Single Episode Of Care Research Articles

The difficulties and solutions in operationalising a hybrid operating room.

As the population ages and grows, health services must evolve in ways to offer versatile patient care, whilst improving patient outcomes and maintaining long-term economic viability. A facility assisting in the provision of such healthcare is the hybrid operating room (HOR): a specialised suite allowing simultaneous radiological and surgical diagnostics and therapeutics in a single episode of care. Versatile and customizable, the HOR is utilised by a broad range of subspecialties in elective and emergency settings, including (but not limited to) vascular surgery, trauma surgery and interventional radiology. Though the benefits of hybrid techniques to patient care are well known, the actual steps in operationalising the HOR can be challenging if not considered and coordinated appropriately. The intention of this narrative review is to highlight issues and suggest solutions in the design and commissioning of an HOR. Key areas in need of specific attention include stakeholder involvement, economic feasibility, suite location, workflow planning, hybrid equipment choice, and team organisation.

SURG-02. INTRAOPERATIVE RADIOTHERAPY FOR BRAIN METASTASES: EVALUATION OF ELECTROCORTICOGRAPHY AND PERI-OPERATIVE SEIZURE RISK

Abstract BACKGROUND Intraoperative radiotherapy (IORT) has emerged as a viable tool for consolidation of surgery and radiation for brain metastases into a single episode of care, but its relative novelty compared to SRS or fractionated radiotherapy warrants evaluation of its safety. While post-operative seizure risk is typically minimal with the use of anti-epileptic drugs during the peri-operative phase, the risk of intra-operative epileptiform discharge remains unknown. METHODS Five consecutive cases of surgically resected brain metastases treated with IORT underwent electrocorticography via direct cortical electrode recordings adjacent to the resection cavity with paddle electrodes used for mapping of phase reversal. Continuous recordings were made before, during, and after radiation delivery and analyzed for evidence of radiation-associated changes. RESULTS No evidence of significant electrophysiological change was noted in any of the cases, nor was there any clinical evidence of seizure in the immediate peri-operative period. These data represent the first direct cortical recordings in human subjects during the delivery of radiation. CONCLUSIONS In this small cohort of IORT treated resected brain metastases, the delivery of intra-operative radiation does not appear to impact cortical activity or precipitate post-operative seizures. Further studies are needed to determine the long-term incidence of treatment associated changes if they exist.

P161 - Cumulative effective dose from multiphase CT scans in a single episode of care

P161 - Cumulative effective dose from multiphase CT scans in a single episode of care

Cumulative radiation doses due to nuclear medicine examinations: a systematic review.

To systematically review the published data regarding the cumulative exposure to radiation in selected cohorts of adults or paediatric patients due to diagnostic nuclear medicine examinations. We conducted PubMed/Medline searches of peer-reviewed papers on cumulated effective dose (CED) from diagnostic nuclear medicine procedures published between 01 January 2010 until 31 January 2021. Studies were considered eligible if the contribution of nuclear medicine examinations to total CED was >10%. Studies reporting cumulative doses in a single episode of care or in a limited time (≤1 year) were excluded. The main outcomes for which data were sought were the CED accrued by patients, the period in which the CED was accrued, the percentage of patients with CED > 100 mSv and the percentage contribution due to nuclear medicine procedures to the overall CED. The studies included in the synthesis were 18 which enrolled a total of 1,76,371 patients. Eleven (1,757 patients), three (1,74,079 patients) and four (535 patients) were related to oncological, cardiologic and transplanted patients, respectively. All the studies were retrospective; some of the source materials referred to small number of patients and some of the patients were followed for a short time. Not many studies accurately quantified the contribution of nuclear medicine procedures to the overall radiation exposure due to medical imaging. Finally, most of the studies covered an observation period which extended mainly in the 2000-2010 decade. There is a need of prospective, multicentric studies enrolling a greater number of patients, followed for longer period in selected groups of patients to fully capture the cumulative exposure to radiation in these settings. This systematic review allows to identify selected group of patients with a specific health status in which the cumulated exposure to radiation may be of concern and where the contribution of nuclear medicine procedures to the total CED is significant.

