95 GOSH legacy and epic inpatient data show changing patient case mix and patient requirements since 2000

2021 ◽  
Author(s):  
William A Bryant ◽  
Richard W Issitt ◽  
Lydia Briggs ◽  
Daniel Key ◽  
John Booth ◽  
...  
Keyword(s):  
Case Mix ◽  
Patient Case

scholarly journals The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line–Associated Bloodstream Infection Risk-Adjustment Methodology

2017 ◽  
Vol 38 (9) ◽  
pp. 1019-1024 ◽  
Author(s):  
Sarah S. Jackson ◽  
Surbhi Leekha ◽  
Laurence S. Magder ◽  
Lisa Pineles ◽  
Deverick J. Anderson ◽  
...  
Keyword(s):  
Disease Control ◽  
Bloodstream Infection ◽  
Risk Adjustment ◽  
Central Line ◽  
Case Mix ◽  
Type Model ◽  
Patient Case ◽  
Icu Patients ◽  
Control And Prevention ◽  
Centers For Disease Control

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024

scholarly journals P063: Is triage score a valid measure of emergency department case mix?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S99-S100
Author(s):  
B.R. Holroyd ◽  
R.J. Rosychuk ◽  
S. Jelinski ◽  
M. Bullard ◽  
C. McCabe ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Reporting System ◽  
Decision Makers ◽  
Case Mix ◽  
Publicly Funded ◽  
Valid Measure ◽  
Patient Case ◽  
Canadian Province ◽  
Policy Makers

Introduction: In the Canadian province of Alberta, (pop. 4,227,879), the publicly-funded health care system uses the five level Canadian Triage and Acuity Scale (CTAS), to prioritize emergency department (ED) patients. Health system decision makers and policy makers currently use CTAS as an isolated metric to describe ED patient case-mix and to compare EDs. Methods: Using the National Ambulatory Care Reporting System dataset, we reviewed the distribution of patient CTAS scores and the proportion of inpatient admissions by CTAS level for the 16 highest volume Alberta hospital EDs during FY 2013/2014. Results: Collectively, the EDs received 1,027,976 patients, with 1%, 18%, 44%, 30% and 7% classified as CTAS 1-5, respectively. The proportions by CTAS level ranged from 0.2% to 2.8% in CTAS 1; 3.3% to 33.3% in CTAS 2; 29.1% to 54.1% in CTAS 3; 16.7% to 49.0% in CTAS 4; and 3.1% to 12.3% in CTAS 5. Admission proportions by CTAS level ranged from 43.9% to 75.2% in CTAS 1; 18.9% to 42.1% in CTAS 2; 5.4% to 24.7% in CTAS 3; 0.8% to 9.3% in CTAS 4; and 0.1% to 9.1% in CTAS 5. Conclusion: Inter-hospital differences in CTAS acuity distributions reflect triage variability and real differences in case-mix. Wide variation in admission proportions by CTAS level reflects differing admission thresholds between sites, but also suggest intra-level differences in patient severity, comorbidity and complexity. Triage levels cannot be used as an isolated metric to describe and compare ED case-mix. Further work is required to accurately characterize ED patient case-mix.

scholarly journals Patient case mix

1981 ◽  
Vol 56 (7) ◽  
pp. 610-1
Author(s):  
J S Gonnella
Keyword(s):  
Case Mix ◽  
Patient Case

scholarly journals Associations between resources and practices of ILD centers and outcomes in patients with idiopathic pulmonary fibrosis: data from the IPF-PRO Registry

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Joao A. de Andrade ◽  
Tejaswini Kulkarni ◽  
Megan L. Neely ◽  
Anne S. Hellkamp ◽  
Amy Hajari Case ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Transplant ◽  
Online Survey ◽  
Case Mix ◽  
P Value ◽  
Patient Case ◽  
Improvement Project ◽  
The Us ◽  
Event Rates

