COVID-19 and delivery of difficult asthma services

The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March–August 2019 when 88 patients were seen face-to-face. There was DA clinic cancellation/non-attendance (16% vs 43%; p<0.0003). In patients with home spirometers, acute hospital admissions (6 vs 26; p<0.01) from March to August 2020 were significantly lower compared with the same period in 2019. There was no difference in the number of courses of oral corticosteroids or antibiotics prescribed (47 vs 53; p=0.81). From April to August 2020, 50 patients with DA performed 253 home spirometry measurements, of which 39 demonstrated >20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring.

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Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison

Journal of Health Services Research & Policy ◽

10.1177/13558196211012732 ◽

2021 ◽

pp. 135581962110127

Author(s):

Irina Lut ◽

Kate Lewis ◽

Linda Wijlaars ◽

Ruth Gilbert ◽

Tiffany Fitzpatrick ◽

...

Keyword(s):

Primary Care ◽

Hospital Admission ◽

Hospital Admissions ◽

Underlying Disease ◽

Primary Diagnosis ◽

Care Quality ◽

Attendance Rates ◽

Admission Rates ◽

Primary Care Quality ◽

Hospital Administrative

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. Results Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. Conclusions The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

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1683. Hospital Admission Patterns in Adult Patients with Complicated Urinary Tract Infections (cUTIs): Identification of Potentially Avoidable Hospital Admissions Across United States (US) Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1861 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S825-S826

Author(s):

Thomas Lodise ◽

Teena Chopra ◽

Brian Nathanson ◽

Katherine Sulham

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Panel Member ◽

Inclusion Criteria ◽

Independent Contractor ◽

Healthcare Database ◽

Admission Rates ◽

Comorbidity Index ◽

Multi Center Study ◽

Tract Infections

Abstract Background There is an increase in hospital admissions for cUTI in the US despite apparent reductions in the severity of admissions. However, there are scant data on cUTI hospital admission rates from the emergency department (ED) stratified by age, infection severity, and presence of comorbidities. This study described US hospitalization patterns among adults who present to the ED with a cUTI. We sought to quantify the proportion of admissions that were potentially avoidable based on presence of sepsis and associated symtpoms as well as Charlston Comorbidity Index (CCI) scores. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. Based on ICD-9/10 diagnosis codes present on admission, incidence of hospital admissions were stratified by age (≥ 65 years vs. < 65 years), presence of sepsis (S), sepsis symptoms but no sepsis codes (SS) (e.g., fever, tachycardia, tachypnea, leukocytosis, etc.), and CCI. Results 187,789 patients met inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 SS symptom (but no S), and 53.9% had no evidence of S or SS. The median [IQR] CCI was 1 [0, 3]. 119,668 out of 187,789 (63.7%) were admitted to hospital. Among inpatients, median [IQR] length of stay (LOS) and total costs were 5 [3, 7] days and $7,956 [$4,834, $13,960] USD. Incidence of hospital admissions by age, presence of S/SS, and CCI score are shown in the Table. 18.9% of admissions (22,644/119,668) occurred in patients with no S/SS and a CCI ≤ 2. Their median [IQR] LOS and total costs were 3 [2, 5] days and $5,575 [$3,607, $9,133]. Incidence of Hospital Admission by Age, Charlson comorbidity index (CCI), Presence of Sepsis (S), and Presence of Sepsis Symptoms (SS) Conclusion Nearly 1 in 5 cUTI hospital admissions may be avoidable. Given the resources associated with the management of inpatients with cUTIs, these findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity. Preventing avoidable hospital admissions has the potential to save the healthcare system substantial costs. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

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Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

BMJ ◽

10.1136/bmj.m4571 ◽

2020 ◽

pp. m4571 ◽

Cited By ~ 1

Author(s):

Caroline Fyfe ◽

Lucy Telfar ◽

Barnard ◽

Philippa Howden-Chapman ◽

Jeroen Douwes

Keyword(s):

Cohort Study ◽

Heart Disease ◽

Confidence Interval ◽

Hospital Admission ◽

Retrospective Cohort ◽

Rate Ratio ◽

Hospital Admissions ◽

Relative Rate ◽

Intervention Programme ◽

Admission Rates

Abstract Objectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.

