Hospital Re-Admissions: An Empirical Analysis of Quality Management in Taiwan

2001 ◽  
Vol 14 (2) ◽  
pp. 92-103 ◽  
Author(s):  
Kai-Li Tsai ◽  
Ay-Chen Lee ◽  
Patrick Asubonteng Rivers
Keyword(s):  
Retrospective Study ◽  
Quality Management ◽  
Quality Evaluation ◽  
Average Length ◽  
Admission Rate ◽  
Emergency Admission ◽  
Patient Characteristics ◽  
Insurance Status ◽  
Significant Relationships ◽  
Level Data

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.

Hospital re-admissions: an empirical analysis of quality management in Taiwan

2001 ◽  
Vol 14 (2) ◽  
pp. 92-103 ◽  
Author(s):  
Kai-Li Tsai ◽  
Ay-Chen Lee ◽  
Patrick Asubonteng Rivers
Keyword(s):  
Retrospective Study ◽  
Quality Management ◽  
Quality Evaluation ◽  
Average Length ◽  
Admission Rate ◽  
Emergency Admission ◽  
Patient Characteristics ◽  
Insurance Status ◽  
Significant Relationships ◽  
Level Data

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.

Challenges in Antenatal Corticosteroid Prescribing: A Retrospective Study

2020 ◽  
Vol 16 (4) ◽  
pp. 327-333
Author(s):  
Shannon Armstrong-Kempter ◽  
Lucinda Beech ◽  
Sarah J. Melov ◽  
Adrienne Kirby ◽  
Roshini Nayyar
Keyword(s):  
Retrospective Study ◽  
Obstetric Care ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Optimal Timing ◽  
Prescribing Practices ◽  
Antenatal Corticosteroids ◽  
Term Infants ◽  
Preterm Premature Rupture ◽  
To Receive

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging. Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period. Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed. Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]). Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

scholarly journals 272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Sharrock ◽  
A Nugur ◽  
S Hossain
Keyword(s):  
Morbid Obesity ◽  
Length Of Stay ◽  
Lower Limb ◽  
Average Length ◽  
Perioperative Complications ◽  
Joint Infection ◽  
Admission Rate ◽  
Tendon Injury ◽  
Morbidly Obese ◽  
Admission Rates

Abstract Introduction There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty. Method We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI >40). Results 285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury. For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications. Conclusions Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.

Perioperative Use of Total Parenteral Nutrition: Variations in Guidelines and Practice in Three Norwegian Hospitals

1995 ◽  
Vol 11 (4) ◽  
pp. 741-749 ◽  
Author(s):  
Marianne Mjaaland ◽  
Arthur Revhaug ◽  
Olav Helge Førde
Keyword(s):  
Retrospective Study ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Gastrointestinal Surgery ◽  
Patient Characteristics ◽  
Substantial Part ◽  
Cross Sectional

AbstractIn a cross-sectional, retrospective study of 604 cases, variations among three Norwegian hospitals in use of perioperative parenteral nutrition (TPN) after gastrointestinal surgery was determined. Postoperative TPN rates were 25%, 34% (p =.05) and 56% (p <.0001). respectively. However, a substantial part of the variation was explained by differences in patient characteristics.

Abstract P550: High Uric Acid Levels Correlate With Treatment- Resistant Hypertension

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Badhma Valaiyapathi ◽  
Mohammed Siddiqui ◽  
Suzanne Oparil ◽  
David A Calhoun ◽  
Tanja Dudenbostel
Keyword(s):  
Uric Acid ◽  
Retrospective Study ◽  
Resistant Hypertension ◽  
Missing Values ◽  
Antihypertensive Agents ◽  
Treatment Resistance ◽  
Patient Characteristics ◽  
Control Group ◽  
Increased Risk ◽  
The University

