scholarly journals LO64: Variation in Alberta emergency department patient populations

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S29-S29
Author(s):  
B. R. Holroyd ◽  
G. Innes ◽  
A. Gauri ◽  
S. E. Jelinski ◽  
M. J. Bullard ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Resource Utilization ◽  
Emergency Department Patient ◽  
Administrative Databases ◽  
Case Mix ◽  
Care Needs ◽  
Free Standing ◽  
Admission Rates ◽  
Left Without Being Seen ◽  
Icd 10

Introduction: Increasing pressures on the health care system, particularly in emergency departments (EDs), make it critical to understand changing ED case-mix, patient demographics and care needs, and resource utilization. Our objective is to assess Alberta (AB) ED volumes, utilization and case mix, stratified by ED type. This knowledge will help identify opportunities for system change and quality improvement. Methods: Data from Alberta Health Services administrative databases, including the National Ambulatory Care Reporting System, ED Admission/Discharge/Transfer data, and Comprehensive Ambulatory Care Classification System codes, were linked for all ED visits from 2010-17. Data were stratified by seven facility categories: tertiary referral (TR), regional referral (RR), community<5,000 inpatient discharges (CL), community>600 inpatient discharges (CM), community <600 inpatient discharges (CS), community ambulatory care (CA), and free-standing EDs (FS). Results: We analyzed 11,327,258 adult patient visits: 13% at TR, 34 % at RR, 24% at CL, 16% at CM, 9% at CS, 1% at CA, and 3% at FS sites. Acuity was highest at TR and RR hospitals, with 76%, 63%, 25%, 26%, 22%, 12% and 55% of patients falling into CTAS levels 1-3, for TR, RR, CL, CM, CS, CA, and FS respectively. Admission rates were highest at TR and RR hospitals, (23%, 13%, 5%, 5%, 4%, 0% and 0%), as were left without being seen rates, (5%, 4%, 1%, 2%, 1%, 0% and 5%). The most common ICD-10 diagnoses were chest pain/abdominal pain in TR and RR centres, and IV (antibiotic) therapy in all levels of community and FS EDs. Conclusion: Acuity and case-mix are highly variable across ED categories. Acuity, admission rates and LWBS rates are highest in TR and RR centres. Administrative data can reveal opportunities for health system re-engineering, e.g. potentially avoidable IV antibiotic visits. Further investigation will clarify the type of ED care provided, variability in resource utilization by case-mix, and allocation, and will help identify the optimal metrics to describe ED case-mix.

scholarly journals P108: Fast track in Calgary hospitals: measures for quality improvement

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S114-S115
Author(s):  
P. Rogers ◽  
A. Oster ◽  
D. Wang
Keyword(s):  
Back Pain ◽  
Fast Track ◽  
Medical Center ◽  
Lower Extremity Injury ◽  
Administrative Databases ◽  
Extremity Injury ◽  
Admission Rates ◽  
Left Without Being Seen ◽  
Consultation Request ◽  
Discharge From Hospital

Introduction: Fast track (FT) implementation in emergency departments (ED) has shown a decrease in patient wait times, length of stay (LOS), left without being seen rates, and has increased patient satisfaction. The objective of this study was to analyze the demographics and presenting complaints of patients presenting to FT in Calgary EDs using local administrative databases to understand the current selection of FT patients, as well as to uncover potential throughput efficiencies through LOS analysis. Methods: Sunrise Clinical Manager data was pulled from the Foothills Medical Center (FMC), Peter Lougheed Center (PLC), and Rockyview General Hospital (RGH) EDs between October 2015 and September 2016. Based on consensus achieved by the Calgary FT-Minor Treatment Sub-committee, data was descriptively analyzed based on the following criteria: (1) triage profiles of the Calgary ED sites; (2) site admission rates by complaint, Canadian Triage and Acuity Scale (CTAS), vitals, and age; (3) LOS for orthopedic patients admitted from FT/Minor; and, (4) LOS in FT for non-admitted back pain patients. Results: A total of 53911 patients were triaged to FT, with 16224 patients triaged to FMC, 18299 to PLC, and 19388 to RGH. 6.9% of FT patients were admitted to hospital at FMC, 4.8% at PLC and 4.8% at RGH. 14.4% of patients at FMC, 18.3% at PLC and 17.6% at RGH were CTAS 2; 40.9% of patients at FMC, 46.2% at PLC and 37.9% at RGH were CTAS 3; 34.0% of patients at FMC, 27.8% at PLC and 33.3% at RGH were CTAS 4; 10.7% of patients at FMC, 7.7% from PLC and 11.2% for RGH were CTAS 5. For FT patients 80 years or older, 10.4% were admitted at FMC, 13.1% at PLC and 9.4% at RGH. The top FT presenting complaints at all sites were lower extremity injury, upper extremity injury, and laceration/puncture. The annual FT bed hours for patients admitted to orthopedic surgery (consultation request to time of orthopedic admission) was 802.3 hours at FMC, 441.1 PLC and 705.1 from RGH. The annual FT bed hours for patients with non-admitted back pain (FT bed to time of discharge) was 2144.3 hours from FMC, 3367.9 from PLC and 1134.9 from RGH. Conclusion: The efficiency of FT is based on streamlining low acuity patients with an expected rapid discharge from hospital. The results of this investigation will be presented to the FT-Minor Treatment Sub-committee in order to utilize current admission rates, patient profiles, and aggregate LOS to potentially improve throughput.

