scholarly journals Predicting diagnostic coding in hospitals: individual level effects of price incentives

2021 ◽  
Author(s):  
Kjartan Sarheim Anthun
Keyword(s):  
Length Of Stay ◽  
Patient Characteristics ◽  
Added Value ◽  
Readmission Rates ◽  
Age Composition ◽  
Specific Patient ◽  
Hospital Funding ◽  
Mortality And Morbidity ◽  
Individual Level ◽  
Diagnostic Coding

AbstractThe purpose of this paper is to test if implicit price incentives influence the diagnostic coding of hospital discharges. We estimate if the probability of being coded as a complicated patient was related to a specific price incentive. This paper tests empirically if upcoding can be linked to shifts in patient composition through proxy measures such as age composition, length of stay, readmission rates, mortality- and morbidity of patients. Data about inpatient episodes in Norway in all specialized hospitals in the years 1999–2012 were collected, N = 11 065 330. We examined incentives present in part of the hospital funding system. First, we analyse trends in the proxy measures of diagnostic upcoding: can hospital behavioural changes be seen over time with regards to age composition, readmission rates, length of stay, comorbidity and mortality? Secondly, we examine specific patient groups to see if variations in the price incentive are related to probability of being coded as complicated. In the first years (1999–2003) there was an observed increase in the share of episodes coded as complicated, while the level has become more stable in the years 2004–2012. The analysis showed some indications of upcoding. However, we found no evidence of widespread upcoding fuelled by implicit price incentive, as other issues such as patient characteristics seem to be more important than the price differences. This study adds to previous research by testing individual level predictions. The added value of such analysis is to have better case mix control. We observe the presence of price effects even at individual level.

scholarly journals Predictors of Neuropsychological Improvement Following Cognitive Rehabilitation in Patients with Gliomas

2010 ◽  
Vol 17 (2) ◽  
pp. 256-266 ◽  
Author(s):  
Karin Gehring ◽  
Neil K. Aaronson ◽  
Chad M. Gundy ◽  
Martin J.B. Taphoorn ◽  
Margriet M. Sitskoorn
Keyword(s):  
Test Performance ◽  
Cognitive Rehabilitation ◽  
Practical Implication ◽  
Neuropsychological Test ◽  
Patient Characteristics ◽  
Rehabilitation Program ◽  
Control Group ◽  
Specific Patient ◽  
Individual Level ◽  
The Individual

AbstractThis study investigated the specific patient factors that predict responsiveness to a cognitive rehabilitation program. The program has previously been demonstrated to be successful at the group level in patients with gliomas, but it is unclear which patient characteristics optimized the effect of the intervention at the individual level. Four categories of possible predictors of improvement were selected for evaluation: sociodemographic and clinical variables, self-reported cognitive symptoms, and objective neuropsychological test performance. Hierarchical logistic regression analyses were conducted, beginning with the most accessible (sociodemographic) variables and ending with the most difficult (baseline neuropsychological) to identify in clinical practice. Nearly 60% of the participants of the intervention were classified as reliably improved. Reliable improvement was predicted by age (p = .003) and education (p = .011). Additional results suggested that younger patients were more likely to benefit specifically from the cognitive rehabilitation program (p = .001), and that higher education was also associated with improvement in the control group (p = .024). The findings are discussed in light of brain reserve theory. A practical implication is that cognitive rehabilitation programs should take the patients’ age into account and, if possible, adapt programs to increase the likelihood of improvement among older participants. (JINS, 2011, 17, 256–266)

scholarly journals EP.FRI.468 A review of the management of malignant bowel obstruction at an NHS teaching hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jessica Banks ◽  
Sony Aiynattu ◽  
Rafik Ishak
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Peritoneal Metastasis ◽  
Palliative Surgery ◽  
Malignant Bowel Obstruction ◽  
Readmission Rates ◽  
Mortality And Morbidity ◽  
Clinical Dilemma ◽  
Complications And Mortality