Background: Serum uric acid (sUA) levels have been found to be positively associated with increased risk of hypertension (HTN), independent of other cardiovascular risk factors. The role of sUA elevation in patients with resistant hypertension (RHTN) is unknown. We hypothesized that sUA levels are higher in RHTN patients compared to patients with controlled HTN. Methods: This retrospective study included, 140 patients from the University of Alabama at Birmingham Hypertension Clinic. Patient characteristics including body mass index (BMI), office blood pressure (BP) and sUA levels were analyzed. RHTN was defined as office BP > 140/90 mmHg on ≥ 3 or more different antihypertensive agents including a diuretic. Patients with RHTN were compared with a control group with controlled hypertension. Patients with sUA levels <3 mg/dl, who were on treatment with allopurinol, and those with missing values were excluded from the study. Results: Patient characteristics of 91 included patients were: 53.4% female, 40.7% African American, mean age 58.8 ± 12.4 years, mean BMI 33.1 ± 7.5 kg/m 2 , mean sUA 6.6 ± 1.9 mg/dL. Mean sUA was higher among RHTN patients compared to the control group (p = 0.0031). Treatment resistance was found to be strongly correlated with sUA levels of ≥ 6 mg/dl (p = 0.0065). Conclusion: In this retrospective study, sUA levels were found to be significantly higher among resistant HTN patients compared to controlled HTN patients, indicating that high sUA levels (≥ 6 mg/dl) may play a role in treatment resistance among hypertensive patients.

Budaya Organisasi dan Komitmen Guru Dalam Pelaksanaan Pengurusan Kualiti Menyeluruh di Sekolah–sekolah Menengah Zon Bukit Mertajam

2012 ◽  
Author(s):  
Keow Ngang Tang ◽  
Abdul Ghani Kanesan Abdullah
Keyword(s):  
Organizational Culture ◽  
Quality Management ◽  
Secondary Schools ◽  
Total Quality Management ◽  
Simple Random Sampling ◽  
Total Quality ◽  
Significant Relationships ◽  
Level Ii ◽  
Research Findings ◽  
High Level

Kajian ini bertujuan untuk mengkaji faktor–faktor berkaitan Pengurusan Kualiti Menyeluruh (PKM) di sekolah–sekolah menengah zon Bukit Mertajam. Faktor–faktor yang dikaji ialah budaya organisasi dan komitmen guru. Kajian yang berbentuk tinjauan korelasi ini merangkumi sejumlah 300 orang guru dari 19 buah sekolah menengah zon Bukit Mertajam yang telah dipilih dengan menggunakan kaedah persampelan rawak mudah. Satu set instrumen kajian yang terdiri daripada tiga bahagian iaitu PKM, budaya organisasi, dan komitmen guru dengan nilai alfa Cronbach masing–masing 0.881, 0.921, dan 0.852 telah digunakan dalam kajian ini. Secara deskriptifnya, dapatan kajian ini menunjukkan: (i) Kebanyakan responden iaitu 65.6 peratus mempunyai persepsi bahawa amalan PKM di sekolah mereka adalah pada tahap yang sederhana manakala persepsi 30.4 peratus responden berada pada tahap tinggi; (ii) Sebanyak 67.3 peratus responden mempunyai persepsi bahawa budaya organisasi mereka berada pada tahap yang sederhana positif; (iii) Kesemua responden berkomitmen sederhana dan tinggi. Di samping itu, penganalisisan data menunjukkan terdapat hubungan yang positif dan signifikan antara budaya organisasi (r = 0.725) dan komitmen guru (r = 0.901) dengan tahap PKM pada aras signifikan 0.01. Hasil kajian daripada analisis regresi pelbagai kaedah ‘Forward’ pula menunjukkan budaya organisasi dan komitmen guru merupakan peramal yang telah berjaya menyumbang sebanyak 81.7 peratus dalam pelaksanaan PKM ini. Kata kunci: Pengurusan kualiti menyeluruh, budaya organisasi, komitmen guru The aim of this research was to study factors associated with Total Quality Management (TQM) in secondary schools Bukit Mertajam zone. Factors that were studied are organizational culture and teachers’ commitment. This descriptive correlational survey research involved a total of 300 teachers from 19 secondary schools in Bukit Mertajam zone that were selected using the simple random sampling method. A set of research instrument comprising of the three section, namely TQM, organizational culture and teachers’ commitment with Cronbach Alpha value 0.881, 0.921 and 0.852 respectively has been used in this research. In descriptive terms, the research findings showed that: (i) Most of the respondents, 65.6 percent perceived the practice of TQM in their schools was at the moderate level while 30.4 percent respondents perceived the practice of TQM was at the high level; (ii) A total of 67.3 percent respondents perceived their organizational culture as moderate positive level; (iii) All respondents were at the moderate and high commitment. In addition, the data analysis showed that there were positive and significant relationships between the organizational culture (r = 0.725) and teachers’ commitment (r = 0.901) with the level of TQM at significent level = 0.01. Findings of the “Forward” method of multiple regression showed that organizational culture and teachers’ commitment were the predictors in which have successfully contributed 81.7 percent to the practice of TQM. Key words: Total Quality Management, organizational culture, teachers’ commitment