Abstract Background Performance benchmarks for the management of idiopathic pulmonary fibrosis (IPF) have not been established. We used data from the IPF-PRO Registry, an observational registry of patients with IPF managed at sites across the US, to examine associations between the characteristics of the enrolling sites and patient outcomes. Methods An online survey was used to collect information on the resources, operations, and self-assessment practices of IPF-PRO Registry sites that enrolled ≥ 10 patients. Site variability in 1-year event rates of clinically relevant outcomes, including death, death or lung transplant, and hospitalization, was assessed. Models were adjusted for differences in patient case mix by adjusting for known predictors of each outcome. We assessed whether site-level heterogeneity existed for each patient-level outcome, and if so, we investigated potential drivers of the heterogeneity. Results All 27 sites that enrolled ≥ 10 patients returned the questionnaire. Most sites were actively following > 100 patients with IPF (70.4%), had a lung transplant program (66.7%), and had a dedicated ILD nurse leader (77.8%). Substantial heterogeneity was observed in the event rates of clinically relevant outcomes across the sites. After controlling for patient case mix, there were no outcomes for which the site variance component was significantly different from 0, but the p-value for hospitalization was 0.052. Starting/completing an ILD-related quality improvement project in the previous 2 years was associated with a lower risk of hospitalization (HR 0.60 [95% CI 0.44, 0.82]; p = 0.001). Conclusions Analyses of data from patients with IPF managed at sites across the US found no site-specific characteristics or practices that were significantly associated with clinically relevant outcomes after adjusting for patient case mix. Trial registration ClinicalTrials.gov, NCT01915511. Registered 5 August 2013, https://clinicaltrials.gov/ct2/show/NCT01915511

scholarly journals Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

2007 ◽  
Vol 89 (5) ◽  
pp. 513-516 ◽  
Author(s):  
JTK Melton ◽  
S Jain ◽  
B Kendrick ◽  
SD Deo
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Ambulance Service ◽  
Case Mix ◽  
Trauma Patients ◽  
Patient Case ◽  
Average Hospital ◽  
Acute Setting ◽  
Time Period ◽  
Emergency Ambulance

INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed.

scholarly journals Population trends in emergency cancer diagnoses: The role of changing patient case-mix

2019 ◽  
Vol 63 ◽  
pp. 101574
Author(s):  
A. Herbert ◽  
S. Winters ◽  
S. McPhail ◽  
L. Elliss-Brookes ◽  
G. Lyratzopoulos ◽  
...  
Keyword(s):  
Population Trends ◽  
Case Mix ◽  
Patient Case

Should Older Patients Be Selectively Referred to High-Volume Centers for Abdominal Aortic Surgery?

Vascular ◽  
2004 ◽  
Vol 12 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Justin B. Dimick ◽  
Peter J. Pronovost ◽  
John A. Cowan ◽  
Reid M. Wainess ◽  
Gilbert R. Upchurch
Keyword(s):  
Hospital Mortality ◽  
Hospital Volume ◽  
Aortic Surgery ◽  
High Volume ◽  
Mortality Rates ◽  
Annual Number ◽  
Case Mix ◽  
Patient Case ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic

The objective of the current study was to determine the effect of hospital volume on outcomes of abdominal aortic surgery for patients older than and younger than 65 years. In order to perform this investigation, information on all adult patients who underwent abdominal aortic surgery in Maryland from 1994 to 1996 ( N = 2,987 patients) in 45 acute care hospitals was obtained. Hospitals were designated as low (< 20/year), medium (20 to 36/year), or high (> 36/year) volume according to the annual number of procedures performed. The relationship of hospital volume and mortality was determined for patients less than or greater than 65 years old. Two separate multiple logistic regression models were used to adjust for patient case-mix in each age category. Of the 2,987 patients, 2,067 (69%) were older than 65 years and 920 (31%) were younger. The crude in-hospital mortality rates according to hospital volume were 2.7% (low), 2.1% (medium), and 2.7% (high) for patients younger than 65 years old ( p = .8). For patients older than 65 years, in-hospital mortality rates were 11.9% (low), 9.9% (medium), and 6.9% (high) ( p = .005). After adjusting for patient case-mix in a multivariate analysis, high hospital volume was associated with a decreased risk of in-hospital mortality for patients older than 65 years (OR 0.57; 95% CI 0.37 to 0.86; p = .008) but not for patients under 65 years old. In conclusion, hospital volume was associated with decreased in-hospital mortality after abdominal aortic surgery only for patients greater than 65 years old. Because of this differential effect, targeting elderly patients for regionalization would achieve most potentially avoidable deaths for this common high-risk surgical procedure.