scholarly journals A Case-Mix System for Children and Youth With Developmental Disabilities

2020 ◽  
Vol 13 ◽  
pp. 117863292097789
Author(s):  
Shannon L Stewart ◽  
Angela Celebre ◽  
Michael J Head ◽  
Mary L James ◽  
Lynn Martin ◽  
...  
Keyword(s):  
Developmental Disabilities ◽  
Prospective Payment System ◽  
Individual Characteristics ◽  
Children And Youth ◽  
Case Mix ◽  
Care Needs ◽  
Payment Reform ◽  
Home Setting ◽  
Service Programs ◽  
The Cost

Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which has led to the development of case-mix systems. The present study sought to develop a new approach to allocate resources among children and youth with intellectual and developmental disabilities (IDD) as part of a system-wide Medicaid payment reform initiative in Arkansas. To develop the system, assessment data collected using the interRAI Child and Youth Mental Health-Developmental Disability instrument was matched to paid service claims. The sample consisted of 346 children and youth with developmental disabilities in the home setting. Using automatic interactions detection, individuals were sorted into unique, clinically relevant groups (ie, based on similar resource use) and a standardized relative measure of the cost of services provided to each group was calculated. The resulting case-mix system has 8 distinct, final groups and explains 30% of the variance in per diem costs. Our analyses indicate that this case-mix classification system could provide the foundation for a future prospective payment system that is centered around stability and equitability in the allocation of limited resources within this vulnerable population.

Abstract P250: A Strategy for Reliable Identification of Ischemic Stroke, Thrombolytics, and Thrombectomy in Large Administrative Databases

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kori S Zachrison ◽  
Sijia Li ◽  
Mathew J Reeves ◽  
Opeolu M Adeoye ◽  
Carlos A Camargo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Administrative Data ◽  
Administrative Databases ◽  
Stroke Patients ◽  
Inpatient Hospitalization ◽  
Accurate Identification ◽  
Stroke Research ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Icd Codes

Background: Administrative data are frequently used in stroke research. Ensuring accurate identification of ischemic stroke patients, and those receiving thrombolysis and endovascular thrombectomy (EVT) is critical to ensure representativeness and generalizability. We examined differences in patient samples based on different modes of identification, and propose a strategy for future patient and procedure identification in large administrative databases. Methods: We used nonpublic administrative data from the state of California to identify all ischemic stroke patients discharged from an emergency department or inpatient hospitalization from 2010-2017 based on ICD-9 (2010-2015), ICD-10 (2015-2017), and MS-DRG discharge codes. We identified patients with interhospital transfers, patients receiving thrombolytics, and patients treated with EVT based on ICD, CPT and MS-DRG codes. We determined what proportion of these transfers and procedures would have been identified with ICD versus MS-DRG discharge codes. Results: Of 365,099 ischemic stroke encounters, most (87.7%) had both a stroke-related ICD-9 or ICD-10 code and stroke-related MS-DRG code; 12.3% had only an ICD-9 or ICD-10 code, and 0.02% had only a MS-DRG code. Nearly all transfers (99.9%) were identified using ICD codes. We identified32,433 thrombolytic-treated patients (8.9% of total) using ICD, CPT, and MS-DRG codes; the combination of ICD and CPT codes identified nearly all (98%). We identified 7,691 patients treated with EVT (2.1% of total) using ICD and MS-DRG codes; both MS-DRG and ICD-9/-10 codes were necessary because ICD codes alone missed 13.2% of EVTs. CPT codes only pertain to outpatient/ED patients and are not useful for EVT identification. Conclusions: ICD-9/-10 diagnosis codes capture nearly all ischemic stroke encounters and transfers, while the combination of ICD-9/-10 and CPT codes are adequate for identifying thrombolytic treatment in administrative datasets. However, MS-DRG codes are necessary in addition to ICD codes for identifying EVT, likely due to favorable reimbursement for EVT-related MS-DRG codes incentivizing accurate coding.

