scholarly journals Healthcare Utilization Due to Suicide Attempts among Homeless Youth in New York State

2021 ◽  
Author(s):  
Rie Sakai-Bizmark ◽  
Hiraku Kumamaru ◽  
Dennys Estevez ◽  
Emily H Marr ◽  
Edith Haghnazarian ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Length Of Stay ◽  
Suicide Attempt ◽  
Healthcare Utilization ◽  
Regression Models ◽  
Homeless Youth ◽  
Suicide Attempts ◽  
New York State ◽  
Individual Characteristics

Abstract Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.

scholarly journals Healthcare Utilization of Homeless Minors with Diabetes Mellitus in New York State from 2009 to 2014

2020 ◽  
Author(s):  
Rie Sakai-Bizmark ◽  
Laurie A. Mena ◽  
Dennys Estevez ◽  
Eliza J. Webber ◽  
Emily H. Marr ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
New York ◽  
Hospital Mortality ◽  
Healthcare Utilization ◽  
Regression Models ◽  
New York State ◽  
Hospitalization Rate ◽  
Homeless Population ◽  
Hospitalization Cost ◽  
Hospitalization Costs

<i>Objective</i>: This study aims to describe differences in healthcare utilization between homeless and non-homeless minors with diabetes mellitus (DM). <p><i>Research Design and Methods</i>: Data from the Healthcare Cost and Utilization Project’s Statewide Inpatient Database from New York for years 2009-2014 was examined to identify pediatric patients <18 years old with DM. Outcomes of interest included: hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and lengths of stay (LOS). Other variables of interest included: age group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS.</p> <p><i>Results</i>: A total of 643 homeless and 10,559 non-homeless cases were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population and 0.38 per 1,000 non-homeless population, respectively. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among non-homeless, <i>p</i> <0.01). Lower rates of DKA (OR 0.75, <i>p</i>=0.02), hospitalization costs (point estimate 0.88,<i> p</i> <.01), and longer LOS (Incidence Rate Ratio (IRR) 1.20, <i>p</i> <0.01) were detected among homeless minors compared to non-homeless minors. </p> <p><i>Conclusions</i>: This study found that among minors with DM, those who are homeless experience a higher hospitalization rate than the non-homeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.</p>

scholarly journals Analysis of suicidal patients admitted to the emergency rooms and their intensive care requirements: A double-center study in Turkey

2019 ◽  
Vol 6 (10) ◽  
pp. 224-229
Author(s):  
Betül Kocamer Şimşek ◽  
Şengül Kocamer Şahin
Keyword(s):  
Emergency Department ◽  
New York ◽  
Domestic Violence ◽  
Intensive Care ◽  
Suicide Attempt ◽  
Suicide Attempts ◽  
Demographic Data ◽  
Acute Poisoning ◽  
Family Issues ◽  
The Mean

Objective: In the present study, the clinical and socio-demographic data of the patients who admitted to the emergency department due to suicide attempt, the duration at the emergency department, and hospitalizations are examined. Requirement of intensive care and duration of hospitalization are investigated in the patients with suicide attempt. Materials and Methods: Patients who were admitted to the emergency department of the hospitals after suicide attempts between 2015 and 2017 and per 2018 were included in the retrospective study. Reason for suicide, suicide modality, duration between the suicide attempt and arrival to the emergency department, suicide time, first treatment at the emergency department, hospitalization, mortality, and the levels at the intensive care unit (ICU) were retrospectively reviewed and analyzed. Data obtained from the archives of the hospitals. SPSS 25.0 (IBM Corporation, Armonk, New York, United States) program was used to analyze the variables. Results: In the present study, 428 patients were included. Ratio of the female to male patients was 319/109. The mean age of the patients was 29.18±10.48. 205 patients were single. 136 patients were unemployed. Ninety-four (22.87%) patients were diagnosed with a psychiatric disorder. Four hundred twenty-two (98.59%) of the patients were attempted suicide with drugs/toxics. One hundred ninety-seven patients (49.75%) reported domestic violence and family issues reasons for suicide. Mean duration between the time of suicide and the time to arrive to the emergency department was 100.53±91.82 minutes. One hundred thirty (30.5%) patients were transferred to ICU, and 45 (10.5%) patients were followed in clinical departments. One hundred twenty (92.3%) patients hospitalized in the first-level ICU, 4 (3%) in the second-level ICU, and 6 (4.6%) in the third-level ICU. The mean ICU stay was 2.37±1.48 days. Conclusion: The suicide attempts were prominent in acute poisoning cases. Majority of the patients stated domestic violence and family issues as a reason of suicide. They were discharged mostly from the emergency department and 10.5% of the patients were kept under surveillance in the departments. When the suicide attempts were evaluated in terms of their time, they were observed during day time at a higher rate.

