Variation In Hospital Admissions Research Articles

Variation in Emergency Department Admission Rates in US Children’s Hospitals: Bourgeois FT, Monuteaux MC, Stack AM, et al. Pediatrics 2014;134:539−45.

There is a wide variation in hospital admissions for common pediatric illnesses. This retrospective, cross-sectional study used information collected from US children’s hospitals to determine the differences in hospital-level admissions, defined as inpatient or observation admission, for common pediatric illnesses. Using the All Patient Refined Diagnosis Related Grouping (APR-DRG) system, the authors identified the common admission diagnoses as asthma, cellulitis/skin infection, bronchiolitis/respiratory syncytial virus (RSV) pneumonia, pneumonia not elsewhere characterized (NEC), kidney/urinary tract infection, seizure, and concussion. A severity index to account for acuity was also applied to admission data for the study.

Factors associated with hospital admission for proximal humerus fracture

BackgroundThe number of inpatient admissions for proximal humerus fracture is increasing, but the factors that determine hospitalization are not well documented. We sought to identify predictors of hospital admission among individuals presenting to the emergency department (ED) with a fracture of the proximal humerus. MethodsUsing the Nationwide Emergency Department Sample for 2010 and 2011, an estimated 285661 patients were identified and separated into those who were admitted to hospital (19%) and those who were discharged directly home (81%). Multivariable logistic regression modeling was used to identify independent predictors of hospital admission. ResultsFactors associated with admission included increasing age and Charlson comorbidity index, ED visit on a weekday, Medicare and Medicaid insurance, open fracture, injury due to motor vehicle crash, polytrauma, urban teaching hospital, and residence in the Northeast. The lowest ratio of hospital admission to home discharge was noted for uninsured patients (0.09). DiscussionFactors unrelated to medical complexity such as insurance status, geographic region, timing of ED visit, and hospital type are associated with inpatient admission for proximal humerus fracture. Interventions to reduce variation in hospital admission and the influence of nonclinical factors merit attention. Level of EvidenceLevel II, prognostic study.

Seasonal variation in case fatality rate in Korean patients with acute myocardial infarction using the 1997-2006 Korean National Health Insurance Claims Database

Objective Seasonal and monthly variation in the occurrence and case fatality rate (CFR) of acute myocardial infarction (AMI) have been reported. We examined the seasonal variation in hospital admissions and CFR in Korean patients with AMI, and analysed the influence of season on fatality risk for AMI.Methods We used the 10-year administrative database of the Korean National Health Insurance covering the entire population of Korea. The data included 265,935 AMI events that occurred in 228,601 patients who were admitted to hospitals across Korea from 1997-2006.Results Hospital admissions and CFR for AMI were highest in winter and lowest in summer. The fatality risk for AMI was significantly higher in spring (odds ratio [OR]: 1.06, confidence interval [CI]: 1.02-1.10), autumn (OR: 1.08, CI: 1.04-1.12), and winter (OR: 1.11, CI: 1.07-1.15) than in summer. Interestingly, among the summer months, the fatality risk for men was higher in August (OR: 1.10, CI: 1.01-1.19) than in June.Conclusions Our findings support the hypothesis that AMI may be triggered by events external to atherosclerotic plaques. This seasonal evidence supports the idea that a disease forecast system may be developed using temperature information in Korea.

Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings.

The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions.

Measuring unexplained variation in acute hospital use by patients enrolled with northern New Zealand general practices

There is increasing concern worldwide at the steady growth in acute inpatient admissions and emergency department (ED) attendances. To develop measures of variation in acute hospital use between populations enrolled at different general practices that are independent of the sociodemographic characteristics of those populations. Two consecutive years of hospital discharge and ED attendance data were combined with primary health organisation (PHO) registers from 385 practices of over 1.5 million people to develop and test two measures of unplanned hospital use: the standardised acute hospital admission ratio (SAAR) and the standardised ED attendance ratio (SEAR). Disease-specific measures were also produced for inpatient events. The enrolled populations of a high proportion of practices had significantly higher or lower than expected acute use of hospitals and this was consistent over both years studied. Practices whose population made unexpectedly high use of acute hospital care for one condition tended to do so for others. Differences in health needs between practice populations as measured by clinical complexity, comorbidities and length of stay did not explain a significant portion of the overall variation in hospital admissions. The enrolled population's average travelling time to a 24-hour ED accounted for some of the practice variation in unplanned utilisation of hospital services. This study confirms that there is considerable unexplained practice variation in acute hospital use. Further development of the SAAR and SEAR measures may be possible to use these to identify modifiable practice-level factors associated with high unplanned hospital use.