scholarly journals Adverse drug events identified in hospitalized patients in Brazil by International Classification of Diseases (ICD-10) code listings

2018 ◽  
Vol 34 (12) ◽  
Author(s):  
Ana Cristina Martins ◽  
Fabíola Giordani ◽  
Lusiele Guaraldo ◽  
Gianni Tognoni ◽  
Suely Rozenfeld
Keyword(s):  
Public Health ◽  
Adverse Drug Events ◽  
International Classification Of Diseases ◽  
Hospitalized Patients ◽  
International Classification ◽  
Administrative Databases ◽  
National Database ◽  
Classification Of Diseases ◽  
Icd 10

Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.

Polypharmacy as a Clinical Pharmacist Specialist Practice

2020 ◽  
Vol 35 (1) ◽  
pp. 34-37
Author(s):  
Michael J. Schuh ◽  
Sheena Crosby
Keyword(s):  
Ambulatory Care ◽  
Tertiary Care ◽  
Medical Clinic ◽  
Care Needs ◽  
Clinical Specialty ◽  
Direct To Consumer ◽  
Care Services ◽  
Medical Issues ◽  
Specialist Practice ◽  
Pharmacist Services

The objective of this manuscript is to review an ambulatory care pharmacist service that evolved into a pharmacotherapy, polypharmacy service with multiple submodels. The practice is located in a multispecialty, tertiary care, destination medical clinic in Florida. Ambulatory care pharmacist services have evolved to demand expertise in multiple, specialized areas to address the more complex medical issues of the polypharmacy patient. Many of these patients are older than 65 years of age, with broad medical care needs. A number of changes have led to the need for these expanded services: the growth and diversification of pharmacists' ambulatory care services, the multitude of sophisticated medications, the continued direct-to-consumer commercialization, the growth of dietary supplements, and the implementation of pharmacogenomic testing, In addition, new advances in clinical and laboratory technologies make polypharmacy a viable pharmacist clinical specialty. With the broad knowledge base needed for these patients, a polypharmacy pharmacist may function as a pharmacology troubleshooter expert.

scholarly journals ICD-10 Codes for the Study of Chronic Overlapping Pain Conditions in Administrative Databases

2020 ◽  
Vol 21 (1-2) ◽  
pp. 59-70
Author(s):  
Andrew Schrepf ◽  
Vy Phan ◽  
J. Quentin Clemens ◽  
William Maixner ◽  
David Hanauer ◽  
...  
Keyword(s):  
Administrative Databases ◽  
Icd 10

scholarly journals Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases

2020 ◽  
pp. svn-2020-000533
Author(s):  
Kori S Zachrison ◽  
Sijia Li ◽  
Mathew J Reeves ◽  
Opeolu Adeoye ◽  
Carlos A Camargo ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Administrative Data ◽  
Administrative Databases ◽  
Accurate Identification ◽  
Stroke Research ◽  
Diagnosis Codes ◽  
Inpatient Hospitalisation ◽  
Icd 10 ◽  
Related Group ◽  
Icd Codes

