General Hospital Services Research Articles

Do Diagnosis Related Groups change admission practice to a large Swiss ICU?

The new Swiss financing system by means of Diagnosis Related Groups (DRG), effective 1 January 2012, forms the basis of a performance-based system to reimburse general hospital services. There are only few data on the influence of DRG on ICU patients [1,2]. We expect that the introduction of the DRG in Switzerland will change the number of admissions from external hospitals to a large ICU with a centre function and will influence the severity of disease of the admitted patients.

Frank Neville Garratt

Frank Neville Garratt was the only child of a headmaster in Dudley. He attended Dudley Grammar School, winning an exhibition to study medicine at Birmingham. After house jobs at Birmingham...

An alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting (ADAPTA): study protocol for a randomized, controlled pilot trial

BackgroundAlcohol misuse is a major cause of premature mortality and ill health. Although there is a high prevalence of alcohol problems among patients presenting to general hospital, many of these people are not help seekers and do not engage in specialist treatment. Hospital admission is an opportunity to steer people towards specialist treatment, which can reduce health-care utilization and costs to the public sector and produce substantial individual health and social benefits. Alcohol misuse is associated with other lifestyle problems, which are amenable to intervention. It has been suggested that the development of a healthy or balanced lifestyle is potentially beneficial for reducing or abstaining from alcohol use, and relapse prevention. The aim of the study is to test whether or not the offer of a choice of health-related lifestyle interventions is more acceptable, and therefore able to engage more problem drinkers in treatment, than an alcohol-focused intervention.Methods/designThis is a pragmatic, randomized, controlled, open pilot study in a UK general hospital setting with concurrent economic evaluation and a qualitative component. Potential participants are those admitted to hospital with a diagnosis likely to be responsive to addiction interventions who score equal to or more than 16 on the Alcohol Use Disorders Identification Test (AUDIT). The main purpose of this pilot study is to evaluate the acceptability of two sorts of interventions (healthy living related versus alcohol focused) to the participants and to assess the components and processes of the design. Qualitative research will be undertaken to explore acceptability and the impact of the approach, assessment, recruitment and intervention on trial participants and non-participants. The effectiveness of the two treatments will be compared at 6 months using AUDIT scores as the primary outcome measure. There will be additional economic, qualitative and secondary outcome measurements.DiscussionDevelopment of the study was a collaboration between academics, commissioners and clinicians in general hospital and addiction services, made possible by the Collaboration in Leadership in Applied Health Research and Care (CLAHRC) program of research. CLAHRC was a necessary vehicle for overcoming the barriers to answering an important NHS question – how better to engage problem drinkers in a hospital setting.Trial registrationISRCTN47728072

Financial impact of accurate discharge coding in a liaison psychiatry service

ObjectivePrevious research has shown that patients seen by liaison psychiatry services are a complex and expensive patient group and that the psychiatric co-morbidities of hospital inpatients are poorly attested at discharge for assignment to diagnosis-related groups (DRGs). The aim of this study was to investigate the accuracy of discharge coding in a neuropsychiatry liaison population. We also aimed to establish whether or not, had the correct diagnosis been assigned, additional funding would have been allocated to the hospital. MethodsDiagnostic codes were retrospectively collected from the discharge diagnoses for all inpatients (n=276) referred to the neuropsychiatry liaison service in a university hospital over a 12month period and these were compared to a consensus diagnosis. Using grouper software, codes were then changed to reflect the consensus diagnoses and DRGs were recalculated to see if the change in diagnosis led to a change in reimbursement for those patients. ResultsDischarge diagnosis and consensus diagnosis were in agreement in 30% of cases. When discharge codes were corrected, patients changed to a higher paying DRG in 28/220 (12.7%) of patients. The increase in costing associated with this change in DRG was €305,349. ConclusionsAccording to these results, not only is the complexity of patients seen by psychiatry consult services in general hospitals not reflected in the discharge diagnosis, but, in this sample of patients, the additional complexity would have led to a significant increase in reimbursement to the hospital. Further training of doctors should increase awareness of this important issue.

Use of general practice, diagnostic investigations and hospital services before and after cancer diagnosis - a population-based nationwide registry study of 127,000 incident adult cancer patients.

BackgroundKnowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services. The health care need of patients with comorbid conditions far exceeds the oncology capacity and it is therefore important to elucidate the role of both primary and secondary care. The aim of this paper is to describe the use of health care services amongst incident cancer patients in Denmark one year before and one year after cancer diagnosis.MethodsThe present study is a national population-based case–control (1:10) registry study. All incident cancer patients (n = 127,210) diagnosed between 2001 and 2006 aged 40 years or older were identified in the Danish Cancer Registry. Data from national health registries were provided for all cancer patients and for 1,272,100 controls. Monthly consultation frequencies, monthly proportions of persons receiving health services and three-month incidence rate ratios for one year before and one year after the cancer diagnosis were calculated. Data were analysed separately for women and men.ResultsThree months before their diagnosis, cancer patients had twice as many general practitioner (GP) consultations, ten to eleven times more diagnostic investigations and five times more hospital contacts than the reference population. The demand for GP services peaked one month before diagnosis, the demand for diagnostic investigations one month after diagnosis and the number of hospital contacts three months after diagnosis. The proportion of cancer patients receiving each of these three types of health services remained more than 10% above that of the reference population from two months before diagnosis until the end of the study period.ConclusionsCancer patients’ health service utilisation rose dramatically three months before their diagnosis. This increase applied to all services in general throughout the first year after diagnosis and to the patients’ use of hospital contacts in particular. Cancer patients’ heightened demand for GP services one year after their diagnosis highlights the importance of close coordination and communication between the primary and the secondary healthcare sector.

Parental Attitudes Toward Obesity and Overweight Screening and Communication for Hospitalized Children

Many studies have evaluated BMI screening, communication, and follow-up recommendations in the outpatient setting. However, few studies have examined parental attitudes toward using the inpatient setting as a time to screen and counsel families regarding their child's BMI. We sought to study parental attitudes about overweight and obesity screening in the inpatient setting. Parents (N= 101) of children aged 2 to 18 years admitted to a general pediatric hospital or surgical service were queried regarding their attitudes about screening and counseling for overweight and obesity. Children's age, gender, height, weight, and diagnosis codes were extracted from electronic medical records and billing databases. BMI was calculated, plotted, and categorized according to standard Centers for Disease Control and Prevention growth charts and expert recommendation. Fourteen percent of children in the study were overweight, and 17% were obese. Parents of overweight and obese children underestimated their child's weight status 68% of the time. The majority believed admitted children should always have their BMI calculated. Almost all parents (90%) indicated that their inpatient physician should inform them if their child were overweight or obese and that primary care providers should be informed of the results of BMI screening. Parents of children admitted to the hospital believed their children should have their BMI screened. If their child was overweight or obese, parents believed they should be informed, and counseling should be initiated. These findings support using the inpatient time to screen and communicate BMI.

Socio-Demographic Correlates of Participation in Mammography: A Survey among Women Aged between 35-69 in Tehran, Iran

The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio- demographic predictors of mammography utilization among participants. The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (P <0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P <0.05)with mammography participation. The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women after adjusting for all other demographic variables in the model.

PTU-014 Levels of care and outcomes in decompensated cirrhosis: a descriptive study

IntroductionAs hospital admissions due to decompensated cirrhosis increase it is important to characterise the severity of disease and establish “best practice” in secondary care units. While many studies have reported...

Sa1243 Survival Over &gt;20 Years in a Large Australian Metropolitan Cohort of Inflammatory Bowel Disease Patients: No Excess Overall Mortality

P082 Survival over >20 years in a large Australian metropolitan cohort of inflammatory bowel disease patients: No excess overall mortality C. Selinger1 *, J.M. Andrews2, O. Dent3, R. Leong4. 1Salford Royal Hospital, Gastroenterology, Salford, United Kingdom, 2Royal Adelaide Hospital, Gastroenterology & Hepatology, Adelaide, Australia, 3Concord Repatriation General Hospital, Gastroenterology and Liver Services, Concord, Australia, 4Concord Hospital, Sydney, Australia

Identifying Reasons for Readmission from the Epilepsy Monitoring Unit Compared to a General Neurology Hospital Service (P04.017)

Objective: To identify reasons for 30-day readmissions from the epilepsy monitoring unit, compared to a general neurology hospital service. Background Reducing readmissions has become a national target for health care reform, but this assumes that a significant proportion of readmissions are preventable. Very little has been published on reasons for readmissions in neurological patients. Without such information it is unclear if readmission rates are an appropriate measure of quality of care in these patient populations. Design/Methods: Patients readmitted to our hospital from 4/1/2011 to 9/30/2011, with any diagnosis, and within 30 days of discharge from either the epilepsy monitoring unit or the general neurology hospital service, were included in this analysis. We retrospectively analyzed, via manual chart review, the electronic medical record to identify reasons for readmission. Reasons for readmissions were classified as planned vs. unplanned, expected recurrence/progression of underlying disease, unexpected recurrence/progression, hospital-acquired complication of index admission, and unrelated to index admission. Results: Sixty-two total readmissions were reviewed. Overall readmit rates were 6% for epilepsy, 7.3% for neurology. Rates for planned readmissions were 40% for epilepsy, 18.5% for neurology, with higher rates observed among epilepsy patients due to readmission for planned epilepsy surgery. Expected recurrence/progression was the primary reason for readmission in 23% of all epilepsy and 48% of all neurological readmissions. Hospital-acquired complications explained 23% of epilepsy, and 11% of neurology readmissions. The most common hospital-acquired complication was medication-related adverse events. Conclusions: Rates of planned readmissions ranged from 20-40%, a fact easily overlooked in national payment reform programs which treat nearly all readmissions, planned and unplanned, equally. Expected recurrence or progression of underlying disease was the most common cause for readmission in both epilepsy and general neurology patient populations. Identifying reasons for readmissions is an important initial step toward the ultimate goal of reducing the number of preventable readmissions. Disclosure: Dr. Bautista has nothing to disclose.

Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study.

BackgroundIn the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China.MethodsThis study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach.ResultsThe more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site.ConclusionThe process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service delivery, integration, hospitals, China.

Problems of providing child and adolescent psychiatric services in general hospitals; Specialized care provided by the child and adolescent psychiatric unit, Yokohama City University Medical Center

Problems of providing child and adolescent psychiatric services in general hospitals; Specialized care provided by the child and adolescent psychiatric unit, Yokohama City University Medical Center

P-219 - Why maintain the adherence to medication? A qualitative study on treatment from the perspective of brazilian adherent bipolar patients

Background This project approaches reasons reported on adherence to treatment for patients with bipolar affective disorder (BAD), through qualitative study of bipolar individuals out of crisis. Purpose To discuss psychological meanings of the stable adherence such as brought in qualitative interviews with bipolar patients considered in complete adherence at psychiatric outpatient service of General Hospital of the State University of Campinas. Method Research methodology from the Humanities employed to health settings, using clinical-qualitative method particularly, employing the technique of semi-directed interview with open-ended questions. The sample was closed by the criterion of theoretical saturation of information. Data were treated through the qualitative content analysis, with free-floating readings of the corpus - the set of the transcribed interviews - in order to categorize in core's discussion. Results Several aspects were reported by patients as essential to maintain the adherence to their treatment over time. For this presentation, two categories were chosen: subjects expressed feelings of fear of the disease, because of its evolution with relapse, although the phases in which they feel almost normal people; and the meaningful emotional connections with their family, the protective health institution and religion - all perceived as supportive of adherence phenomenon. Conclusion To listen to what compliant patients experience in this context can help in practical understanding of integrated health and context, thus promoting greater understanding of the factors of adherence in the treatment of BAD.

Access to primary dental care for patients with inherited bleeding disorders

Patients with inherited bleeding disorders (IBD) can face difficulty in accessing primary dental care either due to disease-specific or patient-related barriers. This can lead to poor oral health and increase the need for more invasive dental treatment. This study aimed to highlight actual and perceived barriers that IBD patients from the East London area were experiencing. It also gives an overview of the experience history of the General Dental Practitioners (GDPs) treating these patients. Information was gathered via pre-designed surveys as part of a service development audit. A total of 105 anonymous patient surveys and 50 GDP surveys were completed between December 2010 and July 2011. The patient survey highlighted more patients to be affected by patient-related than disease-specific barriers to access dental care. The GDP survey identified that just under half of GDPs questioned were not confident in the dental management of patients with bleeding disorders. Identifying misconceptions and barriers to access primary dental care will enable further development of our shared-care approach between General Dental Services, Hospital or Community Dental Services and Haemophilia Centre, optimizing regular preventative advice and follow ups to prevent dental disease and invasive dental treatment requiring haemostatic treatment.

Políticas e inovação em atenção à saúde mental: limites ao descolamento do desempenho do SUS

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

La révolution psychiatrique au Québec, 1950-1962. De l'asile à la psychiatrie communautaire et l' open-door

Psychiatry opens to the world at a time when the very basis of psychiatric practice, namely the asylum, is called into question. Studies appear in Quebec and Canadian journals concurrent to the introduction of new formulas for care, such as the delivery of psychiatric services in general hospitals and clinics, that allow patients to be treated outside the walls of psychiatric hospitals. In addition, postwar psychiatry takes an optimistic view toward the future of children with impairments through the creation of specialized schools and workshops. From the mid-20th century onward, the thinking in psychiatry centres on the open door.

Supplier-induced demand for psychiatric admissions in Northern New England.