Patients undergoing multiphase CT scans and receiving a cumulative effective dose of ≥ 100 mSv in a single episode of care

OBJECTIVES To estimate the number of patients who receive a cumulative effective dose (CED) of ≥ 100 mSv from computed tomography (CT) in a single day or episode of care. METHODS We examined 28,870 patients who underwent 49,834 CT examinations in a tertiary care centre in Italy in 2.5 years. Radiation exposures were retrieved from the hospital's automatic exposure monitoring system. Two cohorts were identified as those who received a CED of ≥ 100 mSv in a single day and within a month starting from the first examination. Organ doses were estimated for the first cohort. RESULTS Among the 1765 (6.1%) patients who received CED ≥ 100 mSv in the observation period, 427 received a CED of ≥ 100 mSv within a month (and 70 patients in a single day). This group represented 1.5% of all patients who underwent CT exams and 24% of those who received CED ≥ 100 mSv in the observation period. The clinical indication for referral included cancer in 132 patients (31%) and non-oncological indications in 295 patients (69%). In 68/70 patients with CED > 100 mSv in a single day, at least one organ/tissue received a dose of ≥ 100 mGy. CONCLUSIONS The finding of a sizeable percentage of patients undergoing CT exams and receiving CED ≥ 100 mSv in a single episode of care points toward the need of imaging appropriateness criteria, to revise the routine protocols, to replace older machines, and to provide to the radiologist the patient's prior radiation history to facilitate an appropriate decision-making process. KEY POINTS • Patients can receive effective doses greater than 100 mSv in a single CT or in multiple CT examinations performed in a single episode of care in 1.5% of patients in a 2.5-year period. • In this study, the clinical indication for CT referral was non-oncological in 69% of patients. • The patient's prior radiation history should be provided to the referring physicians and the radiological medical practitioner to facilitate an appropriate decision-making process.

Evaluating Machine-Learning Models for Predicting Hospital Transfers in Administrative Data: A Study of Admissions for Myocardial Infarction

IntroductionHospital administrative data is a valuable source to measure myocardial infarction (MI) rates. However, admission counts are susceptible to over-inflation if the patient is transferred multiple times during a single episode of care, and variables denoting transfers may not be reliable. To obtain an accurate number of events, hospital transfers need to be correctly identified.
 Objectives and ApproachWe assessed multivariable logistic regression and various machine-learning models to predict transfers in hospital administrative data. Using Western Australian linked hospital data, we identified records from 2000-2016 with a principal discharge diagnosis of MI. Our standard method to compare against was a 24-hour look-back to identify a transfer using just admission and separation dates from the current and previous records for the same patient. Multivariable logistic regression and decision trees with various boosting algorithms were used to predict if a single record was a transfer, using variables recorded in the admission (e.g. age, sex, type of hospital, admitted from, emergency/elective admission). The performance of each model was calculated using metrics including area under the curve (AUC).
 ResultsRecords in the training, validation and testing samples had similar characteristics: mean age=68.9 years, 66% were male and 58% admitted to tertiary hospitals. Gradient Boosting Decision Tree (AUC=0.887, 95%CI: 0.886-0.887) outperformed multivariable logistic regression (AUC=0.875; 95% CI: 0.869-0.881) and random forest models (AUC=0.859; 95% CI: 0.853-0.865).
 Conclusion / ImplicationsMultivariable logistic regression and machine-learning models are able to identify transfers in a single record from existing variables. They can be used in unlinked hospital administrative data where records belonging to the same patient cannot be identified.

Surprise Billing in Surgical Care Episodes - Overview, Ethical Concerns, and Policy Solutions in Light of COVID-19.

Surprise Billing in Surgical Care Episodes - Overview, Ethical Concerns, and Policy Solutions in Light of COVID-19.

Treatment Trajectories During and After a Medication Trial for Opioid Use Disorder: Moving from Research as Usual to Treatment as Usual.

