scholarly journals Newly Initiated In-Hospital Antipsychotics Continued at Discharge in Non-psychiatric Patients

2018 ◽  
Vol 53 (5) ◽  
pp. 308-315 ◽  
Author(s):  
Gabriel V. Fontaine ◽  
Whitney Mortensen ◽  
Kathryn M. Guinto ◽  
Danielle M. Scott ◽  
Russell R. Miller
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Health Care System ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Psychiatric Illness ◽  
Psychiatric Patients ◽  
Final Analysis ◽  
To Receive ◽  
Care System

Objectives: Antipsychotics are commonly initiated in the hospital for agitation and delirium and may be inappropriately continued upon floor transfer and at discharge. We sought to evaluate the magnitude of this issue within our health care system. Methods: We conducted a multicenter, retrospective cohort study within a 22-hospital health care system to evaluate the proportion of patients without identifiable psychiatric illness who received newly initiated inpatient antipsychotics and were then continued on an antipsychotic at hospital discharge. Results: Of 23 049 patients who received at least 1 in-hospital dose of haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone, 8297 patients were included in the final analysis after applying exclusion for identifiable psychiatric illness or previous antipsychotic use. Ultimately, 334 patients (4%) were discharged with a new antipsychotic prescription. Patients receiving antipsychotics at discharge were more likely as an inpatient to receive quetiapine (77.2% vs 35.9%; odds ratio [OR]: 6.1, 95% confidence interval [CI]: 4.7-8.0; P < .001) and less likely to receive haloperidol (15% vs 47%; OR: 0.2, 95% CI: 0.14-0.27; P < .001) or olanzapine (16.2% vs 20.9%; OR: 0.73, 95% CI: 0.53-0.98; P < .04). Conclusions: Antipsychotics may be inappropriately continued in non-psychiatric patients at hospital discharge. Strategies to limit potentially unnecessary antipsychotics upon discharge should be evaluated.

Patient Experiences, Trust, and Preferences for Health Data Sharing

2021 ◽  
Author(s):  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Kent A. Griffith ◽  
Rebecca Spence ◽  
Angela R. Bradbury ◽  
...  
Keyword(s):  
Health Care ◽  
Data Sharing ◽  
Health Care System ◽  
Lived Experiences ◽  
Care Delivery ◽  
Group Discussion ◽  
Final Analysis ◽  
Secondary Use ◽  
The Impact ◽  
Care System

PURPOSE: Scholars have examined patients' attitudes toward secondary use of routinely collected clinical data for research and quality improvement. Evidence suggests that trust in health care organizations and physicians is critical. Less is known about experiences that shape trust and how they influence data sharing preferences. MATERIALS AND METHODS: To explore learning health care system (LHS) ethics, democratic deliberations were hosted from June 2017 to May 2018. A total of 217 patients with cancer participated in facilitated group discussion. Transcripts were coded independently. Finalized codes were organized into themes using interpretive description and thematic analysis. Two previous analyses reported on patient preferences for consent and data use; this final analysis focuses on the influence of personal lived experiences of the health care system, including interactions with providers and insurers, on trust and preferences for data sharing. RESULTS: Qualitative analysis identified four domains of patients' lived experiences raised in the context of the policy discussions: (1) the quality of care received, (2) the impact of health care costs, (3) the transparency and communication displayed by a provider or an insurer to the patient, and (4) the extent to which care coordination was hindered or facilitated by the interchange between a provider and an insurer. Patients discussed their trust in health care decision makers and their opinions about LHS data sharing. CONCLUSION: Additional resources, infrastructure, regulations, and practice innovations are needed to improve patients' experiences with and trust in the health care system. Those who seek to build LHSs may also need to consider improvement in other aspects of care delivery.

Health Care System Structure in the State of Israel

2019 ◽  
Vol 88 (1) ◽  
pp. 39-46
Author(s):  
Mohammad Yasser Sabbah
Keyword(s):  
Health Care ◽  
Medical Treatment ◽  
Health System ◽  
Health Care System ◽  
The State ◽  
The Public ◽  
The Right ◽  
To Receive ◽  
State Of Israel ◽  
Care System

The health care system in the State of Israel consists of two sectors - the public sector, which includes government-owned hospitals and medical institutes. The public health sector includes the community health system, health funds, family medicine, the general care system and the mental health care system. The second sector is the private sector, which includes private hospitals and medical institutes. Both sectors are supervised by the Israeli Ministry of Health, which is the supreme governmental authority through which it implements its policy in the entire health system in Israel. The law provides and guarantees medical insurance for every resident of Israel, the right to receive medical treatment, the prohibition of discrimination, informed consent to medical treatment, the right to receive an additional medical opinion, the dignity and privacy of the patient and the right to attend. Health funds in Israel were established before the State of Israel was established. The ideological concept of the health funds was based on the principle of equality and mutual assistance.

