Use Of Hospital Emergency Services Research Articles

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

The aim of this study was to evaluate the effects of a supervised cardiac rehabilitation (CR) program on long- term quality of life (Qo L) of patients with heart failure (HF).Methods: A sample of 21 HF patients, previously sedentary, NYHA II, was randomly divided into two g roups: the CR group (N = 13) and the control group (CG = 8). The CR consisted of sessions of 120 minutes/day, 3 times/week,for 60 days. CR g roup performed their activ ities under supervision at a rehabilitation clinic, and CG received standard care and was instructed to exercise at ho me. All patients underwent a maximal sympto m-limited test at the beginning and after 30 and 60 days of CR. Qo L was monitored after 60-days, 6, 12 and 18 months of CR. Results:Two-way A NOVA for repeated measures, follo wed by Tukey's test for statistical analysis showed significantimp rovement in peak VO2 at 30 and 60-days of CR (p<0.05). Qo L imp roved after 60-days of CR and remained improved throughout the 18following months in the supervised CR group. The use of hospital emergency services became less frequent (p=0.023) and there was a trend for better survival after 18 months of follow-up (p=0.092).Conclusion: CR was effect ive upon cardiopulmonary and Qo L aspects.

Service Utilization by Hospitalized Suicide Attempters With Schizophrenia or Depression in Montreal

The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.

The Effect of Distance on the Use of Emergency Hospital Services in a Spanish Region With High Population Dispersion

There is geographic variability in the use of hospital emergency services. The effect of distance to the hospital on this variability is unknown. (a) To analyze the independent effect of distance on use of hospital emergency services; (b) to describe the variability among municipalities in use of hospital emergency services and to analyze how much of this variability is explained by distance. Weighted cross-sectional data from the 2003 Regional Health Survey of Castile and Leon were linked with municipal-level data from the 2001 Census, municipal health resources, and distance from municipality to hospital. : Sample of 4281 adults residing in 179 municipalities of the region of Castile and Leon. Using multilevel logistic regression models with random intercept, we analyzed the association between distance to hospital and use of hospital emergency services. The proportion of the sample using hospital emergency services in the last year was 14.4%. The multivariate analysis showed a significant inverse association between distance to hospital and use of emergency services (P=0.001). Use of hospital emergency services varied widely across municipalities (variance 0.484; standard error 0.132). Some 12.8% of the variability is attributable to differences among municipalities. The model explained 31.6% of the variability. : Distance is a barrier to accessing hospital emergency services. There is large variability among municipalities in the use of emergency services not explained by the model. Variables related with the capacity of primary care facilities to resolve emergencies may reduce part of the observed variability.

Evaluating Two Health Care Facilities’ Ability to Meet Health Literacy Needs: A Role for Occupational Therapy

ABSTRACTMany clients have difficulty understanding health information, which may lead to less use of preventive services, greater use of hospital emergency services, poor physical and mental health, and an increased risk of death. Therefore, the objective of this article is to present a review of the accessibility of a rehabilitation center and an independent living facility with regard to navigation of the facility, understandability of written and oral communication, use of technology, and implementation of policies and procedures within these facilities. Findings from the reviews identified areas for improvement for both facilities in navigation as well as written and oral communication. Recommendations to the facilities are discussed for revision of signage and written and oral communication. Implications for occupational therapy practitioners, including establishment of best practices for health literacy and providing consultation for other health care professions, are highlighted. Possible future research is explored regarding evaluation of the effectiveness of the intervention.

Use of Hospital Emergency Services by Youths in Out-of-Home Care

Use of Hospital Emergency Services by Youths in Out-of-Home Care

The changing utilization of a children’s emergency department

ABSTRACT Objective To assess the changing pattern of attendance at an emergency department in a children’s hospital. Design A retrospective review of the attendance register from 1 September 1986 to 31 August 1998. Setting Derbyshire Children’s Hospital, Derby, serving a mixed urban and rural population within the National Health Service. Measurement Total number of attendances and admissions each year. For one week in February and August each year: age and case mix assessed. For the period 1994–98: the source of the referral and the outcome of patients referred by their General Practitioner (GP). Results Over the study period: a rise in attendances from 4853 to 8796; no change in the total number admitted to hospital. A decline in the proportion admitted from 56 to 32%. For the period 1994–98: no change in the number of patients referred by their GP; an increasing number of self‐referrals. Overall age mix: age &lt; 1 year, 27%; age 1–4 years, 42%; age 5–12 years, 26%; age &gt; 13 years, 5%. Overall case mix: medical, 73%; surgical, 9%; trauma/minor injuries, 18%. Conclusion An important change has occurred in the utilization of our paediatric emergency department with increasing numbers of children seeking hospital assessment, largely via self‐referrals, but not requiring hospital admission. Implications for practice Future planning and deployment of paediatric resources need to take account of the change in use of hospital emergency services.

Preschool behavior disorders: Their prevalence in relation to determinants

The occurrence of behavior disorders was investigated in a prospectively followed 3-year-old birth cohort. Of 1116 eligible children, the parents of 918 were successfully contacted. All agreed to complete a telephone interview and were mailed a Childhood Behavior Checklist (CBCL) standardized for 2- to 3-year-old children; 756 (82%) returned the CBCL. The prevalence of one or more of the deviant behavior syndromes identified by the CBCL was 11.1%. From a number of subject characteristics recorded throughout infancy, age-specific determinants for the occurrence of these deviant behaviors were identified. Characteristics most consistently associated with preschool psychopathology included the mother's ill health and lack of social support, the presence of chronic illness in the child, and the frequent use of hospital emergency services. These and other determinant (risk) indicators were entered into logistic regression (LR) models to derived adjusted relative risk estimates for the occurrence of a behavior disorder. The derived LR equations emphasize the important role of both the mother as well and the father and the health of the child.

Outpatient management of the severely ill child. A timed priority system.

Increasing use of hospital emergency services has created many problems in patient management. A small percentage of children seeking emergency services is seriously ill. The identification of these patients and the careful monitoring of their outpatient evaluation requires an organized approach. A system, utilizing a method of selecting appropriate patients while setting a time for their evaluation and disposition, has been established and its effectiveness appraised. Under this system, 348 children were selected for special monitoring from a possible 26,910 patients registering in a short-term care clinic. Ninety-three percent of these children were found to be seriously ill while 54.8% required hospital admissions. In addition, the major factors affecting the time needed for evaluation were analyzed. The average time required to arrive at a complete evaluation and disposition was one hour, 42.setunim

Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services.

Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services. E R Weinerman, R S Ratner, A Robbins, and M A LavenharCopyRight https://doi.org/10.2105/AJPH.56.7.1037 Published Online: August 29, 2011