scholarly journals Measuring hospital spatial accessibility using the enhanced two-step floating catchment area method to assess the impact of spatial accessibility to hospital and non-hospital care on the length of hospital stay

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Gao ◽  
Matthieu Jaffrelot ◽  
Séverine Deguen
Keyword(s):  
Linear Regression ◽  
Hospital Care ◽  
Catchment Area ◽  
Length Of Hospital Stay ◽  
Spatial Accessibility ◽  
Inpatient Hospital ◽  
Care Services ◽  
The Mean ◽  
The Impact ◽  
The Relationship

Abstract Background Optimal healthcare access improves the health status and decreases health inequalities. Many studies demonstrated the importance of spatial access to healthcare facilities in health outcomes, particularly using the enhanced two-step floating catchment area (E2SFCA) method. The study objectives were to build a hospital facility access indicator at a fine geographic scale, and then to assess the impact of spatial accessibility to inpatient hospital and non-hospital care services on the length of hospital stay (LOS). Methods Data concerning older adults (≥75 years) living in the Nord administrative region of France were used. Hospital spatial accessibility was computed with the E2SFCA method, and the LOS score was calculated from the French national hospital activity and patient discharge database. The relationship between LOS and spatial accessibility to inpatient hospital care and to three non-hospital care types (general practitioners, physiotherapists, and home-visiting nurses) was analyzed with linear regression models. Results The mean number (standard deviation) of beds per 10,000 inhabitants was 19.0 (10.69) in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 (2.19) in Postoperative and Rehabilitation Care (SSR) facilities, highlighting important variations within the region. Accessibility to hospital services was higher in large urban areas, despite the dense population and higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, but their geographical repartition was non-homogeneous. The linear regression analysis revealed a strong negative and significant association between LOS and non-hospital care accessibility. Conclusions This is the first study to measure spatial accessibility to inpatient hospital care in France using the E2SFCA method, and to investigate the relationship between healthcare utilization (LOS score) and spatial accessibility to inpatient hospital care facilities and three types of non-hospital care services. Our findings might help to make decisions about deploying additional beds and to identify the best locations for non-hospital care services. They might also contribute to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. International studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods are needed.

scholarly journals Potential inpatient hospital care accessibility scores: association with healthcare utilization and non-hospital care service accessibility

2020 ◽  
Author(s):  
Fei GAO ◽  
Matthieu Jaffrelot ◽  
Séverine Deguen
Keyword(s):  
Linear Regression ◽  
Healthcare Utilization ◽  
Hospital Care ◽  
Healthcare Access ◽  
Spatial Accessibility ◽  
Inpatient Hospital ◽  
Care Services ◽  
Care Facilities ◽  
The Impact ◽  
The Relationship

Abstract Background: Optimal healthcare access improves people's health status and decreases health inequalities. Many studies demonstrated spatial access importance in health outcomes. Recent studies assessed spatial healthcare access using the enhanced two-step floating catchment area (E2SFCA) method. The study aim was to build a hospital facility access indicator at a fine geographic scale and to assess the impact of spatial accessibility to inpatient hospital care and non-hospital care services on the length of hospital stay (LOS). Methods: This study focused on the ≥75-year-old population of the Nord administrative region of France. Hospital spatial accessibility was computed with the E2SFCA method, and then the LOS score was calculated from the French national hospital activity and patient discharge database. Linear regression models were used to analyze the relationship between LOS and spatial accessibility to inpatient hospital care and to three types of non-hospital care services (general practitioners, physiotherapists, and home-visiting nurses). Results: Overall, there were 19.0 beds in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 beds in Postoperative and Rehabilitation Care facilities (SSR) per 10,000 inhabitants, but with important geographic variations. Accessibility to hospital services was higher for people in large urban areas, despite the dense population and the higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, with a non-homogeneous geographical repartition. The linear regression analysis revealed a strong negative and significant association between LOS and non-hospital care accessibility.Conclusions: This is the first study to measure spatial accessibility to inpatient hospital care in France using the E2SFCA method, and the first to investigate the relationship between healthcare utilization (LOS) and spatial accessibility to inpatient hospital care facilities and three types of non-hospital care services. Our findings should help to take decisions about deploying additional beds and to identify the best locations for non-hospital care services. Moreover, they should also help to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. Other international studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods should be developed.

scholarly journals Potential Hospital Care Accessibility Scores: Association with Healthcare Utilization and Non-Hospital Care Service Accessibility

