Abstract 065: Hospital Teaching Status and TAVR Outcomes in the United States - Analysis of the National Inpatient Sample (NIS)

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emmanuel Akintoye ◽  
Samson Alliu ◽  
Oluwole Adegbala ◽  
Haider Aldiwani ◽  
Mohamed Shokr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Kidney Injury ◽  
The United States ◽  
Teaching Hospitals ◽  
National Inpatient Sample ◽  
Mixed Effect ◽  
Significant Difference ◽  
Teaching Status ◽  
Risk Of Hemorrhage ◽  
The U.S

Background: Evidence suggest that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing TAVR Methods: This study was conducted using the National Inpatient Sample (NIS) in the U.S (2011-2013). Teaching status was classified as teaching vs non-teaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model Results: An estimated 17,020 TAVR procedures were performed in the U.S between 2011 and 2013, out of which 87% were in teaching hospitals. Mean (SD) age was 80 (8) and 47% were females. There was no significant difference between hospital teaching status with regards to procedure-related in-patient mortality, myocardial infarction, or other cardiac, vascular, neurological, respiratory complications, post-op DVT/PE, or sepsis (Fig 1). However, compared to non-teaching hospitals, teaching hospitals tend to have higher risk of acute kidney injury (OR: 1.47 [95% CI, 1.08-1.99]) but lower risk of hemorrhage requiring transfusion (OR: 0.67 [95% CI, 0.50-0.91]). The mean length of stay was higher in teaching hospitals (8.3 days) compared to non-teaching hospitals (7.5 days) (fig 2A), but median cost of hospitalization was higher in non-teaching hospitals (USD 59702 vs 49708) (fig 2B) Conclusion: We found that the risks of most TAVR-related complications (except for AKI and hemorrhage) are about the same in teaching compared to non-teaching hospitals. However, length of stay was higher in teaching hospitals while cost was higher in non-teaching hospitals

Abstract 16121: The Decade of Change: Survival Following Out-of-hospital Cardiac Arrest in Teaching versus Nonteaching Hospitals in the United States: 2000-2012

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shaker M Eid ◽  
Aiham Albaeni ◽  
Bolanle Akinyele ◽  
Lekshmi N Raghavakurup ◽  
Nisha Chandra-Strobos
Keyword(s):  
United States ◽  
Length Of Stay ◽  
The United States ◽  
Neurologic Outcome ◽  
Teaching Hospitals ◽  
Dramatic Improvement ◽  
Comorbidity Burden ◽  
Teaching Status ◽  
Good Neurologic Outcome ◽  
Total Charges

Background: All hospitals, regardless of teaching status, need to provide care for OHCA patients. Whether outcomes differ in teaching vs nonteaching hospitals is unknown and was examined in this study. Methods: Using the National Inpatient Sample database, we selected adults ≥18 years old admitted with a principle diagnosis of non-traumatic OHCA (ICD-9 CM codes 427.5 & 427.41) between 2000 and 2012. Patients were stratified to teaching (THs) or nonteaching hospitals (NTHs). The association of hospital teaching status with length of stay, total charges/case, survival to discharge, and survival with good neurologic outcome was assessed by multivariate logistic regression or generalized linear regression models, adjusting for patient and hospital-level characteristics. Results: Of 186,483 admitted patients, 86,053 (46.15%) were treated at teaching hospitals during the study period. Overall OHCA incidence in the United States was 3.86 per 10,000 hospital admissions. Patients at teaching hospitals were more often younger, more likely to have VF, and less likely to be Caucasian [all p < 0.001] but with a similar comorbidity burden. Mean length of stay and total charges were higher in teaching hospitals (5 vs. 4 days, p<0.01 & $72,436 vs. $52,917, p<0.01). Risk-adjusted survival and survival with good neurologic outcome were significantly better in THs as compared to NTHs (odds ratio, 1.06 ; 95% CI 1.02 – 1.14 & 1.19 ; 95% CI 1.09 – 1.29 respectively). Despite a significant increase in OHCA survival at NTHs between 2000 and 2012 ( P trend <0.01), OHCA survival rate at THs remained higher without any change in trend ( P trend =0.07) during the study period. Conclusion: For OHCA patients in the US, survival has been consistently higher in teaching hospitals. However, a dramatic improvement in survival has been realized in nonteaching hospitals over the last 12 years with lesser healthcare expenditure when compared to teaching hospitals; this phenomenon is worthy of further study.