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

2021 ◽  
pp. 153857442199331
Author(s):  
Nicole Ilonzo ◽  
Cody Goldberger ◽  
Songhon Hwang ◽  
Ajit Rao ◽  
Peter Faries ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Bypass Surgery ◽  
New York State ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Peripheral Bypass ◽  
Extreme Risk ◽  
Risk Of Mortality ◽  
Fourth Quartile

Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

The Impact of Legislation Requiring DNR Orders: New York State Compared with Neighboring States

1996 ◽  
Vol 11 (6) ◽  
pp. 335-342 ◽  
Author(s):  
Daniel Teres ◽  
Keith Boyd ◽  
John Rapoport ◽  
Martin Strosberg ◽  
Robert Baker ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Data Base ◽  
New York State ◽  
The Other ◽  
Data Bases ◽  
York State ◽  
Icu Discharge ◽  
The Impact ◽  
Dnr Orders

Decisions to place limitations on the care of patients are complex, and they often involve physicians, other medical professionals, patients, or a surrogate decision-maker, family members, and others. In 1988, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and the New York State government adopted two different approaches to this complex issue of do-not-resuscitate (DNR) orders: one involved professional self-regulation, whereas the other mandated a standardized procedure requiring completion of legal documents. This study examines the impact of these two different approaches to writing of DNR orders for adult intensive care unit (ICU) patients on utilization and resulting length of stay. The study used three data bases. One is from a larger study designed to update the Mortality Probability Model (MPM), a measure of severity of illness for ICU patients. This data base includes consecutive admissions to the adult ICUs of four hospitals in the northeastern United States. The second is a similar data base from the European-North American Study of Severity Systems (ENAS), and it includes 20 hospitals. The third data base, a 1991 national survey of ICUs by the Society of Critical Care Medicine (SCCM), lists characteristics of patients in ICUs in the United States on a specific day. Logistic regression was used to analyze the first two data bases; the percentage of patients in New York with DNR orders was calculated for each of the three data bases and compared with patients in neighboring states. Length of ICU and hospital stay was measured in the first two data sets. In the MPM data, 14.4% of medical patients in New York had a DNR order written at the time of ICU discharge, compared with 198% of medical patients in Massachusetts; and 4.3% of New York surgical patients had a DNR order written at the time of ICU discharge, compared with 8.3% of surgical patients in Massachusetts. In the ENAS data, 7.4% of New York nonoperative patients has a DNR order in place within 24 hours, compared with 8.4% of such patients in the other states; and 1.0% of New York operative patients had DNR orders, compared with 3–5% of operative patients from other states. Logistic regression revealed that a New York patient was less likely to have a DNR order written than a patient located in one of the other states studied. Data from the SCCM survey demonstrated that the New York percentage of patients with “no CPR” orders was 5.50%, compared with a percentage of 6.87% in other states. With few exceptions, these differences between New York and surrounding states did not have an impact on hospital length of stay. During the period studied following implementation of New York's DNR Law, utilization of DNR orders in New York State was significantly lower than neighboring states. This decreased utilization, however, did not effect hospital utilization as measured through length of stay and ICU admissions.

