Interhospital Transfers of Maternal Patients: Cohort Analysis of Nationwide Inpatient Sample, 2011

2017 ◽  
Vol 35 (01) ◽  
pp. 065-077
Author(s):  
Frank Morriss
Keyword(s):  
Health System ◽  
Nationwide Inpatient Sample ◽  
Perinatal Care ◽  
Cohort Analysis ◽  
The United States ◽  
Teaching Hospitals ◽  
Care Hospital ◽  
American Hospital ◽  
American Hospital Association ◽  
System Characteristics

Objective The objective of this study was to estimate the annual rate of interhospital transfers of pregnant and postpartum women in the United States and analyze associated patient and health system characteristics as measures of regionalized perinatal care performance. Methods Separate weighted univariate analyses of the 2011 Nationwide Inpatient Sample (NIS) were performed for all maternal discharges, in-hospital deaths, and transfers. Multivariable logistic regression analyses for transfer dispositions adjusted for health system characteristics, maternal demographics, and diagnoses were performed. Additional perinatal service characteristics were analyzed using NIS merged with the 2011 American Hospital Association Annual Survey database. Results An estimated 18,082 patients, 0.43% of maternal hospitalizations, were transferred to an acute care hospital; 81% occurred without childbirth delivery before transfer. Transfers were toward larger, urban teaching hospitals and hospitals with higher levels of obstetrical and neonatal care and were more likely in states with ≥4.0 maternal–fetal medicine specialists/10,000 live births. Blacks and Native Americans were more likely and Hispanics and Asians were less likely than white patients to be transferred. Privately insured women were less likely to be transferred than were others. Transfers were associated with life-threatening maternal diagnoses and fetal indications. Conclusion Transfers reflected a risk-based regionalized system of perinatal care, with racial and payer differences.

scholarly journals STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S829-S829
Author(s):  
Teri Kennedy
Keyword(s):  
Older Adults ◽  
Health System ◽  
Baby Boomers ◽  
Health Systems ◽  
Adult Population ◽  
The United States ◽  
Essential Elements ◽  
Conceptual Approach ◽  
American Hospital ◽  
American Hospital Association

Abstract This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.

scholarly journals Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhong Li ◽  
Sayward E. Harrison ◽  
Xiaoming Li ◽  
Peiyin Hung
Keyword(s):  
Continuity Of Care ◽  
Psychiatric Care ◽  
The United States ◽  
Psychiatric Services ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Promising Alternative ◽  
American Hospital ◽  
American Hospital Association ◽  
Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

Hospital Care in the United States, Commission on Hospital Care, New York, The Commonwealth Fund

PEDIATRICS ◽  
1950 ◽  
Vol 6 (1) ◽  
pp. 172-172
Keyword(s):  
New York ◽  
Hospital Care ◽  
The United States ◽  
Hospital Services ◽  
Source Book ◽  
American Hospital ◽  
American Hospital Association ◽  
Commonwealth Fund ◽  
Wide Range ◽  
Present Pattern

Many individuals and organizations have had a part in the making of this book. They have described influences and forces whose interaction has resulted in the present pattern of our hospital services, and documented their interpretations. The result is a source book of basic information which should be valuable for all students of hospital problems. The Commission was appointed by the American Hospital Association, and chosen to represent a wide range of those providing hospital, health and welfare services, as well as the consuming public.

Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Mathias J Holmberg ◽  
Catherine Ross ◽  
Paul S Chan ◽  
Jordan Duval-Arnould ◽  
Anne V Grossestreuer ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
The United States ◽  
Annual Incidence ◽  
Adult Patients ◽  
Negative Binomial Regression Model ◽  
American Hospital ◽  
American Hospital Association ◽  
Average Annual Incidence ◽  
Hospital Cardiac Arrest

Introduction: Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States. Methods: Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (>18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events. Results: There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases. Conclusions: Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.

Are nurses still practicing coronary precautions? A national survey of nursing care of acute myocardial infarction patients

1996 ◽  
Vol 5 (2) ◽  
pp. 91-98 ◽  
Author(s):  
B Riegel ◽  
T Thomason ◽  
B Carlson ◽  
I Gocka
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Temperature Measurement ◽  
Rectal Temperature ◽  
Valsalva Maneuver ◽  
The United States ◽  
American Hospital ◽  
American Hospital Association ◽  
Survey Techniques ◽  
The 1960S

BACKGROUND: Coronary precautions were common when coronary care units were instituted in the 1960s. However, research has failed to provide evidence of the validity of most of these restrictions. Only the avoidance of the Valsalva maneuver is clearly indicated as a universal precaution in patients who have experienced acute myocardial infarction. OBJECTIVES: To determine if nurses continue to restrict iced and hot fluids, caffeine, rectal temperature measurement, and vigorous back rubs, and to feed and mandate bedrest for acute myocardial infarction patients. METHODS: Survey techniques were used to describe practice patterns of nurses working in hospitals across the United States. Two sampling methods were used to access a random sample. The survey was mailed to members of the American Association of Critical-Care Nurses and nonmembers working in a hospital accredited by the American Hospital Association and with an intensive care unit. RESULTS: Of the 2549 mailed surveys, 882 were returned with usable data (34.8% response rate). Iced (28.1%) and hot (8.7%) fluids continued to be restricted by nurses. Most (85.6%) restricted stimulant beverages such as coffee. Rectal temperature measurement was avoided by 55.7%, and only 73.3% taught avoidance of the Valsalva maneuver. In terms of rest, 15.6% reported avoiding vigorous back rubs, 8.4% still fed patients, and 33.8% offered bedpans to pain-free patients on the first day after admission. A complete bedbath was offered by 19.8% of nurses to stable, pain-free patients even a day after admission. CONCLUSIONS: The data supporting liberalization of coronary precautions have not been adequately disseminated.

