scholarly journals Hospice Care Inequities in Individuals With Alzheimer's Disease and Related Dementias

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 330-330
Author(s):  
Leah Estrada ◽  
Aditi Durga ◽  
Shih-Yin Lin ◽  
Ariel Ford ◽  
Abraham Brody
Keyword(s):  
Length Of Stay ◽  
Hospice Care ◽  
Pragmatic Trial ◽  
Primary Diagnosis ◽  
Descriptive Statistics ◽  
Secondary Diagnosis ◽  
Association Tests ◽  
Diagnosis Of Dementia ◽  
Race Ethnicity ◽  
Using Data

Abstract Despite known benefits of hospice, inequities exist. Using data from a multi-site pragmatic trial in a representative groups of hospices, we examined inequities in length of stay (LOS) and general inpatient use (GIU) for 12,153 patients with dementia (primary and secondary diagnosis) using descriptive statistics and association tests. There were significant associations between race/ethnicity and GIU and LOS (p< 0.001). In those with primary diagnosis of dementia, Asian (31%) and Black/AA (24%) individuals had significantly greater utilization of GIU than Hispanic (19%) and white individuals (21%). Greater inequities were found in those with a secondary diagnosis. LOS amongst Asians were shortest with 78% having an LOS ≦14 vs 50-59% in other groups. Differences in long-stay >60 days (7%) vs 14-22% in other groups were found. There were similar differences examining by primary vs. secondary diagnosis. These inequities point to cultural and systems factors that require further study and intervention.

scholarly journals MP12: Acute asthma presentations to emergency departments in Alberta: an epidemiological analysis of presentations

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S69
Author(s):  
C. Alexiu ◽  
L. Krebs ◽  
C. Villa-Roel ◽  
B.R. Holroyd ◽  
M. Ospina ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Asthma ◽  
Patient Flow ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
Upper Respiratory Infection ◽  
X Ray ◽  
Icd 10 ◽  
Chest X Ray ◽  
Ionizing Radiation Exposure

Introduction: Asthma is a chronic condition and exacerbations are a common reason for emergency department (ED) presentations across Canada. The objective of this study was to characterize and describe acute asthma presentations over a five-year period. Methods: Administrative health data for Alberta from 2011-2015 was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) acute asthma (ICD-10-CA: J45) ED presentations. All presentations to an Alberta ED with a primary or secondary diagnosis of acute asthma were eligible for inclusion. Presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1 were excluded. Data from NACRS were linked with a provincial diagnostic imaging database. Data are reported as means and standard deviation (SD), medians and interquartile range (IQR) or proportions, as appropriate. Results: From 2011-2015, a total of 51,269 (~10,000/year) acute asthma presentations were made by 34,481 patients (~0.3 presentations per patient per year). The median age was 35 years (IQR: 25, 49 years) and more patients were female (57.2%). Few patients arrived to the ED by ambulance (6.5%) and the most frequent CTAS score was 3 (43.5%). The majority of these patients (77%) had a primary diagnosis of asthma in the ED. Differences were explored between those with a primary asthma diagnosis and those with a secondary diagnosis (e.g., ambulance arrival, length of stay, hospital admission, etc.). Although differences were statistically significant, no clinically relevant differences were identified. Patients with asthma most frequently had a co-diagnosis of acute upper respiratory infection (6.2%); other co-diagnoses included bronchitis (4.7%), pneumonia (3.7%), heart failure (0.18%), pulmonary embolism (0.15%), and pneumothorax (0.03%). For 39.3% of patients, ED management included chest x-ray. The majority of patients were discharged from the ED (92.2%) following a median length of stay of 2.2 hours (IQR: 1.2, 3.8 hours). Conclusion: Acute asthma remains an important ED presentation in Alberta and the absolute frequency of presentations has remained relatively stable over the past five years. Frequency of chest x-ray ordering is high and represents a target for future interventions to reduce ionizing radiation exposure, improve patient flow and reduce healthcare costs.