Relationships Between Length of Stay in and out of the New York State Mental Hospitals

1973 ◽  
Vol 130 (8) ◽  
pp. 904-909 ◽  
Author(s):  
ABBOTT S. WEINSTEIN ◽  
DIANE DIPASQUALE ◽  
FREDERICK WINSOR
Keyword(s):  
New York ◽  
Length Of Stay ◽  
New York State ◽  
York State ◽  
Mental Hospitals ◽  
State Mental

scholarly journals Positive Predictive Value of ICD-10-CM Definitions for Adolescent Intentional Self-Harm: An Emergency Department Medical Record Review

2020 ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia F Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Positive Predictive Value ◽  
Medical Record ◽  
Predictive Value ◽  
Suicide Attempts ◽  
Pediatric Population ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study proposed a definition for identifying intentional self-harm injuries (ISHIs) in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and sought to estimate: (1) the definition’s positive predictive value (PPV) in a pediatric population treated in one Kentucky ED, and (2) the proportion of Intentional self-harm injuries (ISHIs) with intent to die (i.e., suicide attempt) that cannot be captured by ICD-10-CM codes and can only be identified by a medical record abstraction. Methods The study definition captured initial encounters for ISHIs based on first valid external cause-of-injury self-harm codes in the ICD-10-CM range X71-X83, T14.91, T36-T65, or T71. Medical records for a random sample of 207 ED discharge records were reviewed following a specified protocol. The PPV for the study definition was reported with its 95% confidence interval (95%CI). Results The estimated PPV for the study definition’s ability to capture true ISHIs was 88.9%, 95%CI (83.8%, 92.8%). The estimated percentage of ISHIs with intent to die was 45.9%, 95%CI (47.1%, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines allow assignment of this code only when the mechanism of the suicide attempt is unknown. Conclusions This study demonstrated a critical shortcoming in U.S. morbidity surveillance. The ICD-10-CM coding system and coding guidelines do not allow accurate identification of ISHIs with intent to die; modifications are needed to address this issue.

scholarly journals Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department

2021 ◽  
Vol 11 ◽  
Author(s):  
Dong Wook Kim ◽  
Seo Eun Cho ◽  
Jae Myeong Kang ◽  
Soo Kyun Woo ◽  
Seung-Gul Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Emergency Department ◽  
Suicide Attempt ◽  
Old Age ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Interpersonal Stress ◽  
Suicide Attempters ◽  
Male Sex

Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department.Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age &lt;65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups.Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p &lt; 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p &lt; 0.001), male sex (B = −0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = −0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale.Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.

scholarly journals Indicators of early hospitalization decision to shorten emergency department length of stay of suicide attempters

2020 ◽  
Author(s):  
Hye Jin Kim ◽  
Duk Hee Lee
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Psychiatric Ward ◽  
Operating Characteristics ◽  
Psychiatric Admission ◽  
Suicide Attempters ◽  
Tertiary Teaching ◽  
The Mean

Abstract Background Suicide attempters contribute to a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before committing suicide. The emergency department (ED) is the first location where suicide attempters are brought. This study investigated the factors associated with early hospitalization decisions to determine the criteria for patient hospitalization rather than psychiatric ward admission and identify measures to shorten ED length of stay (LOS). Methods This study included suicide attempters (age ≥19 years) who visited the EDs at two tertiary teaching hospitals between March 2017 and April 2020. Results A total of 414 in the hospitalization and 1,346 in the discharge groups patients were included. The mean age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalization and discharge groups (p <0.001). The mean ED LOS was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalization and discharge groups, respectively. In the hospitalization group, the odds ratio and confidence interval for age (1.017, 1.008–1.026), sex (male) (1.787, 1.127–2.515), consciousness (2.330, 1.653–3.266), and the Risk-Rescue Ratio Scale (RRRS) (1.273, 1.242–1.304) were calculated. A receiver operating characteristics analysis of RRRS for the decision to hospitalize suicide attempters showed a cut-off value of 42, with sensitivity, specificity, and area under the curve of 85.7%, 85.5%, and 0.924, respectively.Conclusion For suicidal attempters in the ED, the decision on medical hospitalization rather than psychiatric admission should be based on their level of consciousness and the RRRS to reduce ED LOS and crowding.

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