scholarly journals Comparing national point prevalence surveys of healthcare-associated infection and antimicrobial prescribing: a methodological approach to adjust for differences in case-mix

2020 ◽  
Vol 21 (5) ◽  
pp. 177-181
Author(s):  
Cheryl L Gibbons ◽  
Shona Cairns ◽  
Aynsley Milne ◽  
Melissa Llano ◽  
Jennifer Weir ◽  
...  
Keyword(s):  
Methodological Approach ◽  
Temporal Trends ◽  
Point Prevalence ◽  
Case Mix ◽  
Healthcare Associated Infection ◽  
Patient Case ◽  
Antimicrobial Prescribing ◽  
The Difference ◽  
Urinary Catheterisation ◽  
Healthcare Associated

Background: National point prevalence surveys (PPS) of healthcare-associated infection (HAI) and antimicrobial prescribing in hospitals were conducted in 2011 and 2016 in Scotland. When comparing results of PPS, it is important to adjust for any differences in patient case-mix that may confound the comparison. Aim: To describe the methodology used to compare prevalence for the two surveys and illustrate the importance of taking case-mix (patient and hospital stay characteristics) into account. Methods: Multivariate models (clustered logistic regression) that adjusted for differences in patient case-mix were used to describe the difference in prevalence of six outcomes (HAI, antimicrobial prescribing and four devices: central vascular catheter, peripheral vascular catheter, urinary catheterisation and intubation) between the 2011 and 2016 PPS. Univariate models that did not adjust for these differences were also developed for comparison to show the importance of adjusting for confounders. Results: Without adjustment for case-mix, HAI and intubation prevalence estimates were not significantly different in 2016 compared with 2011 although with adjustment, the prevalence of both was significantly lower ( P=0.03 and P=0.02, respectively). These associations were only identified after adjustment for confounding by case-mix. Conclusions: While prevalence surveys do not provide intelligence on temporal trends as an incidence-based surveillance system would, if limitations and caveats are acknowledged, it is possible to compare two prevalence surveys to describe changing epidemiology. Adjusting for differences in case-mix is essential for robust comparisons. This methodology may be useful for other countries that are conducting large, repeated prevalence surveys.

scholarly journals Trauma system accreditation and patient outcomes in British Columbia: an interrupted time series analysis

2020 ◽  
Vol 32 (10) ◽  
pp. 677-684
Author(s):  
Brice Batomen ◽  
Lynne Moore ◽  
Erin Strumpf ◽  
Natalie L Yanchar ◽  
Jaimini Thakore ◽  
...  
Keyword(s):  
British Columbia ◽  
Time Series ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Interrupted Time Series ◽  
Case Mix ◽  
Trauma Centers ◽  
Patient Case ◽  
Major Complications ◽  
The Impact

Abstract Objective We aim to assess the impact of several accreditation cycles of trauma centers on patient outcomes, specifically in-hospital mortality, complications and hospital length of stay. Design Interrupted time series. Setting British Columbia, Canada. Participants Trauma patients admitted to all level I and level II trauma centers between January 2008 and March 2018. Exposure Accreditation. Main Outcomes and Measures We first computed quarterly estimates of the proportions of in-hospital mortality, complications and survival to discharge standardized for change in patient case-mix using prognostic scores and the Aalen–Johansen estimator of the cumulative incidence function. Piecewise regressions were then used to estimate the change in levels and trends for patient outcomes following accreditation. Results For in-hospital mortality and major complications, the impact of accreditation seems to be associated with short- and long-term reductions after the first cycle and only short-term reductions for subsequent cycles. However, the 95% confidence intervals for these estimates were wide, and we lacked the precision to consistently conclude that accreditation is beneficial. Conclusions Applying a quasi-experimental design to time series accounting for changes in patient case-mix, our results suggest that accreditation might reduce in-hospital mortality and major complications. However, there was uncertainty around the estimates of accreditation. Further studies looking at clinical processes of care and other outcomes such as patient or health staff satisfaction are needed.

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