BackgroundAdministrative data are frequently used in stroke research. Ensuring accurate identification of patients who had an ischaemic stroke, and those receiving thrombolysis and endovascular thrombectomy (EVT) is critical to ensure representativeness and generalisability. We examined differences in patient samples based on mode of identification, and propose a strategy for future patient and procedure identification in large administrative databases.MethodsWe used non-public administrative data from the state of California to identify all patients who had an ischaemic stroke discharged from an emergency department (ED) or inpatient hospitalisation from 2010 to 2017 based on International Classification of Disease (ICD-9) (2010–2015), ICD-10 (2015–2017) and Medicare Severity-Diagnosis-related Group (MS-DRG) discharge codes. We identified patients with interhospital transfers, patients receiving thrombolytics and patients treated with EVT based on ICD, Current Procedural Terminology (CPT) and MS-DRG codes. We determined what proportion of these transfers and procedures would have been identified with ICD versus MS-DRG discharge codes.ResultsOf 365 099 ischaemic stroke encounters, most (87.70%) had both a stroke-related ICD-9 or ICD-10 code and stroke-related MS-DRG code; 12.28% had only an ICD-9 or ICD-10 code and 0.02% had only an MS-DRG code. Nearly all transfers (99.99%) were identified using ICD codes. We identified 32 433 thrombolytic-treated patients (8.9% of total) using ICD, CPT and MS-DRG codes; the combination of ICD and CPT codes identified nearly all (98%). We identified 7691 patients treated with EVT (2.1% of total) using ICD and MS-DRG codes; both MS-DRG and ICD-9/ICD-10 codes were necessary because ICD codes alone missed 13.2% of EVTs. CPT codes only pertain to outpatient/ED patients and are not useful for EVT identification.ConclusionsICD-9/ICD-10 diagnosis codes capture nearly all ischaemic stroke encounters and transfers, while the combination of ICD-9/ICD-10 and CPT codes are adequate for identifying thrombolytic treatment in administrative datasets. However, MS-DRG codes are necessary in addition to ICD codes for identifying EVT, likely due to favourable reimbursement for EVT-related MS-DRG codes incentivising accurate coding.

scholarly journals Specialized fast track: a sustainable model to improve emergency department patient flow

2015 ◽  
Vol 4 (5) ◽  
pp. 40
Author(s):  
Emilpaolo Manno ◽  
Marco Pesce ◽  
Umberto Stralla ◽  
Federico Festa ◽  
Silvio Geninatti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Fast Track ◽  
Patient Flow ◽  
Wait Time ◽  
Emergency Department Patient ◽  
Care Needs ◽  
Time Length ◽  
Hospital Units ◽  
Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

scholarly journals ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

2020 ◽  
Vol 7 (1) ◽  
pp. e000485
Author(s):  
Kelly L Hayward ◽  
Amy L Johnson ◽  
Benjamin J Mckillen ◽  
Niall T Burke ◽  
Vikas Bansal ◽  
...  
Keyword(s):  
Predictive Value ◽  
Large Scale ◽  
Design Method ◽  
International Classification Of Diseases ◽  
Tertiary Hospital ◽  
Administrative Databases ◽  
Resource Utilisation ◽  
Bacterial Peritonitis ◽  
Classification Of Diseases ◽  
Icd 10

ObjectiveThe utility of International Classification of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This study explores the accuracy and limitations of the Australian Modification of the 10th revision of ICD (ICD-10-AM) to detect the presence of cirrhosis and a subset of key complications for the purpose of future large-scale epidemiological research and healthcare studies.Design/methodICD-10-AM codes in a random sample of 540 admitted patient encounters at a major Australian tertiary hospital were compared with data abstracted from patients’ medical records by four blinded clinicians. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, positive predictive value (PPV), negative predictive value and Cohen’s kappa coefficient (κ).ResultsThe PPVs for ‘grouped cirrhosis’ codes (0.96), hepatocellular carcinoma (0.97) ascites (0.97) and ‘grouped varices’ (0.95) were good (κ all >0.60). However, codes under-detected the prevalence of cirrhosis, ascites and varices (sensitivity 81.4%, 61.9% and 61.3%, respectively). Overall accuracy was lower for spontaneous bacterial peritonitis (‘grouped’ PPV 0.75; κ 0.73) and the poorest for encephalopathy (‘grouped’ PPV 0.55; κ 0.21). To optimise detection of cirrhosis-related encounters, an ICD-10-AM code algorithm was constructed and validated in an independent cohort of 116 patients with known cirrhosis.ConclusionMultiple ICD-10-AM codes should be considered when using administrative databases to study the burden of cirrhosis and its complications in Australia, to avoid underestimation of the prevalence, morbidity, mortality and related resource utilisation from this burgeoning chronic disease.

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