Abstract Patients presenting with malignant bowel obstruction (MBO) due to peritoneal metastasis present a clinical dilemma for surgeons: although palliative surgery is beneficial, post-operative complications and mortality are as high as 30%.  A personalised and multi-disciplinary approach is paramount when treating these patients. Aims This study aimed to review the management (surgical versus conservative) of patients presenting with MBO; ascertain if a multi-disciplinary approach was adopted; and compare clinical outcomes including length-of-stay, readmission rates and mortality.  Methods All patients admitted with MBO secondary to peritoneal metastasis between January 2019 – January 2021 were identified. Results 29 patients; 14 females, were identified with a median age 72. The median length of stay was 16 days. All patients had a CT scan and 76% were performed within 24 hours of admission. 25/29 patients were referred to palliative care. Conclusions Overall mortality and morbidity in our cohort, regardless of surgical or conservative management, is consistent with existing literature. Palliative care input was sought for the majority of patients. Management decisions should be individualised and focus on ensuring the best quality of life for the patient. All decisions should be made with multi-disciplinary input. 

scholarly journals Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection

2016 ◽  
Vol 37 (4) ◽  
pp. 404-410 ◽  
Author(s):  
Aaron C. Miller ◽  
Linnea A. Polgreen ◽  
Joseph E. Cavanaugh ◽  
Philip M. Polgreen
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Incidence Rate ◽  
Nationwide Inpatient Sample ◽  
Cohort Analysis ◽  
Patient Characteristics ◽  
Individual Level ◽  
Percentage Point Increase ◽  
Point Increase ◽  
The Individual

BACKGROUNDInpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS.OBJECTIVETo describe the relationship between hospital CDI incidence and the LOS of patients without CDI.DESIGNRetrospective cohort analysis.METHODSWe predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age).SETTINGHealthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009–2011.PATIENTSThe Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals.RESULTSInpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day’s stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS.CONCLUSIONCDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.Infect. Control Hosp. Epidemiol. 2016;37(4):404–410

Length of Stay and Readmission Rates in Pediatric Acute Heart Failure

2021 ◽  
Vol 40 (4) ◽  
pp. S122-S123
Author(s):  
D.S. Burstein ◽  
C. Connelly ◽  
C.S. Almond ◽  
R.A. Niebler ◽  
J.A. Godown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Readmission Rates

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Vallone ◽  
A Tamburrano ◽  
C Carrozza ◽  
A Urbani ◽  
A Cambieri ◽  
...  
Keyword(s):  
Cost Estimation ◽  
Laboratory Tests ◽  
Quality Care ◽  
Clinical Decision Support Systems ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
University Hospital ◽  
Specific Patient ◽  
Global Rate ◽  
Common Laboratory

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p &lt; 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

Impact of Perioperative Tachydysrhythmias on Mortality and Length of Stay in Complete Repair of Tetralogy of Fallot: A Multicenter Retrospective Cohort Study from the Pediatric Health Information System

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Aziez Ahmed ◽  
Parthak Prodhan ◽  
Beverly J. Spray ◽  
Elijah H. Bolin
Keyword(s):  
Information System ◽  
Length Of Stay ◽  
Health Information ◽  
Tetralogy Of Fallot ◽  
Health Information System ◽  
Inpatient Mortality ◽  
Pediatric Health ◽  
Mortality And Morbidity ◽  
Multiple Risk Factors ◽  
Complete Repair

Introduction: Tachydysrhythmias (TDS) frequently occur after complete repair of tetralogy of Fallot (TOF). However, not much is known about the effect of TDS on morbidity and mortality after TOF repair. We sought to assess the associations between TDS and mortality and morbidity after repair of TOF using a multicentre database. Materials and Methods: We identified all children aged 0–5 years in the Pediatric Health Information System who underwent TOF repair between 2004 and 2015. Codes for TDS were used to identify cases. Outcome variables were inpatient mortality and total length of stay (LOS). Univariate and multiple logistic and linear regression analyses were used to identify the effects of multiple risk factors, including TDS, on mortality and LOS. Results: A total of 7,749 patients met inclusion criteria, of which 1,493 (19%) had codes for TDS. There was no association between TDS and inpatient mortality. However, TDS were associated with 1.1 days longer LOS and accounted for 2% of the variation observed in LOS. Conclusion: After complete repair of TOF, TDS were not associated with mortality and appeared to have only a modest effect on LOS.

Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
James Eames ◽  
Arie Eisenman ◽  
Richard J. Schuster
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Mortality And Morbidity ◽  
Emergency Department Admission ◽  
Icu Length Of Stay ◽  
Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

Sign in / Sign up

Export Citation Format

Share Document