scholarly journals Length of Stay in Hospice Care across Racial/Ethnic Minorities over 65 Years of Age: A Descriptive Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 778-778
Author(s):  
Heshuo Yu ◽  
J Scott Brown
Keyword(s):  
African Americans ◽  
Length Of Stay ◽  
Hospice Care ◽  
Descriptive Analysis ◽  
Secondary Analysis ◽  
Female Gender ◽  
The United States ◽  
Future Research ◽  
Race Ethnicity ◽  
The Relationship

Abstract Purpose This study aims to explore the relationship between race/ethnicity and length of stay in hospice care among adults over 65 years of age in the United States. This topic is understudied within a population-representative sample, particularly among non-White decedents. Methods Secondary analysis of data from the 2007 NHHCS (n=3,918). Race/ethnicity included Hispanics/Latinos, Non-Hispanic Whites, African Americans, and other races. Length of hospice stay was measured by the number of days that patients received hospice care from hospice agencies. Results The study found that African Americans have a longer length of stay in hospice agencies than Whites, even after controlling for all other factors in the model. Female gender, older age, and several diseases are covariates that significantly impact length of hospice stay. Discussion Compared to other races/ethnicities, the long length of stay in hospice among African Americans may negatively impact the quality of end-of-life care and quantity of skilled staff visits. Future research is recommended to further explore potential consequences of longer hospice stays, especially within African American communities. Studies with larger samples of minorities that integrate socioeconomic factors need to be done to better study the relationship between length of hospice stay and race/ethnicity.

Abstract 15871: Trends in Myocardial Infarction as a Secondary Discharge Diagnosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emily B Levitan ◽  
Paul Muntner ◽  
Ligong Chen ◽  
George Howard ◽  
Meredith L Kilgore ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Primary Diagnosis ◽  
Discharge Diagnosis ◽  
Secondary Diagnosis ◽  
Medicare Beneficiaries ◽  
Time Period ◽  
Classification Of Diseases ◽  
Episodes Of Care ◽  
Using Data ◽  
Secondary Hospital

Background: Little research has focused on myocardial infarctions (MIs) that are not the primary illness, and thus MI is listed as a secondary hospital discharge diagnosis. Objective: We examined secular trends in the proportion of MI hospitalizations where MI was a secondary diagnosis and changes in the primary reasons for hospitalization associated with secondary diagnosis of MI. Methods: Using data from the Medicare national 5% sample for 1999-2011, we identified MI hospitalizations as inpatient claims with primary or secondary discharge diagnoses of International Classification of Diseases, Ninth Revision, Clinical Modification, 410.xx, excluding 410.x2 which represents subsequent episodes of care. This approach has previously been validated. For each year, we calculated the proportion of MI hospitalizations where the MI diagnosis appeared in a secondary position. For hospitalizations with MI as a secondary diagnosis, we examined the trends in the most common primary diagnoses. Results: The number of MI hospitalizations ranged from 20,821 in 2003 to 17,640 in 2011 among Medicare beneficiaries in the 5% sample. In 1999, 21% of MI diagnoses were secondary diagnoses, and by 2011, this proportion had risen to 36% (Figure). Over this time period, the proportion of MI hospitalizations with congestive heart failure and coronary atherosclerosis as primary diagnoses declined (16% to 9%, and 11% to 3%, respectively) and the proportion with septicemia as the primary diagnosis increased (3% to 17%). Conclusions: Our results suggest that a growing number and percentage of MI diagnoses are occurring among patients hospitalized for other reasons. The causes of this increase require further investigation. Because individuals whose primary illness is not MI are underrepresented in research studies, the appropriateness and effectiveness of secondary prevention of cardiovascular disease in this patient population are not well described.

scholarly journals SAT-LB119 Diabetic Ketoacidosis With PUMP Failure: Analysis of the 2006-2016 U.S. Kid Inpatient Database

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Estelle Everett ◽  
Timothy Copeland ◽  
Tannaz Moin ◽  
Lauren Wisk
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Diabetic Ketoacidosis ◽  
Insulin Pump ◽  
Private Insurance ◽  
Severity Of Illness ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
Pump Failure ◽  
Inpatient Database

