarily a mild, prodromal condition that typically deteriorates into dependence? A 4-year longitudinal epidemiologic study of male drinkers provided data to answer this question. The study used identical questions at baseline and follow-up. At follow-up, 70% of the subjects who were initially classified as alcohol abusers were still abusers or were classified as remitted. This contrasted significantly with outcome in the subjects who initially reported alcohol dependence. Although additional research is needed, these results indicate that alcohol abuse often has a course distinct from that of alcohol dependence.

Changes in admissions, lengths of stay, and discharge diagnoses at a major university-affiliated teaching hospital

The implications for medical education of a declining average length of stay (ALOS) and changes in numbers of hospital admissions have been the subject of considerable discussion. The changing hospital reimbursement schedules and the rise of managed-care systems have altered patterns of hospital use and consequently posed new problems for the education of medical students and residents. Between 1980 and 1986 in one university-affiliated hospital, the ALOS for patients with any of the most frequent discharge diagnoses for either of those years had declined 34% since 1980, despite a 59% increase in the number of patients with those diagnoses. Patients with any one of 21 of the 88 most frequent discharge diagnoses for 1986 were hospitalized for less than one day. Those patients with another eight of the disorders had an ALOSs of between one and two days; some of these patients had serious and common gastrointestinal disorders. Discharge diagnoses were categorized by the hospital service in which students and residents would have rotations and were analyzed for changes in case mix. This study showed that for the hospital's medical students and residents to be exposed to the same case mix of clinical disorders that were seen in-hospital in 1980, it is now necessary for them to have experience in the ambulatory setting.

Characteristics of the recurrently hospitalized adult. An information synthesis.

Hospital use in the US is concentrated in the approximately 2% of the population that is repeatedly hospitalized. Using the research integration technique of information synthesis, empirical studies of readmission were assembled and analyzed to determine the demographic and clinical characteristics of the repeatedly hospitalized adult. The authors' synthesis of articles that met preset criteria of relevance and validity indicated that clinical variables show a more consistent association with readmission than demographic variables. Diagnosis, prior use, and disability appear to be strong predictors of an individual's level of hospital use. Demographic variables with consistent positive associations with readmission include being widowed, living with relatives other than a spouse, decreasing income, living in the South, and living in an urban area, but available work does not indicate whether these demographic variables are independent predictors of readmission or merely markers of an increased prevalence of chronic disease. Findings indicate that future investigations of the predictors of this costly pattern of hospital use will be most illuminating if illness-related factors such as diagnosis, disease severity, functional status, and usage history are carefully specified and examined.

A study of patient referrals

A study using Hospital Activity Analysis (H.A.A.) data, interviews with general practitioners, and a postal survey of a sample of patients, was undertaken to describe and explain the pattern of hospital use exhibited by the residents of a town in Leicestershire. The enthusiasm expressed for the local community hospital and the levels of use made of both the hospitals of a nearby town in a neighbouring health authority and the main hospitals within the town's own authority was explained by the fact that to a large extent, hospital use was found to be determined by considerations of social geography, the non-clinical needs of the patient and the professional needs of the general practitioner.

Ethnic differences in the outpatient use of a public-charity hospital.

The differential use that is made of health services in contemporary American society, particularly by disadvantaged subgroups, is a topic not only of current interest but also of considerable concern. One or both of two general strategies, each having different advantages, disadvantages, and hence, purposes, can be used to examine patterns of health services use: Residents of a more or less bounded population segment may be sampled at one or several points in time and asked to report about use, or the records of key medical facilities and personnel that service the population of interest can be analyzed. In the study to be reported here we followed the second strategy and concentrated on a large public-charity hospital of a metropolitan area in the Southwestern United States. The purpose of this study is to explicate the differences in pattern of hospital use by the three principal ethnic groups of this area: Anglo-Americans, MexicanAmericans and Negro-Americans (hereafter referred to respectively as Anglos, Chicanos and blacks). There exists now a growing literature on the influence that ethnicity has on a variety of medically-relevant issues such as morbidity,' perception and expression of disability,24 lay systems of care,5 etc. There are relatively few studies comparing the use of health services by ethnic groups, however. Social factors that are associated with the use of specific units within a hospital have been documented (see for example 6 and 7). Studies that compare the way ethnic groups use different units within a hospital are needed, since this focus adds comprehensiveness to the interpretations that can be made about the way in which the respective ethnic groups obtain hospital-based medical care. In the study to be reported here the use of several outpatient units of a hospital were compared. Besides ethnic identification, attention is also given to other demographic variables (i.e., age and sex) that may help clarify the pattern of utilization by the ethnic groups. A second feature of the study reported here deserves attention, and that has to do with the properties of the medical care system that exists in the setting where the study was conducted. The area studied has few public-charity hospitals, and the one that was used as the study base constitutes the principal one. A very large portion of the universe that receives this type of medical care is consequently represented in the study sample. In addition, the bulk of the facilities and personnel that comprise the units of the medical care system of the city (including the public-charity hospital) are densely concentrated in one relatively small geographic setting, a setting which has little proximity to the population segments forced to use this type of medical care. Our study sample, then, in addition to encompassing a large representative portion of the economically disadvantaged health services consumer, also includes individuals who have overcome not inconsiderable geographic barriers in the pursuit of medical care.

Patterns of Hospital Use: An Analysis of Short-Run Variations

This study of monthly hospital use in thirty-five diagnoses indicated rational and predictable variations. Admissions in seven diagnostic categories increased in six decreased when monthly occupancy rates exceeded normally acceptable levels. Illnesses in the latter group contrasted with those of the former in a manner consistent with the hypothesis: they were types for which hospital admission might reasonably be considered postponable or discretionary. Patient stays for each group were, respectively, above and below the hospital average, suggesting that a rationing of admissions at high occupancy intensified utilization by inducing an increase in average stay.