Standardized Hospitalization Rates Research Articles

Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model.

To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.

Association between hospitalizations for sensitive conditions and quality of primary care.

To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019. Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman's test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years. A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations. The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.

Global evaluation of the mortality and hospitalization in the Italian contaminated sites included in the SENTIERI project

Since 2006, epidemiological surveillance of populations living in Italian contaminated sites has been ongoing (SENTIERI Project). Updated global estimates of mortality (2013-2017) and hospitalization (2014-2018) are reported. The excess deaths (observed-expected) for the main groups of diseases were calculated for all the 46 sites together. Through a random-effect meta-analysis of the standardized mortality and hospitalization rates (SMR/SHR), the pooled SMR/SHR for all the sites and their groupings were estimated. In the 46 sites, 8,342 exceeding deaths (1,668/year) were estimated, 4,353 in males and 3,989 in females, resulting in an excess risk of 2% in both genders. The risk of hospitalization for all causes was in excess of 3%. These excesses are mainly attributable to malignant tumours. In subgroups of sites, exceeding SMRs were observed for all mesotheliomas and pleural mesotheliomas, lung and colorectal cancers in both genders. SHR for all causes were observed in excess in the first year of life (+8%), in the group 0-19 and 20-29 years (+3-5%); no excesses of mortality were observed in the group 0-29 years.

Incidence of new-onset type 1 diabetes during Covid-19 pandemic: A French nationwide population-based study

AimThe association between infection with SARS-CoV-2 and the development of new-onset type 1 diabetes mellitus (T1DM) is unclear. The aim of this study was to examine the impact of the Covid-19 pandemic on the hospitalization rates for new-onset T1DM and diabetic ketoacidosis at diagnosis, in metropolitan France. MethodsThis nationwide retrospective cohort study included hospital data on all patients aged 1 to 35 years old, hospitalized in France due to onset of T1DM, in 2020 and 2021 compared to 2019. ResultsApart from a decrease during the lockdown in 2020, the number of hospitalizations due to new-onset T1DM was not significantly different in 2020 and 2021 than it was in 2019. In the regions most affected by Covid-19 and covering 7,995,449 inhabitants aged from 1 to 35 years old, standardized hospitalization rates were not significantly different in 2020 and in 2021 compared with 2019. The number of hospitalizations for diabetic ketoacidosis at diagnosis was not significantly different after week 14 in 2020 and in 2021 compared with 2019. ConclusionIn this nationwide study, the incidence of hospitalizations for new-onset T1DM and the incidence of diabetic ketoacidosis at diagnosis was not increased during the Covid-19 pandemic in 2020 and 2021. Our results support the fact that infection with SARS-CoV-2 does not promote the development of T1DM.

Income, education, and hospitalization in Canada: results from linked census and administrative data

BackgroundAddressing population health inequities begins with quantifying how social factors affect the health and health care utilization of individuals. Such quantification relies on the availability of detailed health and demographic data. Unfortunately, administrative health care data rarely includes detailed demographic information. Data linkage, which combines administrative health data with national-level census or survey data, enables researchers to examine socio-economic inequalities in health care utilization in greater detail.Data and methodsWith access to a unique Canadian dataset linking data from the Hospital Discharge Database (DAD) from 2006 to 2007 with detailed individual-level socio-demographic data from the 2006 Canadian Census, we are able to examine the patterning of hospitalization in Canada in the early 2000s across a variety of socio-demographic variables. We examine the association of education and income, controlling for immigration status, rural residence, marital status and ethnicity, with hospitalization rates for both ambulatory care sensitive conditions (ACSCs) and non-ambulatory care sensitive conditions (non-ACSCs) for children and youth, working-age adults, and older adults, in models stratified by sex.ResultsAge standardized hospitalization rates show that there is a clear socio-economic gradient in hospitalization in Canada in the 2000s. Education and income are independently, inversely associated with hospitalization for males and females across three broad age groups. These associations are stronger for ACSCs than non-ACSCs. The association of other socio-demographic variables, such as immigrant status, and rural residence is also stronger for hospitalization for ACSCs. The association of socio-economic status with hospitalization for ACSCs is strongest for working age women and men, and is somewhat attenuated for older adults.ConclusionsLower socio-economic status is associated with a higher likelihood of hospitalization for men and women in Canada across three broad age groups in the 2000s. These associations are stronger for ACSCs, suggesting that in addition to increased likelihood of disease, decreased access to preventative care may be driving up hospitalization rates for marginalized groups. We conclude with the recommendation that in order to track progress in reducing health inequities, health systems should either collect detailed individual-level socio-demographic data or link their administrative health data to existing demographic data sets.