Abstract Background: Insulin pumps are valuable tools in diabetes management and their use has increased dramatically over the past decade. Unfortunately, insulin pump use has also been associated with diabetic ketoacidosis (DKA), relating to pump malfunctions that result in the disruption in insulin administration. Our objective was to examine the prevalence and characteristics of DKA admissions associated with pump failure among pediatric patients. Methods: We used the national Kids’ Inpatient Database to identify pediatric admissions with a primary diagnosis of DKA in years 2006, 2009, 2012, and 2016. We defined a DKA-pump failure admission as an admission with either a primary diagnosis of DKA plus a secondary diagnosis of pump failure/complication or conversely, a primary diagnosis of pump failure/complication with a secondary diagnosis of DKA. We used descriptive statistics and logistic regression to describe the annual trends and characteristics of children admitted for DKA with or without pump failure. Lastly, logistic regression was used to assess the impact of pump failure on length of stay and severity of illness during DKA admissions. Results: Our dataset included 166,583 DKA admissions, of which 2,291 (1.4%) were associated with a primary or secondary diagnosis of insulin pump failure. Between 2006 and 2016, the number of total DKA admissions increased by 58%. Admissions for DKA with pump failure increased from 387 to 665 admissions during this time. Among all children admitted with DKA, those with pump failure were primarily older (60% above age 12), mostly white (63%), female (57%), from urban areas (78%), and almost 2/3rds had private insurance (60%). Adjusted analyses revealed that compared to DKA admissions without pump failure, pump failure was associated with older age, white race, residing in a rural area, private insurance, and higher income. Pump failure admissions were more likely in western and southern hospitals, otherwise there were no significant differences with respect to hospital characteristics. Compared to DKA admissions without pump failure, DKA admissions associated with pump failure had a longer mean length of stay (2.6 vs 1.5 days) and were more likely to have a higher severity of illness category. Conclusion: In this national sample, DKA with pump failure was more often observed among white, privately insured and high income children; these patient characteristics likely reflect the population of youth with diabetes who are more likely prescribed pumps in the US. Admissions for DKA concurrent with insulin pump failure accounted for a minority of pediatric DKA admissions but these admissions were associated with longer lengths of stay and severity of illness. Pump failure has important implications for care and management of children with diabetes.

scholarly journals Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

2021 ◽  
Vol 18 (6) ◽  
pp. 2921
Author(s):  
Jay J. Xu ◽  
Jarvis T. Chen ◽  
Thomas R. Belin ◽  
Ronald S. Brookmeyer ◽  
Marc A. Suchard ◽  
...  
Keyword(s):  
United States ◽  
District Of Columbia ◽  
Ethnic Disparities ◽  
The United States ◽  
Attributable Mortality ◽  
Race Ethnicity ◽  
Using Data ◽  
Rate Ratios ◽  
Degree Of Association ◽  
Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

scholarly journals Sex Differences in the Incidence and Outcomes of Patients Hospitalized by Idiopathic Pulmonary Fibrosis (IPF) in Spain from 2016 to 2019

2021 ◽  
Vol 10 (16) ◽  
pp. 3474
Author(s):  
Belén López-Muñiz Ballesteros ◽  
Marta López-Herranz ◽  
Ana Lopez-de-Andrés ◽  
Valentín Hernandez-Barrera ◽  
Rodrigo Jiménez-García ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Sex Differences ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Transplantation ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
National Hospital ◽  
Hospital Discharges ◽  
Discharge Database

