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

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 Are patients more adherent to newer drugs?

2020 ◽  
Vol 23 (4) ◽  
pp. 605-618
Author(s):  
Katharina E. Blankart ◽  
Frank R. Lichtenberg
Keyword(s):  
Therapeutic Potential ◽  
Unobserved Heterogeneity ◽  
Distribution Channel ◽  
Patient Characteristics ◽  
Situational Factors ◽  
Cross Sectional ◽  
Promotional Activity ◽  
Individual Level ◽  
Percentage Point Increase ◽  
Clinical Benefits

AbstractThe annual preventable cost from non-adherence in the US health care system amounts to $100 billion. While the relationship between adherence and the health system, the condition, patient characteristics and socioeconomic factors are established, the role of the heterogeneous productivity of drug treatment remains ambiguous. In this study, we perform cross-sectional retrospective analyses to study whether patients who use newer drugs are more adherent to pharmacotherapy than patients using older drugs within the same therapeutic class, accounting for unobserved heterogeneity at the individual level (e.g. healthy adherer bias). We use US Marketscan commercial claims and encounters data for 2008–2013 on patients initiating therapy for five chronic conditions. Productivity is captured by a drug’s earliest Food and Drug Administration (FDA) approval year (“drug vintage”) and by FDA” therapeutic potential” designation. We control for situational factors as promotional activity, copayments and distribution channel. A 10-year increase in mean drug vintage is associated with a 2.5 percentage-point increase in adherence. FDA priority status, promotional activity and the share of mail-order prescription fills positively influenced adherence, while co-payments had a negative effect. Newer drugs not only may be more effective in terms of clinical benefits, on average. They provide means to ease drug therapy to increase adherence levels as one component of drug quality, a notion physicians and pharmacy benefit managers should be aware of.

scholarly journals Unplanned hospitalisations in older people: illness trajectories in the last year of life

2021 ◽  
pp. bmjspcare-2020-002778
Author(s):  
Máté Szilcz ◽  
Jonas W Wastesson ◽  
Kristina Johnell ◽  
Lucas Morin
Keyword(s):  
Older People ◽  
End Of Life ◽  
Incidence Rate ◽  
Cause Of Death ◽  
Functional Decline ◽  
Care Transitions ◽  
Average Risk ◽  
Individual Level ◽  
The Individual ◽  
Rate Ratios

ObjectiveUnplanned hospitalisations can be burdensome for older people who approach the end of life. Hospitalisations disrupt the continuity of care and often run against patients’ preference for comfort and palliative goals of care. This study aimed to describe the patterns of unplanned hospitalisations across illness trajectories in the last year of life.MethodsLongitudinal, retrospective cohort study of decedents, including all older adults (≥65 years) who died in Sweden in 2015. We used nationwide data from the National Cause of Death Register linked at the individual level with several other administrative and healthcare registers. Illness trajectories were defined based on multiple-cause-of-death data to approximate functional decline near the end of life. Incidence rate ratios (IRR) for unplanned hospitalisations were modelled with zero-inflated Poisson regressions.ResultsIn a total of 77 315 older decedents (53% women, median age 85.2 years), the overall incidence rate of unplanned hospitalisations during the last year of life was 175 per 100 patient-years. The adjusted IRR for unplanned hospitalisation was 1.20 (95%CI 1.18 to 1.21) times higher than average among decedents who followed a trajectory of cancer. Conversely, decedents who followed the trajectory of prolonged dwindling had a lower-than-average risk of unplanned hospitalisation (IRR 0.66, 95% CI 0.65 to 0.68). However, these differences between illness trajectories only became evident during the last 3 months of life.ConclusionOur study highlights that, during the last 3 months of life, unplanned hospitalisations are increasingly frequent. Policies aiming to reduce burdensome care transitions should consider the underlying illness trajectories.