BackgroundThe development of hospital service areas (HSAs) using small area analysis has been useful in examining variation in medical and surgical care; however, the techniques of small area analysis are underdeveloped in understanding psychiatric admission rates. We sought to develop these techniques in order to understand the relationship between psychiatric bed supply and admission rates in Northern New England. Our primary hypotheses were that there would be substantial variation in psychiatric admission across geographic settings and that bed availability would be positively correlated with admission rates, reflecting a supplier-induced demand phenomenon. Our secondary hypothesis was that the construction of psychiatric HSAs (PHSAs) would yield more meaningful results than the use of existing general medical hospital service areas.MethodsTo address our hypotheses, we followed a four-step analytic process: 1) we used small area analytic techniques to define our PHSAs, 2) we calculated the localization index for PHSAs and compared that to the localization index for general medical HSAs, 3) we used the number of psychiatric hospital beds, the number of psychiatric admissions, and census data to calculate population-based bed-supply and psychiatric admission rates for each PHSA, and 4) we correlated population-based admission rates to population-based psychiatric bed supply.ResultsThe admission rate for psychiatric diagnosis varied considerably among the PHSAs, with rates varying from 2.4 per 100,000 in Portsmouth, NH to 13.4 per 100,000 in Augusta, ME. There was a positive correlation of 0.71 between a PHSA's supply of beds and admission rate. Using our PSHAs produced a substantially higher localization index than using general medical hospital services areas (0.69 vs. 0.23), meaning that our model correctly predicted geographic utilization at three times the rate of the existing model.ConclusionsThe positive correlation between admission and bed supply suggests that psychiatric bed availability may partially explain the variation in admission rates. Development of PHSAs, rather than relying on the use of established general medical HSAs, improves the relevance and accuracy of small area analysis in understanding mental health services utilization.

Dementia Care Deficiencies: Potential for Better Care for Patients in Hospital

ISSN 1758-2024 10.2217/NMT.11.32 © 2011 Future Medicine Ltd Neurodegen. Dis. Manage. (2011) 1(4), 263–266 The basic facts are well established but bear repeating. The population is aging and the majority of hospital beds are now occupied by older people [101]. Approximately 40% of older people in hospital are likely to have dementia [1–3]. People with dementia in hospital are incredibly vulnerable, as they have prolonged hospital stays, experience associated declines in their physical and mental health, which would not be expected given the acute condition alone, and are more likely to be newly admitted to care homes [4]. The excess cost of dementia has been calculated as more than £6 million pounds per year in an average general hospital [5]. The formal recognition that optimal management of dementia is a hospital-specific as well as a general health service and social priority has been a long time coming. Crucially, both the National Dementia Strategy for England and the Coalition Government’s revised dementia plan have emphasized the importance of reversing some of the previously identified failings of hospital care [6,101]. The recent report of the National Audit of Dementia (Care in General Hospitals) provides a useful benchmark against which hospitals can measure their standards of care, and a baseline against which action plans can be developed and improvements in care measured. A total of 210 hospitals from all but one of the 151 NHS organisations providing general hospital services in England and Wales took part in an organizational audit (March–May 2010), supplemented by a review of almost 8000 sets of case notes of patients diagnosed with dementia (discharged September 2009–February 2010) [102]. Standards were divided into three classes:

FP06-3 The Moderating Role of Depression and Poor Social Support on Suicide Ideation in Korean Elders

This study investigated associations between the use of healthcare services and financial status and suicidal ideation (SI) in the past year among elderly people. Additionally, this study explored gender differences in such associations. Cross-sectional data of 1743 elderly people aged 65 years and above, who participated in the 2009 Korea National Health and Nutrition Examination Survey, were analyzed. The results showed that lack of preventive care and failure to obtain necessary healthcare services during the last 12 months had a significant effect on SI, especially among elderly women. Low financial status (i.e., receipt of National Basic Livelihood Security (NBLS) assistance) was significantly associated with SI among elderly men. The findings of this study emphasize the need for community-based suicide intervention services, especially for elderly men who receive NBLS and elderly women who do not undergo medical checkups and fail to obtain necessary medical services. Multiple intervention approaches, including the provision of community-based geriatric psychiatric services, improved social support, links with general hospital services, and local monitoring programs, are likely to be useful.

Active mobilisation following single cross grasp four-strand flexor tenorrhaphy (Adelaide repair)

This paper presents our initial experience using a single cross grasp, four-strand repair with an active mobilization regimen in a general trauma hospital setting. Variably experienced members of the trauma service of a large general hospital used a four-strand single cross grasp tenorrhaphy technique for acute repair of 73 zone one and two flexor digitorum profundus tendon lacerations in 53 patients. Postoperatively, all patients commenced an active mobilization program within 12 hours of the surgical repair. With a minimum 3 months post-repair follow-up of 89% of the repaired flexor digitorum profundus tendons, 71% of fingers achieved a good or excellent outcome. There were three (4.6%) flexor digitorum profundus ruptures post surgery. A four-strand single cross grasp repair using 3-0 braided polyester suture and active post-repair mobilization can achieve satisfactory outcomes in the general trauma service setting; however, patient compliance remains a problem.