Late Mortality, Subsequent Malignant Neoplasms and Hospitalisations in Long-Term Survivors of Adolescent and Young Adult Hematological Cancers.

BackgroundIncreased success in the treatment of hematological cancers contributed to the increase of 5-year survival for most adolescent and young adults (AYAs) with these tumours. However, as 5-year survival increased, it became clear that AYA long-term survivors were at increased risk for severe late effects. Moreover, limited information on long-term cancer impact is available for AYAs, since most studies focused on children and adolescents. We aimed to assess various long-term outcomes on AYA survivors of hematological cancers.MethodsWe selected patients diagnosed with a first primary hematological cancer between 1997 and 2006, in the Italian nationwide population-based cohort of AYA cancer survivors (i.e. alive at least 5 years after cancer diagnosis). Long-term outcomes of interest were: second malignant neoplasms (SMNs), hospitalizations and overall mortality. We calculated standardized incidence ratios (SIRs), standardized hospitalization rate ratios (SHRs) and standardized mortality rate ratios (SMRs). To study morbidity patterns over time, we modeled observed incidence rates by fitting flexible parametric models for nonlinear patterns and we used linear regression for linear patterns.ResultsThe study cohort included 5,042 AYA hematological cancer survivors of which 1,237 and 3,805 had a leukaemia and lymphoma diagnosis, respectively. AYA survivors were at substantially increased risk for SMN (SIR=2.1; 95%CI=1.7; 2.6), hospitalisation (SHR=1.5; 95%CI=1.5; 1.6), and mortality (SMR=1.4; 95%CI=1.2; 1.6) with differences between leukaemia and lymphoma survivors. The highest excess risks of hospitalisations were for infectious diseases, respiratory diseases, and diseases of blood and blood-forming organs. The morbidity pattern differs over time by morbidity type.ConclusionsOur results support the need for strict follow-up plans for survivors, and call for further study to better personalised follow-up plans for AYA cancer survivors.

Número de equipes assistenciais e internações por condições sensíveis à atenção primária

Abstract This study aimed to analyze the correlation between the number of health care teams of the Family Health Strategy (FHS) and the number of hospitalizations due to primary care sensitive conditions (HPCSC) taking into account rates, costs and hospital days in a large municipality of the state of Minas Gerais, Brazil, between 2010 and 2019. We performed an ecological time series correlation study on HPCSC of patients hospitalized by the public health system. Data were obtained from the Hospital Information System of the IT Department of the Public Health System (DATASUS) and from the Primary Care Information and Management System. The correlation analysis was performed based on the number, gross and standardized rates, percentages, costs and hospital days of HPCSC and health care coverage (average number of teams) using Spearman’s correlation coefficient at a significance level of 5% (p < 0.05). No satisfactory correlation was found in the entire period between the increase in the number of health care teams and HPCSC (except for the standardized hospitalization rate). However, during the period in which the FHS coverage of the population was greater than 70%, all correlations were inversely proportional and statistically significant.

Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost.

Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45–64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71–9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790–1142/100,000 admissions, while the US 2010 census standardized rates were 380–552/100,000 from 2005–2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations’ overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005–2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Reduction in hepatitis C-related hospitalizations after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System: regional level differences.