scholarly journals 113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C McCann ◽  
A Hall ◽  
J Min Leow ◽  
A Harris ◽  
N Hafiz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Ward Round ◽  
Fluid Administration ◽  
Ward Staff ◽  
Intravenous Fluid Therapy ◽  
Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of &gt;62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged &gt;55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p &lt; 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p &lt; 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p &lt; 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

Abstract 257: Urban Teaching and Non-Teaching Hospitals Outcomes: Myocardial Infarction

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Priscilla O Okunji ◽  
Johnnie Daniel
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Income Group ◽  
The United States ◽  
Teaching Hospitals ◽  
Age Difference ◽  
Age Group ◽  
Urban Teaching ◽  
Significant Difference ◽  
The Impact

Background: Patients with myocardial infarction reportedly have different outcomes on discharge according to hospital characteristics. In the present study, we evaluated the differences between urban teaching hospitals (UTH) and non-teaching hospitals (NTH), discharged in 2012. We also investigated on the outcomes. Methods: Sample of 117,808 subjects diagnosed with myocardial infarction were extracted from a nationwide inpatient stay dataset using the International Classification Data, ICD 9 code 41000 in the United States, according to hospital location, size, and teaching status. Results: The analysis of the data showed that more whites were admitted to both teaching and non teaching hospitals with more males (~24%) admitted than their female counterparts. However, blacks were admitted more (~15%) in urban teaching hospitals than medium urban non teaching hospitals. Age difference was noted as well, while age group (60-79 years) were admitted more in UTH, inversely urban non-teaching hospitals admitted more older (80 years or older) age group. A significant difference (~28%) was observed in both hospital categories with UTH admitting more patients of $1.00 - $38,999.00 income group than other income categories. In addition, it was observed that patients with MI stayed more (~5%) for 14 or more days, and charged more especially for income group of $80,000 or above in UTH than NTH. No significant difference was found in the mortality rate for both hospital categories. Conclusion: The overall outcomes showed that the mortality rate between urban teaching and non-teaching hospitals were non significant, though the inpatients MI stayed longer and were charged more in UTH than NTH. The authors call for the study to be replicated with a higher level of statistical measures to ascertain the impact of the variables on the outcomes for a more validated result.

A single-center qualitative study evaluating the safety and efficacy of a pharmacist-driven protocol for high-dose methotrexate management

2020 ◽  
pp. 107815522092745
Author(s):  
Stephanie F Matta ◽  
Leslie A Gieselman ◽  
Robert S Mancini
Keyword(s):  
Length Of Stay ◽  
Kidney Injury ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Improvement Project ◽  
Treatment Delays ◽  
Dose Methotrexate ◽  
Significant Difference ◽  
The Impact ◽  
Inpatient Length Of Stay

Introduction Delayed methotrexate clearance in several patients admitted to the oncology unit at a regional medical center necessitated the development of a pharmacist-driven protocol for supportive therapy with high-dose methotrexate. This performance improvement project evaluated the impact of the protocol on inpatient length of stay, patient safety, and clinical outcomes. Methods Retrospective data were collected over 14 months pre-implementation and prospective data were collected over 19 months post-implementation. Primary outcomes included mean length of stay and incidence of kidney injury. Secondary outcomes included myelosuppression, treatment delays, mucositis, protocol adherence, and pharmacist interventions. Chi-squared and unpaired two sample t-test were used for data analysis. Intervention A literature review of consensus recommendations for supportive care post high-dose methotrexate administration was conducted to develop the protocol. Education on implementation was provided to involved disciplines. Results One-hundred ten high-dose methotrexate admissions for 23 patients were analyzed: 24 pre-protocol and 86 post-protocol. Mean length of stay was 5.17 nights pre-protocol and 3.91 nights post-protocol ( p = 0.026). Incidence of kidney injury significantly decreased (16.7% pre-protocol versus 3.5% post-protocol; p = 0.0394). Lower incidences of all-grade anemia (83.3% versus 58.1%), neutropenia (62.5% versus 29.1%), and thrombocytopenia (58.3% versus 33.7%) as well as treatment delays (29.2% versus 11.6%; p = 0.036) were reported post protocol. No statistically significant difference in mucositis was detected. Pharmacist adherence to protocol was ≥80% resulting in 348 interventions with 99.4% provider acceptance. Conclusion The implementation of a pharmacist-driven high-dose methotrexate management protocol resulted in a statistically significant decrease in inpatient length of stay and kidney injury. Further studies are needed to assess the impact on additional outcomes.