scholarly journals Polypharmacy in Older Adults Hospitalized for Heart Failure

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Ozan Unlu ◽  
Emily B. Levitan ◽  
Evgeniya Reshetnyak ◽  
Jerard Kneifati-Hayek ◽  
Ivan Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Racial Differences ◽  
The United States ◽  
Negative Effects ◽  
Real World Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Regards Study

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

Antifungal Susceptibility Testing in Teaching Hospitals

2003 ◽  
Vol 37 (2) ◽  
pp. 192-196 ◽  
Author(s):  
Manjunath P Pai ◽  
Susan L Pendland
Keyword(s):  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Teaching Hospitals ◽  
National Committee ◽  
American Hospital ◽  
American Hospital Association ◽  
Initial Mailing ◽  
Blood Specimens

BACKGROUND: An assessment of antifungal susceptibility testing (AST) has not been conducted since the introduction of the National Committee for Clinical Laboratory Standards (NCCLS) M27-A document. OBJECTIVE: To determine AST practices in teaching hospitals. METHODS: A questionnaire was mailed to the heads of 386 randomly assigned microbiology departments from teaching hospitals identified through the 2000 American Hospital Association Guide. Identifiers were used to delineate responders from nonresponders. A reminder letter was mailed 3 weeks after the initial mailing to all nonresponders. The hospital bed-size and number of inpatient days for respondents were obtained through the American Hospital Directory. RESULTS: The questionnaire was returned by 171 (44.3%) institutions. The total and median (range) number of candida isolates were 137 088 and 8.5 (1–145)/1000 inpatient days for the year 2000, respectively. Approximately 1% (1300) of candida isolates, from predominantly blood specimens, underwent AST. AST was reported by 115 (67.2%) hospitals, with testing on site at 27 hospitals and off site for 88 hospitals. NCCLS methodology (80% broth microdilution) was used by 75% of the hospitals performing on-site AST. The median time to obtain AST results was significantly lower when testing was performed on site (3 d) compared with off site (7–10 d). SUMMARY: A large number of candida bloodstream isolates undergoes AST annually. AST results are obtained sooner when performed on site compared with off site.

scholarly journals Bundled Consent in US Intensive Care Units

2020 ◽  
Vol 29 (3) ◽  
pp. e44-e51
Author(s):  
Maria L. Espinosa ◽  
Aaron M. Tannenbaum ◽  
Megha Kilaru ◽  
Jennifer Stevens ◽  
Mark Siegler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
The United States ◽  
Self Report ◽  
Medical Decision ◽  
Consent Rate ◽  
Surgical Intensive Care ◽  
American Hospital ◽  
American Hospital Association

Background Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients’ wishes into medical decision-making without sacrificing patients’ or surrogates’ understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown. Objective To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent. Methods A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-reportuse of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent. Results Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent. Results Bundled consent use is uncommon in academic and nonacademic intensive care units, most likely because of conflicting evidence about the effect on patients and surrogate decision makers. Future work is needed to determine if patients, family members, and providers prefer bundled consent over per-procedure consent.

Outcomes With Severe Blastomycosis and Respiratory Failure in the United States

2020 ◽  
Author(s):  
Barret Rush ◽  
Sylvain Lother ◽  
Bojan Paunovic ◽  
Owen Mooney ◽  
Anand Kumar
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Ventilatory Support ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
The United States ◽  
Teaching Hospitals ◽  
Historical Case ◽  
Increased Risk

Abstract Background Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. Methods We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged >18 years with a diagnosis of blastomycosis who received MV were included. Results There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P < .01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P < .01). Conclusions In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.

Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and Other U.S. Hospitals

2020 ◽  
Vol 50 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Gracie Himmelstein ◽  
Kathryn E. W. Himmelstein
Keyword(s):  
United States ◽  
The United States ◽  
People Of Color ◽  
American Hospital ◽  
American Hospital Association ◽  
Capital Assets ◽  
Physical Assets ◽  
Association Data ◽  
Hispanic Serving ◽  
Capital Intensive

Racial inequities in health outcomes are widely acknowledged. This study seeks to determine whether hospitals serving people of color in the United States have lesser physical assets than other hospitals. With data on 4,476 Medicare-participating hospitals in the United States, we defined those in the top decile of the share of black and Hispanic Medicare inpatients as “black-serving” and “Hispanic-serving,” respectively. Using 2017 Medicare cost reports and American Hospital Association data, we compared the capital assets (value of land, buildings, and equipment), as well as the availability of capital-intensive services at these and other hospitals, adjusted for other hospital characteristics. Hospitals serving people of color had lower capital assets: for example, US$5,197/patient-day (all dollar amounts in U.S. dollars) at black-serving hospitals, $5,763 at Hispanic-serving hospitals, and $8,325 at other hospitals ( P < .0001 for both comparisons). New asset purchases between 2013 and 2017 averaged $1,242, $1,738, and $3,092/patient-day at black-serving, Hispanic-serving, and other hospitals, respectively ( P < .0001). In adjusted models, hospitals serving people of color had lower capital assets (−$215,121/bed, P < .0001) and recent purchases (−$83,608/bed, P < .0001). They were also less likely to offer 19 of 27 specific capital-intensive services. Our results show that hospitals that serve people of color are substantially poorer in assets than other hospitals and suggest that equalizing investments in hospital facilities in the United States might attenuate racial inequities in care.

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