This work evaluates the potential impact at territorial level of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System on hepatitis C virus (HCV)-associated hospitalizations. Chronic HCV-related hospitalization discharges from 2014 to 2018 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalizations was performed for all chronic, advanced liver disease and non-advanced liver disease. Hospitalization rates were calculated at national and regional level. Year 2015 and period 2016-2018 hospitalization rates were compared to 2014 hospitalization rates using a Poisson model. Municipal standardized hospitalization rates ratios adjusted by age-group were calculated for 2016-2018 period (2014 hospitalization rates as reference). From 2014 to 2018, there were 22,352 chronic HCV-related hospitalizations. In-hospital fatality rate was 4.3% for non-advanced liver disease and 11.7% for advanced liver disease patients. National hospitalization rate decreased 22% (95% CI: 21%-22%), 16% (95% CI: 15%-17%) and 34% (95% CI: 33%-35%) in 2016-2018 compared to 2014 for all chronic, non-advanced and advanced liver disease, respectively. During 2016-2018 period, 11/19 Spanish regions achieved >20% decrease in the hospitalization rates (p<.001) for non-advanced liver disease and 19/19 (except Melilla, the rest with p<.001) for advanced liver disease. At municipal level, 84.8% and 90.2% municipalities had <20% of chronic HCV-related hospitalization need compared to 2014 adjusted by age-group. Based on the data analysed, a high impact on reducing chronic HCV-associated hospitalizations have been achieved after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System. However, small differences between regions and rural/urban areas were noticed.

Disease-specific hospitalizations among 5-year survivors of Wilms tumor: A Nordic population-based cohort study.

With modern therapy, over 90% of Wilms tumor patients can expect to become long-term survivors, and focus on morbidity and late effects become increasingly important. We provide a novel evaluation and insight to subsequent hospitalizations in 5-year survivors of Wilms tumor. As part of the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study, we identified 5-year survivors of Wilms tumor. Based on stratified random sampling, we constructed a population comparison cohort. Outcomes of interest were overall hospitalizations; hospitalizations for specific organ systems and disease-specific categories. Standardized hospitalization rate ratios (SHRR) and absolute excess risks (AER) were calculated. We included 913, 5-year survivors of Wilms tumor and 152231 population comparisons. Survivors of Wilms tumor had an increased overall risk of being hospitalized (SHRR 1.8; 95% confidence interval (CI) 1.7-2.0). The hospitalization risk was increased within all major organ systems: urinary and genital organs (SHRR 2.5; 95% CI 2.1-3.0), endocrine (SHRR 2.5; 95% CI 1.9-3.3), cardiovascular (SHRR 2.2; 95% CI 1.7-2.9), and gastrointestinal (SHRR 1.5; 95% CI 1.3-1.8). Risks for specific diseases are reported in the study. Survivors of Wilms tumor had higher risks than population comparisons for a wide range of diseases, with the highest risks seen for urinary, endocrine, and cardiovascular disorders. Five to 20years after the Wilms tumor diagnosis, 43% of survivors had been hospitalized at least once versus 29% of population comparisons. The overall AER was 2.3, which translates into 0.2 extra hospitalizations in 10years for every Wilms tumor survivor.

Rotavirus gastroenteritis hospitalization in children. Trends in Abruzzo Region, 2008-2018