scholarly journals Association of Resident Duty Hour Restrictions on Mortality of Nervous System Disease and Disorder

2016 ◽  
Vol 8 (4) ◽  
pp. 576-580 ◽  
Author(s):  
Ian Churnin ◽  
Joel Michalek ◽  
Ali Seifi
Keyword(s):  
Nervous System ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Teaching Hospitals ◽  
Nonteaching Hospital ◽  
System Disease ◽  
Significant Difference ◽  
Reform Period ◽  
Teaching Status ◽  
The Impact

ABSTRACT Background  The impact of the 2003 residency duty hour reform on patient care remains a debated issue. Objective  Determine the association between duty hour limits and mortality in patients with nervous system pathology. Methods  Via a retrospective cohort study using the Nationwide Inpatient Sample from 2000–2010, the authors evaluated in-hospital mortality status in those with a primary discharge level diagnosis of disease or disorder of the nervous system. Odds ratios were calculated, and Bonferroni corrected P values and confidence intervals were determined to account for multiple comparisons relating in-hospital mortality with teaching status of the hospital by year. Results  The pre-reform (2000–2002) and peri-reform (2003) periods revealed no significant difference between teaching and nonteaching hospital mortality (P &gt; .99). The post-reform period (2004–2010) was dominated by years of significantly higher mortality rates in teaching hospitals compared to nonteaching hospitals: 2004 (P &lt; .001); 2006 (P = .043); 2007 (P = .042); and 2010 (P = .003). However, data for 2005 (P ≥ .99), 2008 (P = .80), and 2009 (P = .09) did not show a significant difference in mortality. Conclusions  Teaching and nonteaching hospital mortality was similar in patients with nervous system pathology prior to the duty hour reform. While nonteaching institutions demonstrated steadily declining mortality over the decade, teaching hospital mortality spiked in 2004 and declined at a more restricted rate. The timing of these changes could suggest a negative correlation of duty hour restrictions on outcomes of patients with nervous system pathology.

In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample

2020 ◽  
pp. jim-2020-001501
Author(s):  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Michael Albosta ◽  
Beth Bailey ◽  
Jagmeet Singh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

Effect of Hospital Characteristics on Performance of Pediatric Digit Replantation in the United States

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Justin E. Kleiner ◽  
Edward J. Testa ◽  
Nicholas J. Lemme ◽  
Avi D. Goodman ◽  
...  
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
Teaching Hospitals ◽  
Level Of Evidence ◽  
Teaching Status ◽  
Private And Public ◽  
Subsequent Revision ◽  
Privately Owned ◽  
Hospital Characteristics

Abstract Introduction Utilize a national pediatric database to assess whether hospital characteristics such as location, teaching status, ownership, or size impact the performance of pediatric digit replantation following traumatic digit amputation in the United States. Materials and Methods The Kid’s Inpatient Database (KID) was used to query pediatric traumatic digit amputations between 2000 and 2012. Ownership (private and public), teaching status (teaching and non-teaching), location (urban and rural), hospital type (general and children’s), and size (large and small-medium) characteristics were evaluated. Replantations were then divided into those that required subsequent revision replantation or amputation. Fisher’s exact tests and multivariable logistic regressions were performed with p <0.05 considered statistically significant. Results Overall, 1,015 pediatric patients were included for the digit replantation cohort. Hospitals that were privately owned, general, large, urban, or teaching had a significantly greater number of replantations than small-medium, rural, non-teaching, public, or children’s hospitals. Privately owned (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.06–3.06; p = 0.03) and urban (OR: 2.29; 95% CI: 1.41–3.73; p = 0.005) hospitals were significantly more likely to perform replantation. Urban (OR: 4.02; 95% CI: 1.90–8.47; p = 0.0003) and teaching (OR: 2.11; 95% CI: 1.17–3.83; p = 0.014) hospitals were significantly more likely to perform a revision procedure following primary replantation. Conclusion Private and urban hospitals were significantly more likely to perform replantation, but urban and teaching hospitals carried a greater number of revision procedures following replantation. Despite risk of requiring revision, the treatment of pediatric digit amputations in private, urban, and teaching centers provide the greatest likelihood for an attempt at replantation in the pediatric population. The study shows Level of Evidence III.