Systemic Effects of Campaign Spending: Evidence from Corporate Contribution Bans in US State Legislatures

2015 ◽  
Vol 4 (2) ◽  
pp. 343-359 ◽  
Author(s):  
Andrew B. Hall
Keyword(s):  
Campaign Finance ◽  
State Level ◽  
Campaign Spending ◽  
Policy Outcomes ◽  
Systemic Effects ◽  
Individual Level ◽  
Percentage Point Increase ◽  
Corporate Campaign ◽  
Corporate Contribution ◽  
The Individual

In this paper, I examine the systemic effects of campaign spending, looking at outcomes at the level of the legislature rather than the individual seat. Using a difference-in-differences design, I show that state-level corporate campaign contribution bans have a large effect on electoral outcomes at the legislature level. A 1 percentage-point increase in the Democratic (or Republican) party’s share of all contributions in an electoral cycle is estimated to increase its share of the legislature by roughly half a percentage point. Policy outcomes as well as campaign finance reforms occur at the legislature level; understanding the systemic rather than individual-level effect of campaign spending is therefore directly relevant. Aggregating estimated effects of individual-level campaign finance would not produce this same estimate owing to spillovers and other strategic dynamics. Taken together, the analyses suggest that contribution bans have important electoral effects and thus point to the systemic effects of campaign spending.

Healthcare providers perception of therapeutic patient education efficacy according to patient and healthcare provider characteristics

2021 ◽  
pp. 174239532110584
Author(s):  
Deborah Loyal ◽  
Laetitia Ricci ◽  
Julie Villegente ◽  
Carole Ayav ◽  
Joelle Kivits ◽  
...  
Keyword(s):  
Patient Education ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Medical Knowledge ◽  
Patient Characteristics ◽  
Therapeutic Patient Education ◽  
Individual Level ◽  
Individual Interviews ◽  
Provider Characteristics ◽  
The Individual

Objectives Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. Methods Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n=28, including 20 nurses) involved in therapeutic patient education programs ( n=14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). Results Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals’ characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. Discussion Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful.

scholarly journals The Pluralisation of Living Arrangements – A Continuous Trend?

2014 ◽  
Vol 39 (1) ◽  
Author(s):  
Michael Wagner ◽  
Isabel Valdés Cifuentes
Keyword(s):  
Living Arrangements ◽  
East Germany ◽  
Cohort Analysis ◽  
General Social Survey ◽  
Age Groups ◽  
Married Couples ◽  
West Germany ◽  
Household Level ◽  
Individual Level ◽  
The Individual

This paper investigates to what extent a pluralisation of living arrangements can be observed in Germany up to the present day – both on the household level as well as the individual level. The analyses are based on data from the microcensus and the German General Social Survey (ALLBUS) from the last decades.On the household level, eight different living arrangements are distinguished depending on the marital status and the number of generations living in the household. The results show that pluralisation mainly occurred between 1972 and 1996. In contrast, the diversity of living arrangements in West Germany has remained unchanged during the last 20 years, and it even slightly decreased in East Germany. A different picture emerges when separately looking at one-generation and two-generation households. Living arrangements with children have also diversified in recent years, which is mainly the result of less married couples with children.On the individual level, the classification of living arrangements was extended by the characteristic gender-specific division of labour, since the changed role of women is seen as the crucial factor for the changes in the familial sector. The results indicate a continuous pluralisation of living arrangements. This pluralisation of the familial sector is mainly caused by the male breadwinner model losing importance. This trend is more pronounced in East Germany than in West Germany.A cohort analysis reveals a bimodal distribution of diversity on the age-axis: entropy is highest around the ages of 30 and 60, since living arrangements often change at these points. Individuals often marry around the age of 30, and the transition to an “empty nest” mostly occurs around the age of 60. The cohort analysis for different age groups shows that the diversity of living arrangements is generally higher amongst younger cohorts than amongst older cohorts.

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.