Abstract Background Rotavirus is the most important cause of hospitalization for gastroenteritis and dehydration in children under 5 years old. In developed countries, it significantly affects public health in terms of costs and morbidity. Despites the availability of an effective vaccine, the coverage remains low in Italy. This study aimed to evaluate the epidemiological impact of rotavirus hospitalizations in Abruzzo, an Italian region, from 2008 to 2018. Methods Data were obtained from hospital discharge records of all Abruzzo hospitals. For the study, only the admissions due to rotavirus infection occurring in children aged 0 to 5 over the study period were taken into consideration. For each year, age-adjusted standardized hospitalization rates for rotavirus infection were calculated, and time trends were analyzed by joint point regression models. Results A total of 747 admissions were identified. During the study period, a significant increase of admissions was observed among children under 1 year of age (AAPC +9.8%, 95%CI 0.0;20.5, p &amp;lt; 0.001) and a significant decrease was observed among children between 2 and 3 years of age (AAPC -10.6%, 95%CI -20.0; -0.1, p &amp;lt; 0.001). Overall, the standardized rate increased (AAPC +5.2%, 95%CI -3.0;14.1, p = 0.2). Conclusions These results confirm that Rotavirus gastroenteritis has a heavy impact on pediatric hospitalization in Abruzzo Region. Subsequently, the study gives evidence of the need to improve vaccination coverage, in order to reduce morbidity and costs for the Italian healthcare system. Key messages In Abruzzo region, rotavirus gastroenteritis is a very important cause of morbidity and hospitalization in children under 5 years old. This study confirms the need of an improvement in vaccination coverage, that is the most effective mean to reduce the high morbidity, as well as the social and health costs.

Heart failure hospitalizations in persons with and without diabetes in an Italian region: 2008-2018

Abstract Background Hospitalization rate for heart failure (HF) is considered a prevention quality indicator and it is used as a tool to evaluate health services quality. This study aims to assess time trends in HF hospitalizations in a region of Southern Italy, focusing on diabetes mellitus as comorbidity. Methods Data were collected from hospital discharge records. All patients aged 18 or over hospitalized for HF in Abruzzo between 2008 and 2018 were selected, either with or without a diagnostic code of diabetes. Admissions for cardiac procedures were excluded. For each year, gender- and age-adjusted standardized hospitalization rates were calculated. Predictors of HF admissions were estimated by a multivariable regression model. Results Over the study period, 60,737 HF admissions occurred, 34,518 of which among people aged more than 65 (56.8%). A total of 15,424 hospitalizations were performed among diabetic patients (25.4%). The overall age- and gender-adjusted HF hospitalization rate declined substantially from 2008 to 2018 (-12.1%). Diabetes (adjOR 2.48; 95%CI 2.41-2.55), myocardial infarction (adjOR 3.92; 95%CI 3.70-4.14), peripheral vascular disease (adjOR 2.30; 95%CI 2.16-2.44), chronic obstructive pulmonary disease (adjOR 3.97; 95%CI 3.86-4.09) and renal disease (adjOR 5.61; 95%CI 5.44-5.78) were factors associated to an increased risk of HF hospitalization. Although HF admission rates remained higher, a significant reduction was highlighted among diabetic patients (-34.7%). Instead, time trend was nearly stable among persons without diabetes (+2.7%). Conclusions This study has shown a decline in HF hospitalization rate over the period considered, particularly among diabetic patients. HF hospitalization may be potentially avoided with good outpatient care. As the causes for HF admissions may include poor quality of care or problems accessing care, it is worthwhile to identify the triggering factors and the potential targets for an early intervention. Key messages A reduction of HF admissions was observed only among diabetics and not among people without diabetes. As the HF hospitalizations are potentially preventable, the knowledge of the epidemiology is crucial for management of preventive health care.

Recent Trends in Hospitalizations for Cardiovascular Disease, Stroke, and Vascular Cognitive Impairment in Canada