The effectiveness of treatment incorporating relapse prevention medications for opioid use disorder (OUD) is typically examined in research using rigidly predefined endpoints of success versus failure, usually over a single episode of care. But this perspective may not adequately portray the nonlinear trajectories typical of real-world treatment courses in this chronic, remitting, and relapsing disorder. This descriptive study examined 12-month treatment trajectories of n = 60 patients enrolled at a single site of a larger multisite randomized controlled trial examining the comparative effectiveness of buprenorphine versus extended-release naltrexone. While the parent study provided medication treatment through the research protocol for 6 months, this study documents treatment up to 12 months, including medications, provided through standard community resources (treatment as usual) outside of the protocol. Some patients continued medications past the end of the study intervention, whereas others did not. Some patients initiated medications other than the one assigned by the study. Some patients switched from 1 medication to the other. Many patients returned to treatment after 1 or more periods of dropout and/or relapse. Patients utilized multiple episodes of bed-based care, including short-term acute residential and long-term residential treatment, and also recovery housing supports. Described trajectories are also depicted graphically. At 12 months, while rates of continuous treatment retention were low (8%), rates of cross-sectional treatment engagement including return to treatment after drop out were higher (35%). This description of nonlinear treatment trajectories highlights the potential benefits of flexibility and optimism in the promotion of re-engagement, despite interim outcomes that might traditionally be considered "failure" endpoints.

Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up to 192% the cost of an average uncomplicated procedure over 90 days). Level 3.

Innovative Health Care Financing Strategies for Children and Youth With Special Health Care Needs.

* Abbreviations: CYSHCN — : children and youth with special health care needs VBID — : value-based insurance design VBP — : value-based purchasing There is increasing interest in maximizing value in health care purchasing by promoting delivery and payment strategies that are cost-effective and also achieve optimal health outcomes. Although these strategies are often called value-based purchasing (VBP), no 1 shared definition of VBP exists. Damberg et al1 suggest that VBP includes a range of methods that link health care payment and incentives to provider performance. The Centers for Medicare and Medicaid Services has launched a Medicare hospital VBP program that rewards acute care hospitals with financial incentives for meeting specific performance outcomes.2 Payment reform provisions in the Affordable Care Act promote VBP strategies to achieve the Triple Aim of lower cost, increased efficiency, and improved population health.3 Value-based insurance design (VBID) is closely related to VBP. Chernew et al4 identified 2 basic approaches to VBID: reduced copayments for clinically valuable services in general; and reduced copayments for specific groups of patients who receive selected high-value services for specific diagnoses. Within this broad landscape of purchasing and insurance design strategies, other innovative financing approaches can promote the Triple Aim including bundled payments, accountable care organizations, and integrated care systems that link primary care and behavioral health services, among others. The impact of these strategies, especially on children and youth with special health care needs (CYSHCN), is currently unclear and, without careful planning, could present additional risk to an already vulnerable population of children. The issues involved in developing VBP for CYSCHN are critically important for this group of children who, by definition, use more health care services than other children and inevitably incur higher costs.5 Yet, organizing the incentives and payment structures appropriately could reward better care and outcomes also for CYSHCN. Working with the American Academy of Pediatrics, … Address correspondence to James M. Perrin, MD, 125 Nashua Street Boston, MA 02114. E-mail: jperrin{at}mgh.harvard.edu

Unusual presentation of failed metal-on-metal total hip arthroplasty with features of neoplastic process

Metal-on-metal (MoM) total hip arthroplasty (THA) is associated with increased incidence of failure from metallosis, adverse tissue reactions, and the formation of pseudotumors. This case highlights a 53-year-old female with an enlarging painful thigh mass 12 years status post MoM THA. Radiographs and advanced imaging revealed an atypical mass with cortical bone destruction and spiculation, concerning for periprosthetic malignancy. Open frozen section biopsy was performed before undergoing revision THA in a single episode of care. This case illustrates that massive pseudotumors can be locally aggressive causing significant femoral bone destruction and may mimic malignancy. It is important that orthopaedic surgeons, radiologists and pathologists understand the relative infrequency of periprosthetic malignancy in MoM THA to mitigate patient concerns, misdiagnosis, and allow for an evidence based discussion when treating massive pseudotumors.

Impact of a Bundled Payment System on Resource Utilization During Spine Surgery.