Cytoreductive nephrectomy in the United States: Patterns of care and patient characteristics.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 366-366 ◽  
Author(s):  
Che-Kai Tsao ◽  
Erin Moshier ◽  
Alexander C. Small ◽  
Guru Sonpavde ◽  
James Godbold ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Kinase Inhibitor ◽  
Private Insurance ◽  
Patient Characteristics ◽  
The United States ◽  
Teaching Hospitals ◽  
Cytoreductive Nephrectomy ◽  
Treatment Standard ◽  
Patterns Of Use ◽  
Significant Difference

366 Background: Two randomized trials published in 2001 established cytoreductive nephrectomy (CyNx) for patients (pts) with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era (Flanigan, J Urol, 2004). However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR tyrosine kinase inhibitor (TKIs). We evaluated the patterns of use of CyNx in the pre- and post-TKI era and characteristics of pts undergoing CyNx. Methods: The National Cancer Database was queried for pts diagnosed with mRCC between 2000 and 2008. Pts who underwent CyNx were identified and were further categorized by pre- versus post-TKI era (2000–2006 vs. 2006–2008), race, insurance status, and hospital. For these subcategories, prevalence ratios (PR) were generated using the proportion of pts with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) with mRCC diagnosed between 2000 and 2008, 25,616 pts (54%) did not undergo CyNx. The prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2006 (p<0.0001), then decreased 3% each year from 2006 to 2008 (p=0.0048), with a significant difference between the pre- and post-2006 PR (0.97 versus 1.025; p<0.0001). Blacks (PR 1.17) and Hispanics (PR 1.05) were significantly more likely than Caucasian to not undergo CyNx (p<0.008). Pts with Medicaid (PR 1.25), Medicare (PR 1.40), and no insurance (PR 1.42) were significantly more likely than pts with private insurance to not undergo CyNx (p<0.0001). Pts diagnosed at community hospitals (PR 1.29) were significantly more likely than pts at teaching hospitals to not undergo CyNx (p <0.0001). Conclusions: The use of CyNx has declined in the post-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the post-TKI era are awaited to optimize use of this modality.

scholarly journals Higher Incidence of TTP in African Americans and Females: An Analysis of Demographics, Cost and Length of Stay in Teaching and Nonteaching Hospitals for Thrombotic Thrombocytopenic Purpura Between 1999 and 2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4735-4735
Author(s):  
William Lee ◽  
Stuthi Perimbeti ◽  
Mariola Vazquez Martinez ◽  
Nausheen Hakim ◽  
Daniel Kyung ◽  
...  
Keyword(s):  
African Americans ◽  
Length Of Stay ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Teaching Hospitals ◽  
Short Term ◽  
Thrombocytopenic Purpura ◽  
Total Cost ◽  
Chi Square Analysis ◽  
The Cost ◽  
The U.S