BackgroundWe analyzed hospitalization rates for a broad set of cardiovascular diseases, stroke, and vascular cognitive impairment (VCI) between 2007 and 2016 in Canada to characterize population-level trends and demographic and provincial/territorial variation in inpatient health care utilization. MethodsRecord-level administrative hospitalization data from April 1, 2007 to March 31, 2017 for individuals aged 0-105 years were obtained from the Canadian Institute for Health Information Discharge Abstract Database. Data were available for all provinces and territories, except Quebec. Using the International Classification of Diseases (10th Revision, Canada) diagnostic coding standards, we identified disease categories related to cardiovascular disease, stroke, or VCI. Hospitalizations, crude and standardized, for age and sex (direct method) were calculated using the 2011 Census as the standard population. ResultsBetween 2007 and 2016, percent decreases in standardized hospitalization rates were relatively small for heart failure and stroke (−2.4% and −4.7%, respectively), whereas those for coronary artery and vascular disease and heart rhythm disorders were moderate (−27.4% and −16.8%, respectively). Percent increases were relatively small for congenital heart disease (+7.2%) and moderate for acquired valvular heart disease (+31.1%) and VCI (+23.4%). There were notable age- and sex-specific differences along with provincial/territorial variation. ConclusionsBetween 2007 and 2016, there was an overall decrease in standardized hospitalization rates for coronary artery and vascular disease, heart failure, heart rhythm disorders, and stroke, and an increase in hospitalization rates for structural heart disease (congenital heart disease and acquired valvular heart disease) and VCI in Canada.

Differences in realized access to healthcare among newly arrived refugees in Germany: results from a natural quasi-experiment

BackgroundGermany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models.MethodsIn Germany’s largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasi-experiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex.ResultsSIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC.ConclusionThe results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.

Incidence of Hospitalization for Stroke in Queensland, Australia: Younger Adults at Risk

Background: Trends in the incidence of stroke are important for health care planning. Information is particularly scarce in Australia, due to the paucity of studies with access to recent, large-scale, longitudinal datasets. In this paper we investigated the incidence of hospitalization for stroke by sex, age, and subtype in the whole State of Queensland (Australia). Methods: We obtained data of all hospital admissions for stroke in Queensland from 2002 to 2015. Age standardized hospitalization rates for first-ever stroke were calculated along with WHO adjusted rates. Poisson regression analyses were conducted to investigate the influence of time and gender on the incidence of subtypes of stroke as well as the total incidence. Results: Admissions for first-ever stroke were 57,597. Crude hospitalization incidence rose from 87 (95% confidence interval [CI], 84-90) to 108 (95%CI, 105-111) for both sexes. The highest increase was in the age bands 40-49 from 33 (95%CI, 26-40) to 54 (95%CI, 46-62; +62%) and 50-59 from 82 (95%CI, 70-93) to 127 (95%CI, 114-140; +56%) in men and in 60-69 from 118 (95%CI, 100-136) to 159 (95%CI, 143-175; +34%) in women. Ischemic subtype rates appeared to increase more than haemorrhagic rates. Age range, sex, and year reliably predicted incidence rates. Conclusions: If these trends are maintained, the data predict further increases, especially in males aged 40-59. With people apparently stroking earlier and mortality rates dropping, the healthcare system in Australia is faced with a rapidly increasing care burden.

Multidisciplinary Medication Therapy Management and Hospital Readmission in Patients Undergoing Maintenance Dialysis: A Retrospective Cohort Study

Dialysis patients frequently experience medication-related problems. We studied the association of a multidisciplinary medication therapy management (MTM) with 30-day readmission rates. Retrospective cohort study. Maintenance dialysis patients discharged home from acute-care hospitals between May 2016 and April 2017 who returned to End-Stage Renal Disease Seamless Care Organization dialysis clinics after discharge were eligible. Patients who were readmitted within 3 days, died, or entered hospice within 30 days were excluded. MTM consisting of nurse medication reconciliation, pharmacist medication review, and nephrologist oversight was categorized into 3 levels of intensity: no MTM, partial MTM (defined as an incomplete MTM process), or full MTM (defined as a complete MTM process). The primary outcome was 30-day readmission. Time-varying Prentice, Williams, and Peterson total time hazards models explored associations between MTM and time to readmission after adjusting for age, race, sex, diabetes comorbidity, albumin level, vascular access type, kidney failure cause, dialysis vintage and modality, marital status, home medications, frequent prior hospitalizations, length of stay, discharge diagnoses, hierarchical condition category, and facility standardized hospitalization rates. Propensity score matching was performed to examine the robustness of the associations ina comparison between the full- and no-MTM exposure groups on time to readmission. Among 1,452 discharges, 586 received no MTM, 704 received partial MTM, and 162 received full MTM; 30-day readmission rates were 29%, 19%, and 11%, respectively (P< 0.001). Compared with no MTM, discharges with full MTM had the lowest time-varying risk for readmission within 30 days (HR, 0.26; 95% CI, 0.15-0.45); discharges with partial MTM also had lower readmission risk (HR, 0.50; 95% CI, 0.37-0.68). In propensity score-matched sensitivity analysis, full MTM was associated with lower 30-day readmission risk (HR, 0.20; 95% CI, 0.06-0.69). Reliance on observational data. Residual bias and confounding. MTM services following hospital discharge were associated with fewer 30-day readmissions in dialysis patients. Randomized controlled studies evaluating different MTM delivery models and cost-effectiveness in dialysis populations are warranted.