2020 ◽  
Author(s):  
Fei GAO ◽  
Matthieu Jaffrelot ◽  
Séverine Deguen
Keyword(s):  
Linear Regression ◽  
Healthcare Utilization ◽  
Hospital Care ◽  
Healthcare Access ◽  
Spatial Accessibility ◽  
Geographic Scale ◽  
Care Services ◽  
Healthcare Needs ◽  
Care Facilities ◽  
The Relationship

Abstract Background: Optimal healthcare access improves people's health status and decreases health inequalities. Many studies demonstrated spatial access importance in health outcomes. Recent studies assessed spatial healthcare access using the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to build a hospital facility access indicator at a fine geographic scale and to determine whether there is a complementarity between non-hospital and hospital care accessibility by investigating the length of hospital stays (LOS). Methods: This study focused on the ≥75-year-old population of the Nord administrative region of France. Hospital spatial accessibility was computed with the E2SFCA method, and then the LOS score was calculated from the French national hospital activity and patient discharge database. Linear regression models were used to analyze the relationship between LOS and spatial accessibility to hospital-based care and to the three types of non-hospital care services (general practitioners, physiotherapists, and home-visiting nurses). Results: Overall, there were 19.0 beds in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 beds in Postoperative and Rehabilitation Care facilities (SSR) per 10,000 inhabitants, but with important geographic variations. Accessibility to hospital services was higher for people in large urban areas, despite the dense population and the higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, with a non-homogeneous geographical repartition. Linear regression analysis revealed a strong negative and significant association between hospital and non-hospital care accessibility.Conclusions: This is the first study to measure spatial accessibility to hospital-based cares in France using the E2SFCA method, and the first to investigate the relationship between spatial accessibility to hospital-based care facilities and three types of non-hospital care services and healthcare utilization (LOS). Our findings should help to take decisions about deploying additional beds and to identify the best locations for non-hospital care services. Moreover, they should also help to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. Other international studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods should be developed.

scholarly journals Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fei Gao ◽  
Clara languille ◽  
Khalil karzazi ◽  
Mélanie Guhl ◽  
Baptiste Boukebous ◽  
...  
Keyword(s):  
Statistical Methods ◽  
General Practitioners ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Spatial Accessibility ◽  
Negatively Associated ◽  
Inpatient Hospital ◽  
Spatial Autoregressive ◽  
The Impact ◽  
The Relationship

Abstract Background Healthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship. Methods This study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored. Results GWR performed best (highest R2 and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists. Conclusions Our findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation.

Heart Rate and Neurological Outcomes in Patients Undergoing Targeted Temperature Management

2020 ◽  
pp. 088506662098250
Author(s):  
Chad M. Conner ◽  
William H. Perucki ◽  
Andre Gabriel ◽  
David M. O’Sullivan ◽  
Antonio B. Fernandez
Keyword(s):  
Heart Rate ◽  
Positive Association ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Neurological Outcomes ◽  
Neurologic Outcomes ◽  
Resuscitation Guidelines ◽  
The Mean ◽  
The Impact ◽  
The Relationship

Introduction: There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. Methods: We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student’s t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. Results: Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR’s < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR’s in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. Conclusion: During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.

Older people's satisfaction with intermediate care: a systematic review

2007 ◽  
Vol 17 (3) ◽  
pp. 199-218 ◽  
Author(s):  
Andrew Wilson ◽  
Suzanne Richards ◽  
Janette Camosso-Stefinovic
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Older Patients ◽  
Hospital Care ◽  
Patient Choice ◽  
Intermediate Care ◽  
Care Services ◽  
The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

Assessing Barriers to Medication Adherence in Pediatric and Adolescent and Young Adult (AYA) Patients on Anticoagulation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-10
Author(s):  
Kevin E Todd ◽  
Meghan E Mcgrady ◽  
Anne Blackmore ◽  
Carrie Hennessey ◽  
Lori Luchtman-Jones
Keyword(s):  
Young Adults ◽  
Linear Regression ◽  
Medication Administration ◽  
Self Report ◽  
Adolescent And Young Adult ◽  
The Past ◽  
Children And Young Adults ◽  
The Impact ◽  
The Relationship ◽  
Lower Adherence