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The challenge of using routinely collected data to compare hospital admission rates by ethnic group: a demonstration project in Scotland

Journal of Public Health ◽

10.1093/pubmed/fdz175 ◽

2019 ◽

Vol 42 (4) ◽

pp. 748-755 ◽

Cited By ~ 2

Author(s):

S Knox ◽

R S Bhopal ◽

C S Thomson ◽

A Millard ◽

A Fraser ◽

...

Keyword(s):

Hospital Admission ◽

Ethnic Group ◽

Ethnic Groups ◽

Hospital Admissions ◽

Heart Diseases ◽

Equity In Health ◽

Admission Rates ◽

Group A ◽

Rate Ratios ◽

Equity In Health Care

Abstract Background Recording patients’ ethnic group supports efforts to achieve equity in health care provision. Before the Equality Act (2010), recording ethnic group at hospital admission was poor in Scotland but has improved subsequently. We describe the first analysis of the utility of such data nationally for monitoring ethnic variation. Methods We analysed all in-patient or day case hospital admissions in 2013. We imputed missing data using the most recent ethnic group recorded for a patient from 2009 to 2015. For episodes lacking an ethnic code, we attributed known ethnic codes proportionately. Using the 2011 Census population, we calculated rates and rate ratios for all-cause admissions and ischaemic heart diseases (IHDs) directly standardized for age. Results Imputation reduced missing ethnic group codes from 24 to 15% and proportionate redistribution to zero. While some rates for both all-cause and IHD admissions appeared plausible, unexpectedly low or high rates were observed for several ethnic groups particularly amongst White groups and newly coded groups. Conclusions Completeness of ethnicity recoding on hospital admission records has improved markedly since 2010. However the validity of admission rates based on these data is variable across ethnic groups and further improvements are required to support monitoring of inequality.

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Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998

The British Journal of Psychiatry ◽

10.1192/bjp.182.1.31 ◽

2003 ◽

Vol 182 (1) ◽

pp. 31-36 ◽

Cited By ~ 187

Author(s):

David M. Lawrence ◽

Cashel D'Arcy ◽

J. Holman ◽

Assen V. Jablensky ◽

Michael S. T. Hobbs

Keyword(s):

Mental Illness ◽

Heart Disease ◽

General Population ◽

Hospital Admission ◽

Ischaemic Heart Disease ◽

Excess Mortality ◽

Hospital Admissions ◽

Psychiatric Patients ◽

Admission Rates ◽

People With Mental Illness

BackgroundPeople with mental illness suffer excess mortality due to physical illnesses.AimsTo investigate the association between mental illness and ischaemic heart disease (IHD) hospital admissions, revascularisation procedures and deaths.MethodA population-based record-linkage study of 210 129 users of mental health services in Western Australia during 1980–1998. IHD mortality rates, hospital admission rates and rates of revascularisation procedures were compared with those of the general population.ResultsIHD (not suicide) was the major cause of excess mortality in psychiatric patients. In contrast to the rate in the general population, the IHS mortality rate in psychiatric patients did not diminish over time. There was little difference in hospital admission rates for IHD between psychiatric patients and the general community, but much lower rates of revascularisation procedures with psychiatric patients, particularly in people with psychoses.ConclusionsPeople with mental illness do not receive an equitable level of intervention for IHD. More attention to their general medical care is needed.

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Care homes education: what can we learn?

BMJ Open Quality ◽

10.1136/bmjoq-2020-001153 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001153

Author(s):

Sarah Frances Armstrong ◽

Tim Gluck ◽

Anna Gorringe ◽

Annie Stork ◽

Sally Jowett ◽

...

Keyword(s):