A63 HOSPITALIZATION RATES FOR INFLAMMATORY BOWEL DISEASE VARY GEOGRAPHICALLY IN SOUTHERN ALBERTA: A POPULATION-BASED COHORT STUDY

Abstract Background Hospitalization rates for patients with inflammatory bowel disease (IBD) are decreasing throughout Canada; however, this may vary across Canadian jurisdictions. Access to gastroenterologists is limited in many parts of Canada, resulting in care by non-gastroenterologists, and variation in outcomes. Aims To assess trends of hospitalization rates in three regions in Southern Alberta: Calgary zone, a metropolitan city; Chinook region: local gastroenterologists; and Palliser region: no local gastroenterologists. Methods The Alberta IBD Surveillance Cohort is a population-based database consisting of an algorithmically defined prevalent IBD population for Alberta. IBD patients in Southern Alberta were identified by 3-digit postal code and their hospitalizations from the Discharge Administrative Database were extracted (2002 to 2015). IBD patients were stratified by the number of IBD prevalent patients: Calgary Zone (n=9625 in 2015), Palliser region (n=1419), and Chinook region (n=727). Age- and sex- standardized hospitalization rates, per 100 prevalent IBD patients, were calculated for each year. Average Annual Percentage Change (AAPC with associated 95% confidence intervals (CI)) were calculated using the log-linear regression. Rate ratios of standardized hospitalization rates between Calgary, Chinook, and Palliser were calculated. Results From 2002 to 2015 the average hospitalization rate (per 100 prevalent population) was: 27.6 in Calgary, 30.2 in Chinook, and 37.4 in Palliser (Table 1). The AAPCs across these regions were significantly decreasing (Figure 1). By 2011–2015 hospitalization rates fell to 23, 26.3, and 30.2 in Calgary, Chinook, and Palliser, respectively (Table 1). Calgary and Chinook had significantly lower hospitalization rates compared to Palliser (Calgary: 0.72, 95% CI: 0.70, 0.75; Chinook: 0.80, 95% CI: 0.76, 0.84) (Table 1). Conclusions Hospitalization rates for patients with IBD are decreasing, which may be explained by advances in therapeutic modalities and increased expertise of gastroenterologists. The lack of access to a local gastroenterologist in Palliser may account for higher hospitalization rates for patients with IBD. Future studies are needed. Funding Agencies CIHRDHSCN (Digestive Health Strategic Clinical Network), AHS (Alberta Health Services)

From the "real-world evidence" to prevention strategies: health inequalities in immigrants residing in an Italian Local Health Unit.