Background: Medication nonadherence rates as high as 50-75% have been widely reported in children and adolescents with chronic medical conditions. Anticoagulation nonadherence is associated with increased morbidity and mortality from hemorrhagic and thrombotic complications, reported mostly in older adult populations. As direct oral anticoagulant use increases, it is critical that pediatric clinicians understand the prevalence, adverse sequelae, and predictors of nonadherence for various anticoagulants prescribed for children and young adults to facilitate self-management in this population. To begin to address these critical knowledge gaps, this study explored the frequency of reported barriers to anticoagulation adherence and the relationship between reported barriers and adherence among a cohort of children and young adults who were prescribed anticoagulants through a pediatric thrombosis clinic. Methods: Data for this abstract were collected as part of a quality improvement (QI) initiative in the pediatric thrombosis clinic from May 2019 to November 2019. This QI initiative included the administration of a self-report measure which asked families to rate the presence/absence of 19 barriers to adherence and respond to two items assessing adherence ("How many anticoagulation doses did you/your child miss in the past 7 days?"; "Did you/your child miss any anticoagulation doses in the past month?"). Patients aged &gt; 10 years (yr.) and/or their caregivers (for patients 0-17 yr.) visiting the clinic for anticoagulation follow-up completed the measure. With IRB approval, results from 161 anonymous measures from 130 families (n = 37 caregivers; n = 62 patients; n = 31 patient/caregiver dyads) were analyzed. Descriptive statistics were used to summarize the most frequent barriers, rates of adherence, and concordance of barriers within patient/caregiver dyads. Linear regression was used to explore relationships between barriers and adherence after controlling for medication administration type (injections versus oral). To ensure only one measure per family was included in this analysis, the regression was run on the subset of measures completed by caregivers of children &lt; 18 yr. and patients ≥ 18 yr. (n = 105 [37 caregivers + 62 patients + 31 caregivers from patient/caregivers dyad = 130 families; 130 - 25 families with missing adherence data = 105 families]). Results: Of 161 reporters, 120 reported at least 1 barrier. The most common barriers were medication side effects (n = 44), alterations in lifestyle secondary to medication (n = 44) and forgetting to take the medications (n = 37). The distributions of barriers by reporter and medication type are illustrated in Figure 1. Of 31 dyads, 26 reported 1 or more barriers. Only 6 caregiver/child dyads reported the same set of barriers. The remaining 77% (n = 20) of caregivers endorsed different barriers than their children. On average, patients and caregivers reported 1.85 barriers (SD = 1.95, range 0 - 10) and that they/their child took 96% of prescribed doses (SD= 9%, range = 71 - 100%). The linear regression was significant (F(2, 102) = 4.19, p = 0.02, R2 = 0.08). After controlling for medication type (p = 0.06), a greater number of barriers was significantly associated with lower adherence (t = -2.63, p = 0.01). Every one unit increase in total barriers (1 additional barrier reported) was associated with a decrease of .26% in adherence. Discussion: Although self-reported adherence was high, 75% of patients and caregivers reported 1 or more barriers to adherence. A greater number of barriers is associated with lower adherence, regardless of medication route, suggesting that addressing reported barriers might improve adherence. The spectrum of reported barriers was diverse, differing even within patient and caregiver dyads. Therefore, it is important to evaluate both patients and caregivers to fully assess the burden of barriers. Future studies are needed to evaluate the impact of addressing barriers and the relationship between anticoagulation adherence, barriers, and health outcomes. Figure 1 Disclosures Luchtman-Jones: Corgenix: Other: Provided discounted kits for study; Accriva Diagnostics: Other: Provided kits for study.

Combining employment and care-giving: how differing care intensities influence employment patterns among middle-aged women in Germany

2018 ◽  
Vol 40 (5) ◽  
pp. 925-943 ◽  
Author(s):  
Nadiya Kelle
Keyword(s):  
Cox Regression ◽  
Labour Force ◽  
Ageing Population ◽  
Care Providers ◽  
Unpaid Care ◽  
Care Services ◽  
Care Giving ◽  
Employed Women ◽  
The Impact ◽  
The Relationship

AbstractGiven an ageing population and increased participation by women in the labour force, the relationship between unpaid care and the availability of women to the labour force is gaining in importance as an issue. This article assesses the impact of unpaid care on transitions into employment by women aged between 45 and 59 years. It uses the German Socio-Economic Panel (SOEP) from the years 2001–2014 to estimate Cox regression models for 6,201 employed women. The results indicate that women with higher caring responsibilities and women with lower caring responsibilities are heterogeneous in terms of the socio-economic characteristics that they exhibit: higher-intensity care providers tend to have a lower level of educational attainment and a weaker attachment to the labour force than women with less-intensive caring responsibilities. Furthermore, while women with more-intensive caring roles are highly likely to exit the labour market altogether, female carers with less-intensive roles seem to be able to combine work and care better. These results highlight the importance of providing more affordable institutional and professional care services, especially for low- and medium-income families.

scholarly journals Analyzing the Effect of the Senior Management’s Support on the Relationship between Factors Affecting and Employees’ Performance in the Al-Zawiya University of Libya

