Estimating the obstetric co‐morbidity burden using administrative data: The impact of the pregnancy‐related assessment window

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

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Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

Journal of Clinical Medicine ◽

10.3390/jcm10081782 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1782

Author(s):

Ignacio Ricci-Cabello ◽

Aina María Yañez-Juan ◽

Maria A. Fiol-deRoque ◽

Alfonso Leiva ◽

Joan Llobera Canaves ◽

...

Keyword(s):

Primary Care ◽

Patient Safety ◽

Structural Equation ◽

Structural Equation Models ◽

Cross Sectional ◽

Morbidity Burden ◽

Patient Reported ◽

Patient Complexity ◽

Complex Relationships ◽

The Impact

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

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Age- and Sex-Specific In-Hospital Mortality after Myocardial Infarction in Routine Clinical Practice

Cardiology Research and Practice ◽

10.4061/2010/752765 ◽

2010 ◽

Vol 2010 ◽

pp. 1-11 ◽

Cited By ~ 11

Author(s):

Chizobam Ani ◽

Deyu Pan ◽

David Martins ◽

Bruce Ovbiagele

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards ◽

Length Of Hospital Stay ◽

Mortality Rates ◽

Cox Proportional Hazards ◽

Mortality Trends ◽

Male Mortality ◽

Co Morbidity ◽

The Impact ◽

Age And Sex

Background. Literature regarding the influence of age/sex on mortality trends for acute myocardial infarction (AMI) hospitalizations is limited to hospitals participating in voluntary AMI registries.Objective. Evaluate the impact of age and sex on in-hospital AMI mortality using a nationally representative hospital sample.Methods. Secondary data analysis using AMI hospitalizations identified from the Nationwide-Inpatient-Sample (NIS). Descriptive and Cox proportional hazards analysis explored mortality trends by age and sex from 1997–2006 while adjusting for the influence of, demographics, co-morbidity, length of hospital stay and hospital characteristics.Results. From 1997–2006, in-hospital AMI mortality rates decreased across time in all subgroups (), except for males aged <55 years. The greatest decline was observed in females aged <55 years, compared to similarly aged males, mortality outcomes were poorer in 1997-1998 (RR 1.47, 95% CI = 1.30–1.66), when compared with 2005-2006 (RR 1.03, 95% CI = 0.90–1.18), adjusted value for trend demonstrated a statistically significant decline in the relative AMI mortality risk for females when compared with males (<0.001).Conclusion. Over the last decade, in-hospital AMI mortality rates declined for every age/sex group except males <55 years. While AMI female-male mortality disparity has narrowed, some room for improvement remains.

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COPD, Depression and COVID-19 Pandemic: A Harrowing, Demoralizing and Deleterious Triad

Clinical Medical Reviews and Reports ◽

10.31579/2690-8794/095 ◽

2021 ◽

Vol 3 (8) ◽

pp. 01-06

Author(s):

Iqbal Akhtar Khan ◽

Hamza Iltaf Malik

Keyword(s):

Hospital Admissions ◽

Hospital Readmissions ◽

Public Health Problem ◽

Well Being ◽

Care Utilization ◽

Global Public Health ◽

Increased Risk ◽

Co Morbidity ◽

Pulmonary Manifestations ◽

The Impact

COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

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Three Essays on Adverse Events and Student Outcomes

10.26686/wgtn.17151098 ◽

2021 ◽

Author(s):

◽

Olivia Wills

Keyword(s):