scholarly journals Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

2017 ◽  
Vol 27 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Anthony L. Asher ◽  
Clinton J. Devin ◽  
Brandon McCutcheon ◽  
Silky Chotai ◽  
Kristin R. Archer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Lumbar Spine ◽  
Smoking Status ◽  
Patient Characteristics ◽  
Lumbar Spine Surgery ◽  
Multivariable Logistic Regression Analysis ◽  
Insurance Status ◽  
Quality Outcomes

OBJECTIVEIn this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration.METHODSA total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present.RESULTSIn total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients’ smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients’ propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers.CONCLUSIONSUsing a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

scholarly journals Necrotizing fasciitis: presentation, microbiology and outcomes in a community hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2471
Author(s):  
Mercy N. Jimenez ◽  
Emily S. Seltzer ◽  
Bhavana Devanabanda ◽  
Martine Louis ◽  
Nageswara Mandava
Keyword(s):  
New York ◽  
Necrotizing Fasciitis ◽  
Clinical Decision Making ◽  
Community Hospital ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Blood Cultures ◽  
Average Length Of Stay

Background: Necrotizing fasciitis (NF) is an aggressive and often fatal, soft tissue infection. Delayed surgical therapy leads to worsened outcomes. This study evaluates the mortality, outcomes, and characteristics of patients with NF in a diverse New York City Community Hospital Network.Methods: Retrospective chart review from 2012 to 2019 using ICD-9 and ICD-10 codes of gas gangrene, Fournier’s gangrene, and necrotizing fasciitis was done. Of the 297 patients reviewed 28 met inclusion criteria of imaging findings, operative reports, and clinical diagnosis of NF by an attending surgeon.Results: On average patients in ER were seen by the surgical team within less than 12 hours. Most patients were debrided within 10 hours of surgical consultation and on average received 2.2 procedures. Of the wound cultures obtained 65.38% were polymicrobial in nature. The average length of stay was 17.4 days and 32% of patients required ICU admission. The surgical mortality rate was 7.61%.Conclusions: Necrotizing fasciitis is a rare entity and increasing provider knowledge on patient characteristics as well as the complexity of these patients and the types and number of procedures they require may help guide clinical decision making. We identified that while most of our patients had negative blood cultures on admission, those that had positive blood cultures had multiple organisms growing. Knowing that these patients are complex and likely require multiple procedures, prompt operative intervention is key.

A Cross-National Epidemiological Study of Mania

1976 ◽  
Vol 129 (5) ◽  
pp. 428-437 ◽  
Author(s):  
J. P. Leff ◽  
Margit Fischer ◽  
A. Bertelsen
Keyword(s):  
Retrospective Study ◽  
Epidemiological Study ◽  
Admission Rate ◽  
Annual Incidence ◽  
Screening Procedure ◽  
West Indians ◽  
One Year ◽  
First Admission ◽  
Cross National

SummaryAn epidemiological study of the first admission rate for mania was carried out in London and Aarhus. The case registers in these two centres were used to conduct a retrospective study of case notes covering several years, and a screening procedure was used for the prospective collection of new cases over the course of one year. The annual incidence of mania was found to be virtually identical in both centres. The retrospective study gave a figure of 2.6 per 100,000 population in both Aarhus and London. But the London sample was found to contain 45 per cent of immigrants in contrast to the Aarhus sample in which only a negligible proportion were born outside Denmark. Male West Indians, in particular, were over-represented in the London sample.

Sign in / Sign up

Export Citation Format

Share Document