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Higher Serum Levels of Vitamin D Are Associated With a Reduced Risk of Diverticulitis

Recent studies have shown geographic and seasonal variations in hospital admissions for diverticulitis. Because this variation parallels differences in ultraviolet light exposure, the most important contributor to vitamin D status, we examined the association of prediagnostic serum levels of vitamin D with diverticulitis. Among patients within the Partners Healthcare System who had blood drawn and serum levels of 25-hydroxyvitamin D (25-[OH]D) measured, from 1993 through 2012, we identified 9116 patients with uncomplicated diverticulosis and 922 patients who developed diverticulitis that required hospitalization. We used multivariate logistic regression to estimate relative risks and 95% confidence intervals to compare serum 25(OH)D levels between these groups. Patients with uncomplicated diverticulosis had significantly higher mean prediagnostic serum levels of 25(OH)D (29.1 ng/mL) than patients with diverticulitis who required hospitalization (25.3 ng/mL; P < .0001). Compared with patients in the lowest quintile of 25(OH)D, the multivariate-adjusted relative risk for diverticulitis hospitalization was 0.49 (95% confidence interval, 0.38-0.62; P for trend < .0001) among patients in the highest quintile of 25(OH)D level. Compared with patients with uncomplicated diverticulosis, the mean level of 25(OH)D was significantly lower for patients with acute diverticulitis without other sequelae (25.9 ng/mL; P < .0001; n = 594), for patients with diverticulitis with abscess (25.8 ng/mL; P = .0095; n = 124), for patients with diverticulitis requiring emergent laparotomy (22.7 ng/mL; P = .002; n = 65), and for patients with recurrent diverticulitis (23.5 ng/mL; P < .0001; n = 139). Among patients with diverticulosis, higher prediagnostic levels of 25(OH)D are associated significantly with a lower risk of diverticulitis. These data indicate that vitamin D deficiency could be involved in the pathogenesis of diverticulitis.

Social exclusion, deprivation and child health: a spatial analysis of ambulatory care sensitive conditions in children aged 0–4 years in Victoria, Australia

Recent Australian policy initiatives regarding primary health care focus on planning services around community needs and delivering these at the local area. As in many other countries, there has also been a growing concern over social inequities in health outcomes. The aims of the analysis presented here were firstly to describe small area variations in hospital admissions for ambulatory care sensitive conditions (ACSC) among children aged 0–4 years between 2003 and 2009 in the state of Victoria, Australia, and secondly to explore the relationship of ACSC hospitalisations with socio-economic disadvantage using a comparative analysis of the Child Social Exclusion (CSE) index and the Composite Score of Deprivation (CSD). This is a cross sectional secondary data analysis, with data sourced from 2003 to 2009 ACSC data from the Victorian State Government Department of Health; the Australian Standard Geographical Classification of remoteness; the Australian 2006 Census of Population and Housing; and AMPCo General Practitioner data from 2010. The relationship between the indexes and child health outcomes was examined through bivariate analysis and visually through a series of maps. The results show there is significant variation in the geographical distribution of the relationship between ACSCs and socio-economic disadvantage, with both indexes capturing important social gradients in child health conditions. However, measures of access, such as geographical accessibility and workforce supply, detect additional small area variation in child health outcomes. This research has important implications for future primary health care policy and planning of services, as these findings confirm that not all areas are the same in terms of health outcomes, and there may be benefit in tailoring mechanisms for identifying areas of need depending on the outcome intended to be affected.

Seasonal influences on admissions for mood disorders and schizophrenia in a teaching psychiatric hospital in Egypt

Distinct seasonal variation in hospital admission and various associations with the climatic parameters for mood disorders and schizophrenia have been previously reported in several world regions. There are, however, no North-African studies on this association. The charts of 1987 patients with mood disorders (mania 1181, depression 806) and 1359 patients with schizophrenia admitted from 2003 to 2007 from an university hospital at Mansoura, Egypt, were reviewed. Seasonality was assessed with Cosinor Analysis. Correlations of the rate of admissions for affective disorders and schizophrenia to climatic variables were performed, including lagged and differenced data. There was a significant seasonal variation in the monthly admission frequencies both for mania (peak in June) and for depression (peak in December) but no significant seasonal variation was found in admissions with diagnosis of schizophrenia. The number of admissions for mania was positively correlated to indicators of temperature and luminosity, but inversely correlated to relative humidity. Quite the opposite, the number of admissions for depression showed a negative correlation to temperature and luminosity, but a positive correlation to relative humidity. 55-57% of the monthly variance of the number of admissions for mood disorders was explained by climatic variables. Seasonality of admissions for mood disorders, but not for schizophrenia, has been demonstrated, in an African Mediterranean region with a fairly constant climate. The association between admission rates and climatic variables found in this study could pave the way for further studies aiming at exploration of the biological mechanism of this association as well as tailoring of treatment interventions on mood disorders.