In a bundled payment system, a single payment covers all costs associated with a single episode of care. Spine surgery may be well suited for bundled payments because of clearly defined episodes of care, but the impact on current practice has not been studied. We sought to examine how a theoretical bundled payment strategy with financial disincentives to resource utilization would impact practice patterns. A multiple-choice survey was administered to spine surgeons describing eight clinical scenarios. Respondents were asked about their current practice, and then their practice in a hypothetical bundled payment system. Respondents could choose from multiple types of implants, bone grafts, and other resources utilized at the surgeon's discretion. Forty-three respondents completed the survey. Within each scenario, 24%-49% of respondents changed at least one aspect of management. The proportion of cases performed without implants was unchanged for four scenarios and increased in four by an average of 8%. Use of autologous iliac crest bone graft increased across all scenarios by an average of 18%. Use of neuromonitoring decreased in all scenarios by an average of 21%. Differences in costs were not statistically significant. Financial disincentives to resource utilization may result in some changes to surgeons' practices but these appear limited to items with less clear benefits to patients. Choices of implants, which account for the majority of intra-operative costs, did not change meaningfully. A bundling strategy targeting peri-operative costs solely related to surgical practice may not yield substantive savings while rationing potentially beneficial treatments to patient care. 5.

Primary-care-based episodes of care and their costs in a three-month follow-up in Finland

Objective To explore patient characteristics, resource use, and costs related to different episodes of care (EOC) in Finnish health care.Design Data were collected during a three-month prospective, non-randomized follow-up study (Effective Health Centre) using questionnaires and an electronic health record.Setting Three primary health care practices in Pirkanmaa, Finland.Subjects Altogether 622 patients were recruited during a one-week period. Inclusion criteria: the patient had a doctor’s or nurse’s appointment on the recruiting day and agreed to participate. Exclusion criteria: patients visiting a specialized health guidance clinic for pregnant women, children, and mothers.Main outcome measures Patient characteristics, resource use, and costs based on the ICPC-2 EOC classification.Results On average, the patients had 1.22 EOCs during the three months. Patient characteristics and resource use differed between the EOC chapters. Chapter L, “Musculoskeletal”, had the most episodes (17%). The most common (8%) single EOC was “upper respiratory infection”. The mean cost of an episode (COE) was €389.56 (standard error 61.11) and the median COE was €165.00 (interquartile range €118.46–288.56) during the three-month follow-up. The most expensive chapter was K, “Circulatory”, with a mean COE of €909.85. The most expensive single COE was in chapter K, €32 545.56. The most expensive 1% of the COEs summed up covered 36% of the total COEs.Conclusion Patient characteristics, resource use, and costs differed between the ICPC-2 chapters, which could be taken into account in service planning and pricing. Future studies should incorporate more specific diagnoses, larger data sets, and longer follow-up times.Key pointsThe most common episodes were under the ICPC-2 “Musculoskeletal” chapter, but the highest mean and single-episode costs were related to the “Circulatory” chapter.The mean (median) cost of episodes that started in primary care was €390 (€165) during the three-month follow-up.Patient characteristics, resource use, and costs differed significantly between the ICPC-2 chapters. The most expensive 1% of the episodes covered 36% of the total costs of all the episodes.

Clinical Impact of Chemotherapy-Related Adverse Events in Patients with Metastatic Breast Cancer in an Integrated Health Care System.

Stage IV breast cancer, also known as metastatic breast cancer (mBC), is not a curable condition. However, treatment can prolong life, delay the progression of the cancer, or improve quality of life. Currently, patients with mBC are often treated with chemotherapy. Patients often experience adverse events from chemotherapy during the treatment cycle, which leads to chemotherapy modifications such as dose delay, dose reduction, or discontinuation of chemotherapy. Previous studies have evaluated the rates of adverse events that occur from the use of chemotherapy; however, few studies have evaluated the clinical impact on the chemotherapy regimen once the adverse event occurs. This study evaluates the clinical impact on the chemotherapy regimen from chemotherapy-related adverse events in patients with mBC in an integrated health care delivery system. To assess the adverse events in patients with mBC and evaluate the clinical impact on the chemotherapy regimen from these adverse events in an integrated health care delivery system. This study is a retrospective cohort of patients with mBC newly initiated on chemotherapy. The first infusion was defined as the index date. Patients were aged greater than 18 years at time of index date and had 6 months or more of Kaiser membership and drug eligibility prior to the index date and continuous membership and drug eligibility throughout follow-up. Adverse events were identified after the index date and during the follow-up using ICD-9-CM diagnosis and procedure codes. Single or multiple episodes of care were created from the adverse events. Chart review was conducted to establish whether the adverse event was related to chemotherapy and if any modification to the chemotherapy regimen occurred-a dose delay, dose reduction, or discontinuation was considered a clinical impact on therapy. Multivariate logistic regression was used to examine factors associated with clinical impact versus no clinical impact from the delivery of chemotherapy treatment. A total of 1,682 patients with mBC were identified during our time period with an average follow-up of 2.21 years on first-line chemotherapy (SD = 1.83). 909 patients (54%) had at least 1 adverse event, and 773 patients (46%) did not have any adverse events during follow-up. Significant differences at baseline between these 2 groups included race, peripheral vascular disease, and length of stay (P less than 0.05). From the 909 patients who had at least 1 adverse event, 185 patients (20%) experienced an impact on their chemotherapy regimens. Patients with single episodes of care with any chemotherapy regimen impact experienced mostly hematological, infection/pyrexia, and gastrointestinal-related adverse events. In multiple episodes of care, neurological impact was more frequent than gastrointestinal-related effects. Patients with hospitalizations of greater than 3 days experienced the most impact, demonstrating that severe adverse events have more impact on chemotherapy regimens. In our multivariate analysis, patients aged greater than 65 years, having more than 1 comorbidity and having longer duration in days for each episode of care were all associated with clinical impact. Black and Hispanic patients were more likely to have a modification in their chemotherapy compared with white patients. This retrospective analysis demonstrates that chemotherapy-related adverse events in patients with mBC have an impact on the delivery of chemotherapy regimens. Having multiple comorbidities, increased age, and prolonged hospitalizations because of adverse events appear to be some of the primary factors related to chemotherapy modification.