What's Missing? Discussing Stem Cell Translational Research in Educational Information on Stem Cell “Tourism”

2013 ◽  
Vol 41 (1) ◽  
pp. 254-268 ◽  
Author(s):  
Zubin Master ◽  
Amy Zarzeczny ◽  
Christen Rachul ◽  
Timothy Caulfield
Keyword(s):  
Health Care ◽  
Stem Cell ◽  
Health Care System ◽  
Medical Tourism ◽  
Regulatory System ◽  
Cell Therapies ◽  
The Public ◽  
Stem Cell Tourism ◽  
To Receive ◽  
Care System

Stem cell tourism is a form of medical tourism in which patients travel to receive unproven or untested stem cell-based interventions for many different diseases and conditions. A few studies indicate that patients and the public have several reasons for seeking these treatments for themselves or for their loved ones. Among these are the feeling of not having any other clinical options left, distrust of or frustration with their home country’s health care system, and a perception that their home country has a burdensome or sluggish regulatory system for the approval of novel stem cell therapies. These last two viewpoints may contribute to a certain sense of distrust of regulatory agencies governing the conduct of clinical research, and perhaps the perception of a health care system that seems unresponsive to the needs of patients suffering from severe conditions.

scholarly journals An investigation of postpartum mothers’ readiness for hospital discharge and the affecting factors

2017 ◽  
Vol 14 (2) ◽  
pp. 1484
Author(s):  
Derya Kaya Şenol ◽  
Semiha Aydın Özkan ◽  
Nevin Hotun Şahin
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Health Care System ◽  
Postpartum Period ◽  
Affecting Factors ◽  
Factors Affecting ◽  
Related Literature ◽  
Breastfeeding Monitoring ◽  
Postpartum Mothers ◽  
Care System

Introduction: Postpartum period which contains important changes in the woman’s and newborn’s life, WHO recommends monitoring the mother and newborn in health care system, encouraging breastfeeding, monitoring the newborn’s development, and supporting and empowering parents about newborn care.Purpose: The purpose of this study is to identify postpartum mothers’ readiness for hospital discharge and the affecting factors. Method and material: The study was conducted with 190 mothers who gave birth between May and July, 2014 in a Maternity and Children Hospital located in Mersin. The data were collected through the Identification Form developed by the researcher in line with the related literature and Readiness for Hospital Discharge Scale-Postpartum Mother Form (RHDS-PMF).Results: Of all the participants, 84.7% were ready for discharge, 69.4% received information from midwives or nurses about their own care, and 68.7% received information about the baby’s care. Mean scores for the participants’ Readiness for Hospital Discharge Scale was found 50.47±12.16 for Personal State, 45.08±12.33 for Knowledge, 21.0±75.68 for Ability, 28.13± 8.91 for Expected Support and 144.76±30.15 for total score. The scores were found to be significantly higher for mothers who reported to be ready for discharge, who stated to have received information about their own care and the baby’s care, who were multiparous, and who would receive support for their care and the baby’s care after hospital discharge (p<0.05).Conclusion: Majority of the participants in this study were found to be ready for hospital discharge and factors affecting readiness for hospital discharge were identifed as informing mothers about their care and the baby’s care after delivery, mothers’ being multiparous, and receiving support about their care and the baby’s care after hospital discarge.

scholarly journals Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Robert J. Reid ◽  
Melissa L. Anderson ◽  
Paul A. Fishman ◽  
Jennifer B. McClure ◽  
Ron L. Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Health Care System ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
One Health ◽  
System A ◽  
Lipid Testing ◽  
Care System

Abstract 094: Evaluation of Readmission and Survival Rates After Heart Failure Hospitalization in the Veterans Affairs Health Care System Between 2006 and 2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Justin Parizo ◽  
Shoutzu Lin ◽  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care System ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Laboratory Data ◽  
Mortality Rates ◽  
Veterans Affairs ◽  
Readmission Rates ◽  
Care System