Hospital Admission ◽

Medical Care ◽

Communication Systems ◽

Hospital Admissions ◽

Early Recognition ◽

Care Home ◽

Internal Communication ◽

Care Homes ◽

Attendance Rates ◽

Teaching Programme

Medical care received by care home residents can be variable. Initiatives, such as matron-led community teams, ensure a timely response to alerts about unwell residents. But early recognition of deterioration is vital in accessing this help. The aim of this project was to design and deliver an education programme for carers. It was hypothesised that the implementation of a teaching programme may result in improved medical care for residents. By understanding the enablers and barriers to implementing teaching, we hoped to identify the components of a successful teaching programme. Four care homes in Enfield received training on topics such as deterioration recognition over a 1-year period. The project was evaluated at 3, 6 and 9 months. Each evaluation comprised: pre-and-post-teaching questionnaires, focus groups, analysis of percentages of staff trained, review of overall and potentially avoidable, hospital admission rates. A Plan–Do–Study–Act cycle structure was used. The programme was well-received by carers, who gave examples of application of learning. Modules about conditions frequently resulting in hospital admission, or concerning real cases, demonstrated the best pre-and-post lesson change scores. However, the reach of the programme was low, with attendance rates between 5% and 28%. Overall, the percentage of staff trained in deterioration recognition ranged from 35% (care home one) to 12% (care home three). Hospital admissions reduced from 37 hospital admissions to 20 over the duration of the project. Potentially avoidable admissions reduced from 16 to 5. Proving causality to the intervention was difficult. Factors facilitating delivery of training included a flexible approach, an activity-based curriculum, alignment of topics with real cases and embedding key messages in every tutorial. Barriers included: time pressures, shift work, low attendance rates, inequitable perception of the value of teaching and IT issues. Care home factors impacting on delivery included: stability of management and internal communication systems.please ensure space here

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Future projections of child oral-related hospital admission rates in Western Australia

Australian Journal of Primary Health ◽

10.1071/py15132 ◽

2016 ◽

Vol 22 (6) ◽

pp. 491 ◽

Cited By ~ 1

Author(s):

Alla Alsharif ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Dental Caries ◽

Hospital Admission ◽

Hospital Admissions ◽

Admission Rate ◽

Projection Data ◽

Impacted Teeth ◽

Admission Rates ◽

The Future ◽

Hospital Morbidity ◽

Western Australian

This study aimed to project the hospital admission rates of Western Australian children for oral conditions, with a particular focus on dental caries, embedded and impacted teeth, and pulp and periapical conditions through to the year 2026. Two methods were used to generate projection data through to the year 2026, using the Western Australian Hospital Morbidity Dataset for the period 1999–2000 to 2008–2009. The projected admission rate increase in those children aged 14 years and younger from 2000 to 2026 was 43%. The admission rates are expected to more than double over time (7317 cases in 2026 compared to only 3008 cases in 2000) for those children living in metropolitan areas. Dental caries, embedded and impacted teeth, and pulp and periapical conditions will remain the top (mostly) preventable causes of admission throughout this time. Anticipating the future burden of oral-related hospital admissions in children, in terms of expected numbers of cases, is vital for optimising the resource allocation for early diagnosis, prevention and treatment. A concerted effort will be required by policymakers and oral healthcare communities to effect substantial change for the future.

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Assessing the causal impact of adiposity variation on rates of hospital admission: Application of Mendelian randomization

10.1101/2020.07.14.20153742 ◽

2020 ◽

Author(s):

Audinga-Dea Hazewinkel ◽

Padraig Dixon ◽

Rebecca Richmond ◽

Kaitlin H Wade

Keyword(s):

Body Mass Index ◽

Hospital Admission ◽

Body Mass ◽

Hospital Admissions ◽

Mendelian Randomization ◽

Causal Role ◽

Hospital Admission Rate ◽

Admission Rates ◽

Waist Hip Ratio

Background Body mass index (BMI) and waist-hip-ratio (WHR) are measures of adiposity, the former being a good marker for overall total body fat, the latter describing regional adiposity. Higher adiposity has been associated with the increased prevalence of many chronic diseases and a positive association between BMI and increased hospital admissions has previously been established. The aim of this study was to estimate the causal relationship between BMI, WHR and WHR adjusted for BMI (WHRadjBMI) and yearly hospital admission rates. Methods and Findings Mendelian randomization (MR) approaches were used to test the causal effect of BMI, WHR and WHRadjBMI on yearly hospital admission rates. Using data on 310,471 participants of White-British ancestry from the UK Biobank, we performed one-sample and two-sample MR analyses on the exposures individually and in a multivariable setting. MR analyses supported a causal role of adiposity on hospital admissions, with consistency across one- and two-sample MR methods. Primarily, one-sample MR analyses estimated fold-increases in yearly hospital admission rates of 1.13 (95% CI: 1.02, 1.27), 1.26 (95% CI: 1.00, 1.58) and 1.22 (95% CI: 1.01, 1.47) per SD for BMI, WHR and WHRadjBMI, respectively. A multivariable approach yielded estimates of 1.04 (95% CI: 0.99, 1.03) for BMI and 1.31 (95% CI: 1.04, 1.67) for WHR, while adjusting for WHR and BMI, respectively. Conclusions The results support a causal role of higher BMI and WHR in increasing the yearly hospital admission rate. The attenuation of the BMI effect, when adjusting for WHR in the multivariable MR analyses, suggested that an adverse fat distribution, rather than a higher BMI itself, may drive the relationship between adiposity and increased risk of hospital admission. Keywords: Body mass index (BMI), waist-hip-ratio (WHR), hospital admission, Mendelian randomization