S051: Comparison of flexible ureterorenoscopy and mini percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm

INTRODUCTION AND OBJECTIVES: Medium-sized renal stones are primarily treated with one of three methods: ureteroscopy (URS), shockwave lithotripsy (SWL), or percutaneous nephrolithotomy (PCNL). Many studies have addressed the efficacy of these procedures, but evaluating the relative costs is rarely done because actual cost data (not charge data) is not readily available. In this study, we used an innovative tool to evaluate the efficacy and cost of treating medium-sized renal stones. METHODS: We retrospectively identified all adult patients treated from January 2012 to December 2013 for unilateral, 10-20 mm renal stones with URS, SWL, or PCNL by a single surgeon. Patient demographics, stone characteristics, procedural data, and complications were obtained from electronic medical records. Efficacy was measured by the stone free rate (SFR). Complications were defined as seeking medical attention for urinary symptoms/complaints within 30 days of treatment, e.g. UTI, hematuria, flank pain. Costs were calculated using a proprietary cost-allocation tool developed at the University of Utah (Value Driven Outcomes, VDO). We used VDO to itemize and assign all costs associated with each patient episode including all postoperative visits, both routine and unexpected. Importantly, the allocated costs are independent of hospital charges. RESULTS: Forty-two patients met inclusion criteria. Demographics and stone characteristics are similar between all three groups. The cost of SWL was set at 1.0; other costs are relative to SWL. PCNL is the most expensive, and PCNL and SWL have similar retreatment and complication rates. URS is more expensive than SWL but has the lowest retreatment and complication rates, as well as the highest SFR (see table). CONCLUSIONS: For medium-sized renal stones, SWL is the least expensive for a single episode of care, but URS offers the best balance between efficacy and cost when compared to SWL and PCNL. In an era of healthcare cost concerns, this study supports VDO as being a valuable tool in evaluating the relative costs of different treatment modalities for the same disease.

Meeting Contemporary Expectations for Physical Therapists: Imperatives, Challenges, and Proposed Solutions for Professional Education