Objective: Evaluate trends in readmission and mortality rates after heart failure (HF) hospitalization among veterans in the era of improved utilization of guideline directed therapy and nation-wide focus on decreasing hospital readmission rates. Background: In the past decade, a strong emphasis has been placed on decreasing HF readmissions. Concurrently, adherence to guideline directed therapy has improved. A 2002 to 2006 evaluation of the Veterans Affairs Health Care System (VAHCS) showed stagnant HF readmission rates, but declining mortality rates. It is unclear to what extent the recent focus on decreasing readmission and following guidelines has affected these outcomes. Methods: The 30-day mortality and 30-day readmission rates of patients admitted with a first diagnosis of HF from 2006 to 2013 in the VAHCS were assessed for temporal trends. Odds ratios for these outcomes were adjusted for patient demographics, medical history, and laboratory data. Results: This study included 119,261 patients admitted to VAHCS institutions between 2006 and 2013 with a new diagnosis of HF. Among these patients, 116,849 were male, the mean age was 71.1 years, 80,497 were white, 24,753 were black, and 6,548 were Hispanic. During the two years preceding admission, the incidence of renal disease, ischemic heart disease, diabetes, malignancy, hypertension, COPD, CVD, and acute myocardial infarction were 46.1% (54,984 of 119,261), 73.5% (87,640 of 119,261), 56.1% (66,883 of 119,261), 16.2% (19,257 of 119,261), 92.8% (110,687 of 119,261), 53.7% (64,064 of 119,261), 22.9% (27,268 of 119,261), and 26.5% (31,619 of 119,261), respectively. During the study period, the 30-day readmission rate declined from 19.56% (3852 of 19,694) to 13.76% (1420 of 10,317, p < 0.0001) with an adjusted odds ratio of 30-day readmission in 2013 (vs 2006) of 0.66 (95% CI: 0.66 to 0.76) (Figure 1). Conversely, the 30-day mortality rate was stable at 5.62% (1107 of 19,694) in 2006 and 5.30% (547 of 10,317) in 2013 (p = 0.45) with an adjusted odds ratio of 30-day mortality in 2013 (vs 2006) of 1.22 (95% CI: 1.09 to 1.37). This odds ratio was stable from 2007 through 2013. Conclusions: Despite the observed decline in 30-day readmission rates, 30-day mortality rates have been unaffected by the recent focus on preventing readmission and improved guideline adherence.

A Clinical Review of Biosimilars Approved in Oncology

2020 ◽  
pp. 106002802094459
Author(s):  
Dat Ngo ◽  
Jason Chen
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Data Extraction ◽  
Cost Savings ◽  
Final Analysis ◽  
Fda Approval ◽  
Study Selection ◽  
The Us ◽  
Primary Literature ◽  
Care System

Objective: To summarize and review the clinical data of Food and Drug Administration (FDA)-approved biosimilars for use in treatment of cancer and the current challenges health care institutions face when implementing a newly approved biosimilar. Data Sources: A literature search of the following databases was performed between January 1, 2012, and December 31, 2019: PubMed, Google, and ClinicalTrials.gov. Search terms included the words biosimilar, bevacizumab, rituximab, and/or trastuzumab. Study Selection and Data Extraction: Only primary literature on biosimilars with an ongoing or completed phase 3 trial and/or FDA approval were included in the final analysis. Primary literature consisted of peer-reviewed publications, published abstracts, and any results posted on the ClinicalTrials.gov database. Data Synthesis: Clinical trials of FDA-approved biosimilars for bevacizumab, rituximab, and trastuzumab showed no significant differences with respect to efficacy, safety, and pharmacokinetics when compared with their reference products. Relevance to Patient Care and Clinical Practice: The anticipated growth of biologics in oncology and the recent introduction of biosimilars over the past few years have placed a lot of emphasis on biosimilars as a significant source of cost savings for the health care system. Our article compiles and analyzes existing data on biosimilar efficacy, safety, and financial impact. Conclusions: The major concerns of biosimilars revolve around their long-term efficacy and safety. Even with many questions to be answered, biosimilars have the potential for significant cost savings in the US health care system.

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