Abstract Background: Limited studies compare the differences in care for Thrombotic Thrombocytopenic Purpura (TTP) patients in teaching versus nonteaching hospitals. TTP is a rare, life-threatening disease marked by widespread aggregation of platelets throughout the body, resulting in multi-organ sequelae including neurological dysfunction and renal insufficiency: a timely diagnosis is imperative for successful treatment. Academic centers generally have more individuals involved in each patient's care. This was considered in the evaluation of demographics, cost, length of stay, and disposition at discharge in the different settings. Methods: Adult admissions with a primary diagnosis of TTP for a 15-year period between 1999 and 2013 were extracted from the National Inpatient Sample database using the ICD-9 code 446.2 during a 15 year period between 1999 and 2013 (N=6,292, for a weighted N=30,011). The sample was weighted to approximate the full inpatient population of the U.S. over the time period. Teaching and nonteaching hospitals were compared within the parameters of gender, race, total cost, insurance, length of stay, mortality, and disposition. Chi square analysis was performed to examine differences in the categorical variables. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Results: The total number of admission for TTP was weighted N=28,058, divided between 20,426 for teaching and 8,082 for nonteaching hospitals. 67.6% of TTP admissions were female in both categories but a greater percentage of African Americans with TTP were admitted to teaching (N=6,842; 33.50%) than nonteaching hospitals (N=1,962; 24.28%) (p < 0.0001). More Caucasians with TTP were admitted to non-teaching (N=2,707; 33.50%) than teaching hospitals (N=6,834; 32.46%) (p <0.0001). The overall length of stay for TTP hospitalizations was 12.30 days +/- 0.16, with teaching hospitals being found to have a shorter length of stay at 11.26 +/- 0.28 days compared to nonteaching hospitals with 13.15 +/- 0.20 days (p < 0.0001). There was a slightly higher mortality rate in nonteaching hospitals: 8.92% in teaching hospitals versus 9.32% in nonteaching hospitals (p <0.6232). Overall hospital mortality decreased from 12.1% in 1999 to 6.0% in 2013. At discharge, more patients from nonteaching hospitals were transferred to short term facilities than those from teaching: 1,877 (23.23%) non-teaching patients versus 2,038 (9.98%) teaching patients (p = 0.0001). The overall cost of a TTP hospitalization was $106,184.94 +/- $1,762.57. Nonteaching hospitals had more costly hospitalizations at $113,437.87 +/- $2247.78 than teaching hospitals, which cost $99,481.35 +/- $3093.53 (p <0.0001). Medicare paid 26.23% of TTP hospitalizations in nonteaching hospitals and 22.91% in teaching hospitals (p <0.0006). Medicaid paid for 18.12% of TTP hospitalizations in teaching hospitals and 12.89% in nonteaching hospitals (p <0.0006). An increase in the cost for admissions for TTP was noted from 1999 to 2013. While the total charge of TTP admission was $58,437 in 1999, it was found to be $153,643 in 2013, or $109,878 when adjusted for inflation. This amounted to an adjusted 88% increase despite an essentially unchanged average length of stay, 12.5 days in 1999 and 12.6 days in 2013. Conclusion: In comparing TTP hospitalizations, teaching hospitals had a shorter length of stay, lesser cost of stay, and sent fewer patients to short term facilities upon discharge. However, these factors did not play a statistically significant role in decreasing mortality. Additionally, a trend of increasing total charges was noted from 1999 to 2013 despite an unchanged length of hospitalization and a decrease in mortality. Advanced age is associated with worse outcome in TTP and this is reflected by the higher mortality and higher percentage of Medicare payment in nonteaching hospitals. Medicaid was responsible for a higher percentage of payment in teaching hospitals and correlated with an improved mortality. Both African Americans and females were found to have more admissions regardless of hospital type, with African Americans being admitted more often to teaching than nonteaching hospitals. Further studies are necessary to determine the etiology of this significant rise in the cost of TTP treatment and to investigate the disproportionately higher incidence of TTP in African Americans and females. Disclosures No relevant conflicts of interest to declare.

Critical Strategies for Information Systems Development Projects

2011 ◽  
pp. 251-267
Author(s):  
Chung S. Kim ◽  
Dane K. Peterson
Keyword(s):  
Information Systems ◽  
The United States ◽  
Project Team ◽  
Successful Implementation ◽  
Project Leader ◽  
Team Members ◽  
Project Team Member ◽  
Crucial Component ◽  
Significant Difference ◽  
The U.S

This study investigated the perceptions of information systems (IS) developers from the United States and Japan with regards to the relative importance of 18 strategies that prior research has indicated are important for the successful implementation of an IS. The results of a principal components analysis revealed that the 18 IS strategies could be reduced to five components: (1) Organizational Integration, (2) Communications, (3) Characteristics of the Project Leader, (4) Characteristics of the Project Team Members, and (5) Project Development Techniques. The analysis also indicated that there were a significant difference in the perceptions of developers from the U.S. and Japan with respect to the importance of the five components. The developers from the U.S. viewed Communications as the most critical component and Project Leader Characteristics as the least important component. Conversely, developers from Japan perceived the Project Leader as the most crucial component for determining the success of an IS project. Team Member Characteristics was viewed as the least important component by developers from Japan. The results were discussed in terms of cultural differences.

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