to assess the health inequalities of immigrants in the Local Health Unit (LHU) n.1 of the Abruzzo Region with a real-world approach. In particular, 4 main categories of hospitalisation (MDC) linked to health risk behaviours and social determinants were analysed. retrospective study on hospital discharge data (HDD). resident population in the LHU n.1 of the Abruzzo Region between 2010 and 2018. Hospital discharge forms (HDFs) of the hospitals under the administration of the LHU No. 1 of the Abruzzo Region, which includes three geographical areas (Marsica, Peligno-Sangrina, L'Aquila), in the years 2010-2018 were analysed. crude hospitalisation trends for immigrants and Italians; comparison of standardised hospitalisation rates in the main immigrant communities. overall, 26,570 SDO were analysed. Average age of inpatients was 40 years (±16) and average hospital stay was 4 days (±7). Immigrants showed a lower tendency to hospitalisation than Italians with a decreasing trend from 2010 to 2018, contrary to the Italians. The Romanian population has a hospitalisation risk for alcohol abuse/drugs and induced organic mental disorders about twice as much as the Italian population. Women from Morocco experienced caesarean section with complications about four times more than the Italian women. the analysis of routine data highlighted excesses of hospitalisation by some causes and birthplaces. A real-world approach can be useful and timely to the implementation of preventive strategies for specific diseases in defined local areas.

The impact of gender on diabetes-related lower extremity amputations: An Italian regional analysis on trends and predictors

BackgroundDiabetes-related lower extremity amputations (LEAs) are a major public health issue. The aim of the study was to evaluate trends by gender and predictors of LEAs in an Italian region. MethodsData were collected from hospital discharge records between 2006 and 2015. Gender- and age-adjusted standardised hospitalisation rates for major and minor amputations were calculated. Poisson regression model was performed to estimate trends in LEAs. ResultsHospitalisation rates decreased for minor amputations both among males (−30.0%) and females (−5.3%), while the major amputation rates decreased only for males (−44.7%). Males were at higher risk of undergoing major (IRR 1.41, 95%CI 1.19–1.67) and minor (IRR 1.62, 95%CI 1.45–1.82) amputations. Peripheral vascular disease was the leading predictor of major and minor amputations. ConclusionA significant reduction of LEAs was observed only for males. Identifying their predictable factors may help caregivers to provide higher standards of diabetes care.

Trends by gender and predictors of diabetes-related amputations: an Italian regional analysis

Abstract Background Lower extremity amputations (LEAs) are common among people with diabetes, resulting in high disability and mortality. Understanding trends in diabetes-related LEAs is important for assessing the quality of care. Aim of this study was to evaluate predictors and time trends in LEAs in a region of Southern Italy, focusing on gender difference. Methods Hospital discharge records were used to identify all diabetic adult patients hospitalized for LEAs between 2006 and 2015. For each year, gender- and age-adjusted standardized hospitalization rates for major and minor amputations were calculated and time trends were analyzed by gender. Predictors of LEAs were estimated by a multivariable regression model. Results In the study period, 579 major and 1345 minor amputations were performed in Abruzzo. Gender- and age-adjusted standardized admission rates decreased for minor amputations among both males (-29.96%) and females (-5.33%), whereas major amputations rates decreased only for males (-44.73%). Males were at higher risk of undergoing major (Rate Ratio [RR] 1.41, 95%CI 1.19-1.67) and minor (RR 1.62, 95%CI 1.45-1.82) amputations, but the male-to-female rate ratio decreased for major and minor amputations. Peripheral vascular disease was the main predictor of major (adjOR 4.09, 95%CI 3.31-5.06) and minor amputations (adjOR 12.90, 95%CI 11.00-15.12). Age over 85 (adjOR 9.07, 95%CI 1.84-44.71) and more than 3 comorbidities (adjOR 2.51, 95%CI 1.75-3.60) were parameters associated only with major amputations. Conclusions Reducing the number of LEAs represents a healthcare priority. This study emphasizes the existence of gender disparities in LEAs, highlighting a significant reduction of LEAs for males and a lack of improvement for females. Thus, it is worthwhile to investigate potential clinical, behavioral and healthcare-related causes of this difference, in order to plan health system changes aimed at improving care and facilitating access to health care for women. Key messages Time trends in LEAs showed a substantial improvement only for males, highlighting the existence of gender difference. Understanding the underlying causes is essential to improve the quality of care.