BACKGROUND AND PURPOSEThe intimate relationship between practice and education in any profession demands an integrated view of the pressures of the work environment and the social culture in which that work lies. The mission of health care always has been to improve health-first of individuals-and then of populations as science evolved and a more global view of human health emerged.1 Advances in science and shifts in the structure of health care brought new expectations that shaped how the realities of practice must fit the changing demographics of health, illness, and disability. Currently emerging changes in health care policy and regulation have required physical therapists (PTs) to respond to many new expectations.2 These changes are catalysts to lead the evolution of practice and capture opportunities to promote the health of our patients via new delivery models. This position paper proposes changes in professional education to allow PTs to respond to the complexities of health and health care, and be full partners in what must become an integrated and interdisciplinary service industry.POSITION AND RATIONALEWe address 3 focal areas to drive change in physical therapist didactic and clinical education. First, achieving true interdisciplinary practice demands that physical therapist educators create learning experiences that result in interprofessional competence. This expectation must apply initially and across the entire continuum of professional development. Second, while responding to new accountabilities of the federal Affordable Care Act (ACA) may be stressful for practitioners, there is opportunity to create new approaches to address current stresses in clinical education. We advocate expanding the breadth of clinical education to include experiences in accountable care organizations (ACOs) or patient-centered medical homes (PCMHs) as a strategy for building practice options for care across the lifespan of patients. Finally, providing focused and in-depth education in the care of patients with highly prevalent conditions may prepare graduates to implement new care models and pathways that transform how contemporary health conditions are managed. Low back pain, obesity, and cancer survivorship are used as examples of conditions that are common in the adult health profile of the United States (US) and about which PTs must be especially well-educated. Effectively managing these conditions requires more than a single episode of care and demands an interdisciplinary approach inclusive of both treatment and prevention. We propose to develop new paradigms of clinical practice by tailoring professional education to achieve an integrated, interdisciplinary approach to health and health care that will meet contemporary needs.The Interdisciplinary EnvironmentInterprofessional education (IPE) is not a new concept, but it is now an imperative. The US was recognized as a leader in IPE in the 1970s3 and is experiencing a resurgence as health care providers acknowledge the need to be truly interdisciplinary. IPE gained global attention when the World Health Organization (WHO) established its Expert Committee on Medical Education.4 Additional impetus for formalizing IPE arose in 2002 when the Institute of Medicine (IOM) requested that educators focus on IPE as a core essential.5 By 2008, the IOM had restated this request as an imperative. The Association for Prevention Teaching and Research (APTR) fueled interest in IPE by creating the Healthy People Curriculum Task Force (HPCTF) in 2002, and then convening the first Institute for IPE Prevention Education in 2007. In this Institute, interdisciplinary team members from the same institution proposed IPE projects.6 Then, in 2009, the IPE Collaborative (IPEC), comprised of 6 different professional associations, collaborated to publish a report on core competencies for IPE in the health professions.7 Although not a part of the IPEC, the American Physical Therapy Association (APTA) supports having core competencies in IPE and has embraced the work of defining and promoting interprofessional expectations for physical therapy. …

Postdischarge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Readmission

Readmission after hospitalization for heart failure (HF) has received increasing attention due to the significant burden it places on patients and payers.[1][1]–[2][2] Among Medicare beneficiaries, readmission within 30 days following heart failure hospitalization approaches 25%.[2][2] Even after

637 30-day Readmission Rates For Heart Failure in Alberta: 2002-2010

637 30-day Readmission Rates For Heart Failure in Alberta: 2002-2010

The diagnostic yield of the first episode of a periodic health evaluation: a descriptive epidemiology study

BackgroundThe benefits of a periodic health evaluation remain debatable. The incremental value added by such evaluations beyond the delivery of age appropriate screening and preventive medicine recommendations is unclear.MethodsWe retrospectively collected data on a cohort of consecutive patients presenting for their first episode of a comprehensive periodic health evaluation. We abstracted data on new diagnoses that were identified during this single episode of care and that were not trivial (i.e., required additional testing or intervention).ResultsThe cohort consisted of 491 patients. The rate of new diagnoses per this single episode of care was 0.9 diagnoses per patient. The majority of these diagnoses was not prompted by patients’ complaints (71%) and would not have been identified by screening guidelines (51%). Men (odds ratio 2.67; 95% CI, 1.76, 4.03) and those with multiple complaints at presentation (odds ratio 1.12; 95% CI, 1.05, 1.19) were more likely to receive a clinically relevant diagnosis at the conclusion of the visit. Age was not a predictor of receiving a diagnosis in this cohort.ConclusionThe first episode of a comprehensive periodic health evaluation may reveal numerous important diagnoses or risk factors that are not always identified through routine screening.

Total Burden Assessment of Surgical Site Infections in Initial Admissions and Readmissions Using National Administrative Claims Data

Surgical site infections (SSIs) have a significant negative impact on hospital reimbursement and clinical outcomes. This study quantifies the incidence and economic burden of SSIs in 6 selected surgical categories as an aggregate. Uniquely, this investigation focuses on the impact of patients having SSI in their initial admission with downstream outcomes, including readmission counts, payments and total length of stay (LOS) to assess the complete consequences of SSI, not just a single episode of care.