Medical surveillance unit: patient characteristics, outcome, and quality of care in Saskatchewan, Canada

Abstract Background: The U.S. lacks a stroke surveillance system. This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality.Methods: Two statistical approaches were used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample. Post-stratification survey weights were estimated using a raking procedure and Bayesian interpolation methods. Weighting methods were adjusted to limit the dispersion of weights and make reasonable epidemiologic estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national estimates were reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated were patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results: A total of 1,388,296 acute ischemic strokes occurred between 2012 and 2014. Raking and Bayesian estimates of clinical data not recorded in administrative databases were estimated within 5% to 10% of the margins of expected values. Median weights for the raking method were 1.386 and the weights at the 99th percentile were 6.881 with a maximum weight of 30.775. Median Bayesian weights were 1.329 and the 99th percentile weights were 11.201 with a maximum weight of 515.689. Conclusions: Leveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. These methods may be applied to other diseases or settings to better monitor population health.

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Faculty Opinions recommendation of The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.721230456.793502509 ◽

2014 ◽

Author(s):

Jean-Luc Vachiery

Keyword(s):

Heart Failure ◽

Quality Of Care ◽

Patient Characteristics ◽

Patients With Heart Failure

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Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study

BMJ Open ◽

10.1136/bmjopen-2019-036264 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036264 ◽

Cited By ~ 1

Author(s):

Matthew D McHugh ◽

Linda H Aiken ◽

Carol Windsor ◽

Clint Douglas ◽

Patsy Yates

Keyword(s):

Quality Of Care ◽

Emotional Exhaustion ◽

Nurse Staffing ◽

Patient Characteristics ◽

Public Hospitals ◽

Job Dissatisfaction ◽

Additional Patient ◽

Cross Sectional ◽

Hospital Size

ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.DesignAnalysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.SettingPublic hospitals in Queensland.Participants4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.ResultsMedical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).ConclusionsBefore ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.

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Quality of Care Differs by Patient Characteristics: Outcome Disparities After Ambulatory Surgical Procedures

American Journal of Medical Quality ◽

10.1177/1062860607307996 ◽

2007 ◽

Vol 22 (6) ◽

pp. 395-401 ◽

Cited By ~ 10

Author(s):

Nir Menachemi ◽

Askar Chukmaitov ◽

L. Steven Brown ◽

Charles Saunders ◽

Robert G. Brooks

Keyword(s):

Quality Of Care ◽

Surgical Procedures ◽

Patient Characteristics ◽

Ambulatory Surgical Procedures

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Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

Annals of Intensive Care ◽

10.1186/s13613-021-00978-3 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Dave A. Dongelmans ◽

Fabian Termorshuizen ◽

Sylvia Brinkman ◽

Ferishta Bakhshi-Raiez ◽

M. Sesmu Arbous ◽

...

Keyword(s):

Quality Of Care ◽

The Netherlands ◽

Patient Characteristics ◽

Third Wave ◽

The Third ◽

Icu Discharge ◽

Occupancy Rates ◽

Second Wave ◽

Care Evaluation

Abstract Background To assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands. Methods Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020–January 31, 2021) and the final upsurge of the second wave, called the ‘third wave’ (N = 4602: February 1, 2021–June 30, 2021) were compared with those during the first wave (N = 2733, February–May 24, 2020). Results During the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71–0.90]). Conclusions These data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

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Regional Variations in Heart Failure Quality and Outcomes: Get With The Guidelines–Heart Failure Registry

Journal of the American Heart Association ◽

10.1161/jaha.120.018696 ◽

2021 ◽

Author(s):

Luke C. Cunningham ◽

Gregg C. Fonarow ◽

Clyde W. Yancy ◽

Shubin Sheng ◽

Roland A. Matsouaka ◽

...

Keyword(s):

United States ◽

Heart Failure ◽

Quality Of Care ◽

Length Of Stay ◽

Patient Characteristics ◽

The United States ◽

Short Term ◽

Quality And Outcomes ◽

Get With The Guidelines

Background Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short‐term outcomes of hospitalized patients with HF across the United States. Methods and Results We examined regional demographics, quality measures, and short‐term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG‐HF (Get With The Guidelines–Heart Failure) registry from 2010 to 2016. Differences in length of stay and mortality by region were examined with multivariable logistic regression. The study included 423 333 patients hospitalized for HF in 488 hospitals. Patients in the Northeast were significantly older. Completion of achievement measures, with few exceptions, were met with similar frequency across regions. Multivariable analysis demonstrated significantly lower in‐hospital mortality in the Midwest compared with the Northeast (hazard ratio, 0.64; 95% CI, 0.51–0.8; P <0.00001). The length of stay varied significantly by region with a significantly higher risk‐adjusted length of stay in the Northeast compared with other regions. Conclusions Although we did not find any substantial differences by region in quality of care in patients hospitalized for HF, risk‐adjusted inpatient mortality was found to be lower in the Midwest compared with the Northeast, and may be secondary to unmeasured differences in patient characteristics, and to longer length of stay in the Northeast.

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Gender Differences in Patient Characteristics and Quality-of-Care Indicators Among Referrals to Queensland Statewide Heart Failure Support Services

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.06.137 ◽

2018 ◽

Vol 27 ◽

pp. S104

Author(s):

Y. Wong ◽

A. Hickey ◽

T. Nunan ◽

J. Adsett ◽

C. Denaro ◽

...

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Quality Of Care ◽

Support Services ◽

Patient Characteristics

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RACIAL DISPARITIES IN HIP FRACTURE CARE

Innovation in Aging ◽

10.1093/geroni/igz038.1750 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S469-S469

Author(s):

Iman Ali ◽

Jessica Jang ◽

Sanjana Vattigunta ◽

Ankit Bansal ◽

Uma Srikumaran

Keyword(s):

Quality Of Care ◽

Hip Fracture ◽

Racial Disparities ◽

Hip Fractures ◽

Quality Care ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Outcome Variable ◽

Black Patients

Abstract Hip fractures are associated with significant morbidity and mortality. Delaying surgery for more than 24 hours after presentation results in more complications, higher 30-day mortality rate, and longer stays in the hospital. As such, high-quality care should be provided consistently to an increasingly diverse patient population. We determined if race characteristics influence the quality of care provided to patients with hip fractures. We conducted a retrospective analysis on patients at our institution between January 2015 and December 2017. Patients were categorized as white, Black, Asian, and other. The primary outcome variable was the time between presentation to surgery. Other outcomes included length of hospital stay and narcotic pain medication consumption in the first 24 hours postoperatively. Adjusted analysis was performed, controlling for sex, age, body mass index (BMI), American Society of Anesthesiologists’ (ASA) classification of health, and Charlson Comorbidity Index (CCI). There were 1544 hip fracture patients included in the study. The majority of patients were white (84.1%) followed by Black (7.6%), Asian (4.5%), and other (3.7%). Most patients were female (69.6%). After adjusting for patient characteristics, Black patients experienced a significantly greater delay to surgery after presentation than white patients (42.1 vs. 34.9 hours). In addition, Black patients experienced significantly longer length of hospital stays compared to their white counterparts (6.9 vs. 5.8 days). Racial disparities in the quality of care provided to hip fracture patients persist even after adjusting for patient characteristics. Addressing these disparities can possibly enhance outcomes for minority patients.

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