High School ◽

High School Students ◽

Adverse Events ◽

Administrative Data ◽

Degree Completion ◽

Student Outcomes ◽

Fixed Effects ◽

Hospital Admissions ◽

The Impact ◽

Low Ability

<p>This dissertation contains three essays on the impact of unexpected adverse events on student outcomes. All three attempt to identify causal inference using plausibly exogenous shocks and econometric tools, applied to rich administrative data. In Chapter 2, I present evidence of the causal effects of the 2011 Christchurch earthquake on tertiary enrolment and completion. Using the shock of the 2011 earthquake on high school students in the Canterbury region, I estimate the effect of the earthquake on a range of outcomes including tertiary enrolment, degree completion and wages. I find the earthquake causes a substantial increase in tertiary enrolment, particularly for low ability high school leavers from damaged schools. However, I find no evidence that low ability students induced by the earthquake complete a degree on time. In Chapter 3, I identify the impact of repeat disaster exposure on university performance, by comparing outcomes for students who experience their first earthquake while in university, to outcomes for students with prior earthquake exposure. Using a triple-differences estimation strategy with individual-by-year fixed effects, I identify a precise null effect, suggesting that previous experience of earthquakes is not predictive of response to an additional shock two years later. The final chapter investigates the impact of injuries sustained in university on academic performance and wages, using administrative data including no-fault insurance claims, emergency department attendance and hospital admissions, linked with tertiary enrolment. I find injuries, including minor injuries, have a negative effect on re-enrolment, degree completion and grades in university.</p>

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Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

10.21203/rs.2.10974/v2 ◽

2019 ◽

Author(s):

Jason Davis ◽

Rhodri Saunders

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Change ◽

Health Care Systems ◽

Sensitivity Analyses ◽

Published Data ◽

Morbidity Burden ◽

Co Morbidity ◽

Care Systems ◽

Predict Weight Loss

Abstract Background Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories . The present analysis explores how improving a patient’s post-surgical weight change could impact co‑morbidity prevalence, treatment and associated costs in the Canadian setting. Methods Published data were used to derive statistical models to predict weight loss and co‑morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1,710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

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Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.32.30312 ◽

2016 ◽

Vol 21 (32) ◽

Cited By ~ 1

Author(s):

Ajay Oza ◽

Fionnuala Donohue ◽

Howard Johnson ◽

Robert Cunney

Keyword(s):

Administrative Data ◽

Risk Adjustment ◽

Antibiotic Consumption ◽

Factors Affecting ◽

Defined Daily Doses ◽

Acute Hospitals ◽

Consumption Rates ◽

Hospital Antibiotic Consumption ◽

Bed Days ◽

The Impact

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.

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TP10.2.11The consequences of COVID-19 on the colorectal red-flag cancer pathway- A 3 month review 2019 to 2020

British Journal of Surgery ◽

10.1093/bjs/znab362.148 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

R Sarah Small ◽

Rachael Coulson ◽

Ian Mcallister

Keyword(s):

Colorectal Cancer ◽

Definitive Treatment ◽

Data Sets ◽

Patient Demographics ◽

Cancer Services ◽

Information Time ◽

Co Morbidity ◽

Red Flag ◽

Time To First Treatment ◽

The Impact

Abstract Aim The COVID-19 pandemic is an evolving healthcare challenge introducing greater burden on existing resources. With 1,100 people in Northern Ireland diagnosed with colorectal cancer (CRC) per annum, concerns over disruption of cancer services and secondary consequences have been highlighted. We aim to evaluate the impact of COVID-19 on the CRC red flag pathway in comparison to the pre-COVID era. Methods Two comparative data sets were compiled through retrospective analysis of red-flag colorectal referrals over a 3-month period for both April to June 2019 and 2020. A comprehensive review of each patient’s electronic care record and medical notes was completed. Patient demographics, co-morbidity, referral information, time to hospital appointment and investigation modality were documented. For patients identified with CRC the stage and time to first definitive treatment was documented. Results A total of 47 CRCs were identified from both red-flag referral groups; 25 CRCs 2019 compared to 22 in 2020. Median age at time of referral was 79 years in 2019 compared to 71 years in 2020. Time to outpatient review was significantly less during 2020 compared to 2019; 16 days and 31 days respectively (p < 0.05). Time to first treatment was 103 days 2019 compared to 75 days 2020 (p < 0.05). Advanced diagnostic stage or increased number of emergency hospital presentations in the COVID-19 period was not demonstrated. Conclusion Despite disruption of established colorectal cancer services during the COVID-19 pandemic, we demonstrated patients waited less time to outpatient review and intervention. With comparative cases of CRC to the pre-COVID era diagnosed.

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