Changes in vascular accesses and in incidence rates of dialysis-related bloodstream infections in Québec, Canada, 2011–2017

2019 ◽  
Vol 40 (6) ◽  
pp. 627-631
Author(s):  
Élise Fortin ◽  
Manale Ouakki ◽  
Claude Tremblay ◽  
Jasmin Villeneuve ◽  
Simon Desmeules ◽  
...  
Keyword(s):  
Cohort Study ◽  
Incidence Rate ◽  
Poisson Regression ◽  
Generalized Estimating Equations ◽  
Bloodstream Infections ◽  
Incidence Rates ◽  
Chronic Dialysis ◽  
Individual Level ◽  
The Individual ◽  
Over Time

AbstractObjective:Surveillance of dialysis-related bloodstream infections (DRBSIs) has been mandatory in Québec since April 2011. The aim of this study was to describe the epidemiology of DRBSIs in Québec.Methods:Cohort study of prevalent patients undergoing chronic dialysis in the 36 facilities that participated without interruption in the provincial surveillance, between April 2011 and March 2017. Two indicators were analyzed: proportion of patient months dialyzed using a fistula (a patient month is a 28-day cycle during which an individual patient received dialysis) and incidence rate of DRBSI. Binomial and Poisson regression with generalized estimating equations were used to describe the evolution of indicators over time and to quantify the association between facilities’ proportion of fistulas and their incidence rate.Results:Globally, 42.6% of all patient months were dialyzed using a fistula, but there was a statistically significant decrease over time (46.2% in 2011–2012 to 39.3% in 2016–2017). Despite this decline in the use of fistulas, rates of DRBSIs have also decreased, going from 0.38 DRBSIs per 100 patient months in 2011–2012 to 0.23 DRBSIs per 100 patient months in 2016–2017. No association was found between facility use of fistulas and the rate of DRBSI. At the individual level, however, the DRBSI rate was 4.12 times higher for patients using a catheter.Conclusions:In Québec, the rate of DRBSIs has decreased over a 6-year period despite an increasing proportion of patients dialyzed by catheter.

Usefulness of mean number of adenomas per positive screenee for identifying meticulous endoscopists among those who achieve acceptable adenoma detection rates

Endoscopy ◽  
2020 ◽  
Author(s):  
Satimai Aniwan ◽  
Kunvadee Vanduangden ◽  
Stephen J. Kerr ◽  
Naruemon Wisedopas ◽  
Natanong Kongtab ◽  
...  
Keyword(s):  
Detection Rate ◽  
Linear Models ◽  
High Standard ◽  
Patient Characteristics ◽  
Detection Rates ◽  
Percentage Point Increase ◽  
Additional Information ◽  
Point Increase ◽  
Adenoma Detection ◽  
Advanced Adenomas

Abstract Background Adenoma detection rate (ADR) is a quality indicator for colonoscopy. However, many missed adenomas have subsequently been identified after colonoscopies performed by endoscopists with ADR ≥ 25 %. Adenomas per positive participant (APP; mean number of adenomas detected by an endoscopist among screenees with positive findings) correlates well inversely with adenoma miss rate. This study aimed to evaluate whether APP added additional information on the detection rate for advanced adenomas (AADR) and proximal adenomas (pADR) and among endoscopists with acceptable ADRs (≥ 25 %). Methods A total of 47 endoscopists performed 7339 screening colonoscopies that were retrospectively reviewed. Using a cutoff APP value of 2.0, endoscopist performance was classified as high or low APP. Endoscopist ADRs were also classified as acceptable (25 % – 29 %), high standard (30 % – 39 %) and aspirational (≥ 40 %). Generalized linear models were used to assess the relationship between AADR or pADR, and ADR and APP, after adjusting for potential confounders. Results After adjusting for endoscopist performance and patient characteristics, endoscopists with high APP had a significant 2.1 percentage point increase in AADR (95 %CI 0.3 to 3.9; P = 0.02) and a 2.1 percentage point increase in pADR (95 %CI – 0.8 to 5.1; P = 0.15) compared to endoscopists with low APP. In total, 11 (24 %), 18 (38 %), and 18 (38 %) endoscopists were classified as having acceptable, high standard, and aspirational ADRs, respectively. APP values higher than the cutoff were found in 18 %, 44 %, and 72 % of endoscopists with acceptable, high standard, and aspirational ADRs, respectively (P = 0.02). Conclusion APP is helpful for identifying more meticulous endoscopists who can detect a greater number of advanced adenomas. Endoscopists who achieved an only acceptable ADR had the lowest APP.

Sign in / Sign up

Export Citation Format

Share Document