Association of indoor smoke-free air laws with hospital admissions for acute myocardial infarction and stroke in three states.

Objective. To examine whether comprehensive smoke-free air laws enacted in Florida, New York, and Oregon are associated with reductions in hospital admissions for acute myocardial infarction (AMI) and stroke. Methods. Analyzed trends in county-level, age-adjusted, hospital admission rates for AMI and stroke from 1990 to 2006 (quarterly) for Florida, 1995 to 2006 (monthly) for New York, and 1998 to 2006 (monthly) for Oregon to identify any association between admission rates and passage of comprehensive smoke-free air laws. Interrupted time series analysis was used to adjust for the effects of preexisting moderate local-level laws, seasonal variation in hospital admissions, differences across counties, and a secular time trend. Results. More than 3 years after passage of statewide comprehensive smoke-free air laws, rates of hospitalization for AMI were reduced by 18.4% (95% CI: 8.8–28.0%) in Florida and 15.5% (95% CI: 11.0–20.1%) in New York. Rates of hospitalization for stroke were reduced by 18.1% (95% CI: 9.3–30.0%) in Florida. The few local comprehensive laws in Oregon were not associated with reductions in AMI or stroke statewide. Conclusion. Comprehensive smoke-free air laws are an effective policy tool for reducing the burden of AMI and stroke.

Seasonal Variations in Hospital Admissions for ST-Elevation Myocardial Infarction in New Zealand.

BackgroundIncreased numbers of ST Elevation Myocardial Infarction (STEMI) admissions have been observed during winter in many countries. Our aim was to assess if seasonal variation of STEMI was present in the Waikato region of New Zealand.MethodsCase notes of patients admitted to Waikato hospital with STEMI between July 1998 and December 2007 were analysed. The incidence of STEMI during summer (December to February), autumn (March to May), winter (June to August) and spring (September to November) were calculated. The individuals were divided into 2 age groups of ≤ 70 and > 70 years of age.ResultsA total of 3,569 patients (mean age 66.9 ± 14.1 years, 64% men) were included. STEMI presentation during winter was significantly higher compared with summer (35 ± 13 versus 27.3 ± 11.3 cases per month, P < 0.02) with 3 additional STEMI admissions per fortnight during winter months. The increase in STEMI in winter was more apparent in patients > 70 years of age, with an 8.5% increase in winter admissions compared to summer (P < 0.01). There was no significant difference in the incidence of STEMI between other seasons.ConclusionThere is a higher incidence of STEMI during winter in the Waikato region compared with summer. This increased incidence is particularly pronounced in patients over 70 years of age. Further investigations are necessary to elicit potential causes.

Seasonal Variation in Hospital Admission in Patients with Heart Failure and Its Effect on Prognosis

Background: A seasonal variation in hospital admissions in patients with heart failure (HF) has been described and most admissions occur during the winter season. The effect of this seasonal variation on prognosis is less clear. Objectives: To evaluate the effect of the seasonal timing of hospital admission on clinical outcome in patients with HF. Methods: We prospectively enrolled 362 consecutive patients hospitalized with a definite clinical diagnosis of HF during a 2-year period. Patients were followed clinically for a period of 1 year. Results: There was a prominent seasonal variation in hospital admissions in patients with HF with peak admissions during the winter. The admission rate inversely correlated with the average monthly temperature. Admission during the summer season was a significant predictor of reduced survival (59 vs. 75%, p < 0.01). Cox regression analysis demonstrated that independent predictors of reduced survival after adjustment for other predictors were admission during the hottest 6 months or admission during the summer. In addition, increased mean environmental admission temperature was an independent predictor of reduced survival. Conclusions: Seasonal temperature has a significant effect on the rate of hospital admission in patients with HF. Admission during warmer weather is a sign of a poor prognosis.

Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

To characterize the increasing incidence and geographic variation of acute diverticulitis. Using the nationwide inpatient sample (NIS) we identified a cohort who had been admitted with diverticulitis between 1998 and 2005. We calculated age-, sex-, and region-specific rates of hospitalizations for diverticulitis over time. The age-adjusted hospitalization rate for diverticulitis increased from 61.8 per 100,000 to 75.5 per 100,000 between 1998 and 2005, and increased similarly in both sexes. Diverticulitis-associated admissions were male-predominant in those younger than age 45 years but were female-predominant thereafter. Admission rates increased the most among those < 45 years, while remaining unchanged for those ≥ 65 years. By 2005, the majority of hospitalized patients were < 65 years. Age-adjusted rates of diverticulitis-associated hospitalizations were lower in the West (50.4/100,000) compared to the Northeast (77.7/100,000), South (73.9/100,000), and Midwest (71.0/100,000). Diverticulitis-associated hospitalizations have steeply risen, especially in young adults. These epidemiological trends vary by geographic region and warrant further investigation into potential dietary and environmental etiologies.

Hospital admissions of young persons for illicit drug use or abuse: Does neighborhood of residence matter?

Adolescence constitutes a period of risk for drug use and drug use disorders. Previous research, largely focused on individual risk factors, has failed to include neighborhood structure in the study of determinants of youth drug use or abuse. A cohort of 76,693 adolescents ages 13–15 from 586 urban neighborhoods in Sweden were followed up for 12 years, from age 16 to age 28. Multilevel modeling was used to analyze neighborhood variations in hospital admissions due to illicit drug use or abuse. We found a variation of 8% by neighborhood economic status and the risk of being admitted to hospital increased 73% in low-compared to high-income neighborhoods. Our results suggest that neighborhood of residence in adolescence plays a significant role in predicting future health-related behaviors and that the need for drug abuse interventions at a neighborhood level is compelling.

Epidemiology of hospitalised burns patients in France

BackgroundBurns affect approximately 500 000 persons each year in France (65 million inhabitants). At the national level, this issue is poorly investigated, although previous studies have been performed at a...

Hospitalization in Tajikistan: determinants of admission, length of stay, and out‐of‐pocket expenditures. Results of a national survey

To assess factors explaining hospitalization in Tajikistan and discuss policy implications for reforms in hospital care. This study involves a secondary analysis of micro-data collected from a nationally-representative household survey conducted in Tajikistan in 2003. Three empirical models are employed: binomial logit regression for the admission to the hospital; zero truncated negative binomial (ZTNB) regression for the length of hospital stay; and ordinary least square (OLS) for the amount of out-of-pocket expenditures for hospitalization. Variation in hospital admission is due to the differences in ability to pay, long-standing illness, gender, age, and educational level. Factors explaining out-of-pocket expenditures include ability to pay, having long-standing illness, and having surgery and receiving intensive care. The most important out-of-pocket expenditures are payments for pharmaceuticals and supplies. Finally, long hospital stay that is the result of outdated treatment protocols, rigid financial and management system, lack of funding, and weakness of primary and long-tem care. As a result, long time in inpatient care is mostly used ineffectively. Strategies to address the existing deficiencies include voluntary community-based health insurance for rural areas, targeted subsidized care for the neediest, improvements in procurement of pharmaceuticals and supplies, and rationalization of hospital primary and long-term care.

Weekly variation of hospital admissions for stroke in Nis (Serbia)

Objectives Weekly variability in stroke occurrence could be related to the change in behaviors of patients or medical personnel that occur during certain periods of the week. The aim of the present study was to examine the weekly variation in hospital admissions for stroke in Nis (Serbia), as well as to investigate how the demographic factors influenced these changes. Patients and methods The main data source for this study was the Nis Stroke Registry. During the study period (1996–2007) a total of 9675 stroke patients were registered. According to stroke subtypes, all registered patients were divided into three groups: patients with subarachnoid hemorrhage (SAH) (438 or 4.5%), patients with intracerebral hemorrhage (ICH) (1576 or 16.3%) and patients with ischemic stroke (IS) (6946 or 71.8%). Analyses were conducted separately for SAH, ICH and IS. Each stroke type was stratified by gender, age group and education level. Results We have showed that there is a significant weekly variability in the number of SAH ( p = 0.028) and IS ( p < 0.001) admissions, with the minimum number of admissions on Sundays (39.27 and 14.04% less than expected), and the maximum one on Tuesdays (21.46% more than expected) and Wednesdays (10.96% more than expected), respectively. We have also registered more SAH ( p = 0.015) and IS ( p < 0.001) admissions on weekdays than on weekend days. Conclusion Results of this hospital-based study confirm that there is a pattern in the variation of the number of stroke admissions on the weekly level. Reasons for the weekly variation of hospital admissions for stroke cannot be determined from the present study.