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Abstract T P138: Time Trends over Five Decades in Rates of Hospital Admission for Any Stroke and Stroke Subtypes in England

Stroke ◽

10.1161/str.45.suppl_1.tp138 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Olena O Seminog ◽

Nick Hall ◽

Michael J Goldacre

Keyword(s):

Hospital Admission ◽

Ischaemic Stroke ◽

Time Trends ◽

Hospital Admissions ◽

Haemorrhagic Stroke ◽

Hospital Episode Statistics ◽

Sharp Decline ◽

Admission Rates ◽

Stroke Subtypes ◽

Hospital Statistics

Aim: To study 43 year trends in England in the rates of hospital admission for any stroke, and for stroke subtypes divided into stroke that was coded as haemorrhagic, ischaemic or of undefined etiology. Methods: We analysed routine hospital statistics from the Hospital In-Patient Enquiry and Hospital Episode Statistics to estimate trends in hospital admissions for any stroke and the three stroke subtypes in England from 1968 to 2011. The rates were age-standardised and expressed per 100 000 population. Results: The study included 2 555 180 admissions for stroke. Annual admission rates for any stroke increased from 169.79 (95% CI 165.61-173.97) in 1968 to 272.4 (270.86-273.93) in 1993; and then started to decline to reach 196.58 (195.38-197.79) in 2011. Admission rates for haemorrhagic stroke declined from 30.40 (28.61-32.19) in 1968 to 15.07 (13.80-16. 34) in 1982, and then steadily increased to 44.65 (44.07-45.24) in 2011. Admission rates for ischaemic stroke halved between 1968 and 1982 from 60.3 (57.81-62.80) to 32.32 (30.53-34.11). This was followed by a steep rise to 128.10 (127.13-129.07) in 2011. Admission rates for stroke of undefined cause increased from 75.54 (72.75-78.33) in 1968 to 178.35 (174.35-182.34) in 1984. This was followed by a sharp decline to 27.66 (27.22-28.11) in 2011. Conclusions: Considering any stroke in England, in the 1970s and1980s there was an increase in admission rates, followed by a decline in the 1990s, and a plateau in the first decade of the 21st century. Changes in stroke rates for haemorrhagic and particularly for ischaemic stroke tended to go in opposite directions from rates in stroke of unspecified type. Specifically, the observed declines in haemorrhagic and ischaemic stroke rates between 1968-1983 coincided with a rise in stroke of undefined cause. These trends reflect shifts in diagnostic preferences towards the latter at that time. The recent dramatic increase in ischaemic stroke rates is mirrored by a sharp fall in stroke of unspecified type. These changes are likely to result from the increasingly wide use of brain imaging. Trends in admission rates for a particular subtype of stroke should not be considered on its own, as changes in diagnostics, and preferences for diagnostic terminology, are likely to affect the rates.

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Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

BMJ ◽

10.1136/bmj.m4075 ◽

2020 ◽

pp. m4075

Author(s):

Victoria Coathup ◽

Elaine Boyle ◽

Claire Carson ◽

Samantha Johnson ◽

Jennifer J Kurinzcuk ◽

...

Keyword(s):

Hospital Admission ◽

Gestational Age ◽

Record Linkage ◽

Hospital Admissions ◽

Population Based ◽

Admission Rates ◽

Adjusted Rate ◽

Gestational Age At Birth ◽

Adjusted Rate Ratio ◽

Age At Birth

AbstractObjectiveTo examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.DesignPopulation based, record linkage, cohort study in England.SettingNHS hospitals in England, United Kingdom.Participants1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.Main outcome measuresPrimary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.Results1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.ConclusionsThe association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.

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