(1) Background: To assess sex differences in the incidence, characteristics, procedures and outcomes of patients admitted with idiopathic pulmonary fibrosis (IPF); and to analyze variables associated with in-hospital mortality (IHM). (2) Methods: We analyzed data collected by the Spanish National Hospital Discharge Database, 2016–2019. (3) Results: We identified 13,278 hospital discharges (66.4% men) of IPF (primary diagnosis 32.33%; secondary diagnosis: 67.67%). Regardless of the diagnosis position, IPF incidence was higher among men than women, increasing with age. Men had 2.74 times higher IPF incidence than women. Comorbidity was higher for men in either primary or secondary diagnosis. After matching, men had higher prevalence of pulmonary embolism and pneumonia, and women of congestive heart failure, dementia, rheumatoid disease and pulmonary hypertension. Invasive ventilation, bronchoscopy and lung transplantation were received more often by men than women. IHM was higher among men with IPF as primary diagnosis than among women and increased with age in both sexes and among those who suffered cancer, pneumonia or required mechanical ventilation. (4) Conclusions: Incidence of IPF was higher among men than women, as well as comorbidity and use of bronchoscopy, ventilation and lung transplantation. IHM was worse among men than women with IPF as primary diagnosis, increasing with age, cancer, pneumonia or mechanical ventilation use.

Abstract MP29: Effects of System-Level Factors on Race/Ethnic Differences in In-Hospital Mortality After Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Abdullah Ibish ◽  
Philip Sun ◽  
Daniela Markovic ◽  
Roland Faigle ◽  
Rebecca F Gottesman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Black Women ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cause Of Death ◽  
Primary Diagnosis ◽  
System Level ◽  
Stroke Severity ◽  
Race Ethnicity ◽  
Minority Men

Introduction: Stroke mortality has declined, with differential changes by race; stroke is now the 5 th leading cause of death overall, but 2 nd leading cause of death in blacks. Little is known about recent race/ethnic trends in in-hospital mortality after acute ischemic stroke (AIS) and whether system-level factors contribute to possible differences. Methods: Using the National Inpatient Sample, adults (>18 yrs) with a primary diagnosis of AIS from 2006 to 2017 (n=763,808) were identified. We assessed in-hospital mortality by race/ethnicity (white, black, Hispanic, Asian/Pacific Islander [API], other), sex, and age. Hospitals were categorized by proportion of minority patients served: <25% minority (white hospitals); 25-50% (mixed hospitals), and >50% (minority hospitals). Using survey adjusted logistic regression, the association between race/ethnicity and odds of mortality was assessed, adjusting for key sociodemographic, clinical, and hospital characteristics (e.g. age, comorbidities, stroke severity, DNR status, and palliative care). Results: Overall, mortality decreased from 5.0% in 2006 to 2.9% in 2017, p<0.001. Comparing 2006-2011 to 2012-2017, there was a 66% reduction in mortality after adjustment for covariates, most prominent in whites (68%) and smallest in blacks (58%). Compared to whites, blacks and Hispanics had lower adjusted odds of mortality (AOR 0.82, 95% CI 0.78-0.86 and AOR 0.92, CI 0.86-0.98), primarily driven by those >65 yrs (age x ethnicity interaction p = 0.003). Compared to white men, black, Hispanic, and API men and black women had lower odds of mortality. Adjusted mortality was lower in minorities vs. whites and most pronounced in white hospitals (white: AOR 0.78, 0.73-0.85; mixed: 0.85, 0.80-0.91; minority: 0.89, 0.82-0.95; interaction effect: p=0.018). These differences were present for both minority men and women in white and mixed hospitals, but not women in minority hospitals. Discussion: AIS mortality decreased dramatically in recent years. Overall, black and Hispanic AIS patients have lower mortality than whites, a difference that is most striking in white hospitals. Further study is needed to understand these differences and to what extent biological, sociocultural, and system-level factors play a role.

scholarly journals Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007–2014

2018 ◽  
Vol 36 (08) ◽  
pp. 835-848 ◽  
Author(s):  
Virginia Tangel ◽  
Robert S. White ◽  
Anna S. Nachamie ◽  
Jeremy S. Pick
Keyword(s):  
Black Women ◽  
Length Of Stay ◽  
Cesarean Delivery ◽  
White Women ◽  
Average Length ◽  
Ethnic Disparities ◽  
Maternal Outcomes ◽  
Racial And Ethnic Disparities ◽  
Mortality And Morbidity ◽  
Race Ethnicity

Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population. Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay. Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses. Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.

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