2017 ◽  
Vol 13 (3) ◽  
pp. 42
Author(s):  
Nasreddin Ramadhan Dukhan ◽  
Norhisham Mohamad ◽  
Asbi B Ali
Keyword(s):  
Likert Scale ◽  
Factors Affecting ◽  
The Mean ◽  
Multiple Groups ◽  
Strongly Agree ◽  
The Impact ◽  
The Relationship ◽  
Variable Performance

This study aims to test the influence of the senior management’s support as a moderating variable on the relationship between the independent factors (Training, Empowerment, Motivation and Communication) and the dependent variable (Performance of Employees). (SEM-AMOS) is used to test the impact of the moderating variable. Where it is depended on the method of sampling or analysis of what is known as multiple-groups analysis. The paragraphs of the senior management’s support variable are collected and divided into two groups according to the mean of the total paragraphs. In addition, according to the relative weights given to the paragraphs of the questionnaire, using a five- point’s Likert scale: 1= strongly disagree to 5 = strongly agree. The first group consisted of the grades less than the mean and it is considered as the group which is non-supporters of the existence of support. While the second group consisted of the grades higher than the mean and considered as the group which is a supporter of the existence of support. The study found that the model of study in the presence of the support of the senior management’s is appropriate for the second group and inappropriate in light of the lack of support by the senior management’s support for the first group.

scholarly journals THE LUCK IN “TALENT VERSUS LUCK” MODELING

2020 ◽  
Vol 23 (03) ◽  
pp. 2050007
Author(s):  
SEAN ELVIDGE
Keyword(s):  
Mean Value ◽  
Maximum Amount ◽  
Random Numbers ◽  
Individual Parameter ◽  
Input Parameters ◽  
The Mean ◽  
Model Variability ◽  
The Impact ◽  
The Relationship

This paper further investigates the Talent versus Luck (TvL) model described by [Pluchino et al. Talent versus luck: The role of randomness in success and failure, Adv. Complex Syst. 21 (2018) 1850014] which models the relationship between ‘talent’ and ‘luck’ on the impact of an individuals career. It is shown that the model is very sensitive to both random sampling and the choice of value for the input parameters. Running the model repeatedly with the same set of input parameters gives a range of output values of over 50% of the mean value. The sensitivity of the inputs of the model is analyzed using a variance-based approach based upon generating Sobol sequences of quasi-random numbers. When using the model to look at the talent associated with an individual who has the maximum capital over a model run it has been shown that the choice for the standard deviation of the talent distribution contributes to 67% of the model variability. When investigating the maximum amount of capital returned by the model the probability of a lucky event at any given epoch has the largest impact on the model, almost three times more than any other individual parameter. Consequently, during the analysis of the model results one must keep in mind the impact that only small changes in the input parameters can have on the model output.

scholarly journals PENGARUH REVIU RKA-K/L OLEH APIP TERHADAP EFISIENSI ALOKASI ANGGARAN KEMENTERIAN AGAMA

2019 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Edy Effendi ◽  
Muhammad Imron
Keyword(s):  
Linear Regression ◽  
Simple Linear Regression ◽  
Independent Variables ◽  
Dependent Variables ◽  
Before And After ◽  
The Impact ◽  
The Relationship ◽  
Positive Effect

Research on the role of the APIP review of the Ministry/agency Work Plan and Budget document to determine the impact on the efficiency of ministry/agency spending (case study at the Ministry of Religion). The method used in this study uses simple linear regression with dummy. The use of linear regression is used to examine the relationship between independent variables (certain types of expenditure) and dependent variables (total expenditure). Whereas, dummy is used to find out before and after the APIP review is done. Throughout the author's search, this research has never been done. Based on the results of linear regression obtained, the APIP review significantly had a positive effect on official travel expenditure and honorarium but did not significantly affect building spending and equipment. Abstrak   Penelitian atas peran reviu APIP atas dokumen Rencana Kerja dan Anggaran Kementerian Negara/Lembaga untuk mengetahui dampaknya terhadap efisiensi belanja kementerian/lembaga (studi kasus pada Kementerian Agama). Metode yang digunakan dalam penelitian ini menggunakan regresi linier sederhana dengan dummy. Penggunaan regresi liner digunakan untuk meneliti hubungan antara variable independen (jenis belanja tertentu) dan variable dependen (total belanja). Sedangkan, dummy digunakan untuk mengetahui sebelum dan setelah reviu APIP dilakukan. Sepanjang penelusuran penulis, penelitian ini belum pernah dilakukan. Berdasarkan hasil regresi linier diperoleh, reviu APIP signifikan berpengaruh positif terhadap  belanja perjalanan dinas dan honorarium tetapi tidak signifikan berbengaruh terhadap belanja gedung dan alat.

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