Seasonal pattern of peptic ulcer hospitalizations: analysis of the hospital discharge data of the Emilia-Romagna region of Italy

BackgroundPrevious studies have reported seasonal variation in peptic ulcer disease (PUD), but few large-scale, population-based studies have been conducted.MethodsTo verify whether a seasonal variation in cases of PUD (either compicated or not complicated) requiring acute hospitalization exists, we assessed the database of hospital admissions of the region Emilia Romagna (RER), Italy, obtained from the Center for Health Statistics, between January 1998 and December 2005. Admissions were categorized by sex, age (<65, 65-74, ≥ 75 yrs), site of PUD lesion (stomach or duodenum), main complication (hemorrhage or perforation), and final outcome (intended as fatal outcome: in-hospital death; nonfatal outcome: patient discharged alive). Temporal patterns in PUD admissions were assessed in two ways, considering a) total counts per single month and season, and b) prevalence proportion, such as the monthly prevalence of PUD admissions divided by the monthly prevalence of total hospital admissions, to assess if the temporal patterns in the raw data might be the consequence of seasonal and annual variations in hospital admissions per se in the region. For statistical analysis, the χ2 test for goodness of fit and inferential chronobiologic method (Cosinor and partial Fourier series) were used.ResultsOf the total sample of PUD patients (26,848 [16,795 males, age 65 ± 16 yrs; 10,053 females, age 72 ± 15 yrs, p < 0.001)], 7,151 were <65 yrs of age, 8,849 between 65 and 74 yrs of age, and 10,848 ≥ 75 yrs of age. There were more cases of duodenal (DU). (89.8%) than gastric ulcer (GU) (3.6%), and there were 1,290 (4.8%) fatal events. Data by season showed a statistically difference with the lowest proportion of PUD hospital admissions in summer (23.3%) (p < 0.001), for total cases and rather all subgroups. Chronobiological analysis identified three major peaks of PUD hospitalizations (September-October, January-February, and April-May) for the whole sample (p = 0.035), and several subgroups, with nadir in July. Finally, analysis of the monthly prevalence proportions yielded a significant (p = 0.025) biphasic pattern with a main peak in August-September-October, and a secondary one in January-February.ConclusionsA seasonal variation in PUD hospitalization, characterized by three peaks of higher incidence (Autumn, Winter, and Spring) is observed. When data corrected by monthly admission proportions are analyzed, late summer-autumn and winter are confirmed as higher risk periods. The underlying pathophysiologic mechanisms are unknown, and need further studies. In subjects at higher risk, certain periods of the year could deserve an appropriate pharmacological protection to reduce the risk of PUD hospitalization.

Seasonal variation in hospital admission for road traffic injuries in England: analysis of hospital statistics

Objective:To report on seasonal variation in hospital admissions for traffic injuries to car and truck occupants, motorcyclists, cyclists, and pedestrians.Methods:Descriptive study of hospital admission statistics in England, 1999–2004. Main outcome...

Relationship among latitude, climate, season and self-reported mood in bipolar disorder

Objective Many researchers have analyzed seasonal variation in hospital admissions for bipolar disorder with inconsistent results. We investigated if a seasonal pattern was present in daily self-reported daily mood ratings from patients living in five climate zones in the northern and southern hemispheres. We also investigated the influence of latitude and seasonal climate variables on mood. Method 360 patients who were receiving treatment as usual recorded mood daily (59,422 total days of data). Both the percentage of days depressed and hypomanic/manic, and the episodes of depression and mania were determined. The observations were provided by patients from different geographic locations in North and South America, Europe and Australia. These data were analyzed for seasonality by climate zone using both a sinusoidal regression and the Gini index. Additionally, the influence of latitude and climate variables on mood was estimated using generalized linear models for each season and month. Results No seasonality was found in any climate zone by either method. In spite of vastly different weather, neither latitude nor climate variables were associated with mood by season or month. Conclusion Daily self-reported mood ratings of most patients with bipolar disorder did not show a seasonal pattern. Neither climate nor latitude has a primary influence on the daily mood changes of most patients receiving medication for bipolar disorder.