scholarly journals Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243373
Author(s):  
Pei-Fang Huang ◽  
Pei-Tseng Kung ◽  
Wen-Yu Chou ◽  
Wen-Chen Tsai
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Payment System ◽  
Hospital Ownership ◽  
Related Factors ◽  
Factors Associated ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Ed Visits ◽  
Monthly Salary

Objectives Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC). Methods We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System. Results In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69–9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32–31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals. Conclusion The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.

scholarly journals Characteristics and Related Factors of Length of Stay and Readmission Rates of Inpatients Under a DRG Based Payment System: a Cohort Study

2021 ◽  
Author(s):  
Ming-Wei Luo ◽  
Shi-Wei Xie ◽  
Ming-Yang Luo ◽  
Xian-Qin Cheng ◽  
Jing Yan
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Critical Condition ◽  
Diagnosis Related Groups ◽  
Risk Groups ◽  
Payment System ◽  
Readmission Rates ◽  
Related Factors ◽  
Increased Risk ◽  
Using Data

Abstract ObjectivesPanzhihua has implemented the Diagnosis Related Groups (DRGs) since 2018, and the quality of medical under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics of patients under the DRG payment system based on the related factors, length of stay, readmission of inpatients.MethodsWe conducted a retrospective cohort study using data from Hospital Information System (HIS) from 2019 . The study used logistic regression analysis to investigate the factors related to hospitalization time and readmission rate of patients under the DRG payment system.ResultsIn this study ,68210 inpatients were included in the study. Among these inpatients ,5.84% were readmitted within 30 days.The factors associated with the increased risk of readmission included age, DRG payment, admission, critical condition, and discharge (p <0.05). Surgical patients had the highest risk of readmission within 30 days (OR=1.04995% CI：0.982-1.122). Among the inpatients readmitted within 30 days, 79.65% of them were readmitted within 14 days. 11.49% of the inpatients were transferred to other hospitals.ConclusionThe study shows a significant correlation between readmission and age, DRG payment, admission, critical condition, and discharge. The results suggested that high risk groups need in-depth examination and evaluation when discharged and admitted to hospital.

scholarly journals THU0417 READMISSION RISK AND QUALITY OF CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH GOUT FLARES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 446.2-446
Author(s):  
L. Brunetti ◽  
J. Vekaria ◽  
P. Lipsky ◽  
N. Schlesinger
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Economic Burden ◽  
Hospital Admissions ◽  
Medical Center ◽  
Research Support ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Anti Inflammatory ◽  
Gout Flares

Background:Gout is the most common form of inflammatory arthritis and its economic burden is substantial, with estimates for the overall cost exceeding $20 billion (US) annually. Contributing to the economic burden are hospital admissions and iatrogenic events associated with pharmacotherapy. Identification of modifiable risk factors would be an important contribution to clinical practice.Objectives:The aim of this study was to identify opportunities for enhancing gout care in patients presenting to the Emergency Department (ED) with gout flares.Methods:This retrospective cohort study used data from electronic medical records (EMR) at a large community hospital. All consecutive patients visiting the medical center ED with a primary diagnosis of gout from 1/1/2016 to 7/1/2019 were included. Patients were then followed for 90 days to determine whether they were readmitted to the ED for any reason. A chart review identified whether they were on appropriate medications in terms of gout flare management. All data were summarized using descriptive statistics. A multiple logistic regression was constructed to identify risk factors for ED utilization within 90 days of the index visit.Results:A total of 214 patients were included in the analysis. Most patients were male (79%), mean age was 59.4 ± 15.6 years, and mean Charlson comorbidity index was 0.5 ± 1.14. The most common medications prescribed during the ED visit included NSAIDs (41.6%), opioids (28%), corticosteroids (26.6%), and colchicine (21%). Allopurinol and febuxostat were initiated in the ED in 4.7% and 0.9%, respectively. Discharge medications for the management of gout included NSAIDs (37%), corticosteroids (34.6%), opioids (23.8%), colchicine (14%), febuxostat (7%), and allopurinol (6.5%). Of the patients sent home with an opioid, 40% were newly prescribed. An anti-inflammatory medication was not prescribed in 29.6% of patients discharged from the ED. Readmission within 90 days was recorded in 16.8% of patients. Of these readmissions, 33.3% were gout-related and 11.1% were cardiac related.After adjusting for age and comorbidity index, patients receiving colchicine were 2.8 times more likely (OR, 2.81; 95% CI, 1.12 to 7.02; p=0.027) to return to the ED within 90 days. The most common cause of readmission in this subset was gout-related (54.5%).Conclusion:Nearly 30% of patients were discharged from the ED without an anti-inflammatory medication, whereas initiation of urate lowering therapy was rare. Opiates were used frequently, but the indication was uncertain. Only 5.6% of subjects revisited the ED for gout-related diagnoses in the subsequent 3 months. Colchicine prescription was associated with an increased risk of gout-related ED utilization within 90 days. Treatment of gout in the ED is sub-optimal and often does not follow established guidelines.Disclosure of Interests: :Luigi Brunetti Grant/research support from: Astellas Pharma, CSL Behring, Consultant of: Horizon Foundation of New Jersey, Janaki Vekaria: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon

scholarly journals Factors associated with unplanned readmissions in a major Australian health service

2019 ◽  
Vol 43 (1) ◽  
pp. 1 ◽  
Author(s):  
Julie Considine ◽  
Karen Fox ◽  
David Plunkett ◽  
Melissa Mecner ◽  
Mary O'Reilly ◽  
...  
Keyword(s):  
Health Service ◽  
Hospital Admission ◽  
Acute Care ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Factors Associated ◽  
Australian Health ◽  
Increased Risk ◽  
Patient Groups ◽  
Comorbidity Index

Objective The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods A retrospective study of 20575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results The unplanned readmission rate was 7.4% (n=1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index &gt;1 (OR 1.1–1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) &gt;2 days (OR 1.4–1.8), hospital admission(s) (OR 1.7–10.86) or emergency department (ED) attendance(s) (OR 1.8–5.2) in the 6 months preceding the index admission and health service site (OR 1.2–1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic? Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add? The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a ‘one size fits all approach’ to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS &gt;2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners? One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments.

scholarly journals Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance: a mortality follow-back survey

2019 ◽  
Vol 48 (5) ◽  
pp. 680-687
Author(s):  
Anna E Bone ◽  
Catherine J Evans ◽  
Lesley A Henson ◽  
Wei Gao ◽  
Irene J Higginson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Health Professional ◽  
End Of Life ◽  
Respiratory Disease ◽  
Community Support ◽  
Free Text ◽  
Coordinated Care ◽  
Factors Associated ◽  
Increased Risk

Abstract Background frequent emergency department (ED) attendance at the end of life disrupts care continuity and contradicts most patients’ preference for home-based care. Objective to examine factors associated with frequent (≥3) end of life ED attendances among older people to identify opportunities to improve care. Methods pooled data from two mortality follow-back surveys in England. Respondents were family members of people aged ≥65 who died four to ten months previously. We used multivariable modified Poisson regression to examine illness, service and sociodemographic factors associated with ≥3 ED attendances, and directed content analysis to explore free-text responses. Results 688 respondents (responses from 42.0%); most were sons/daughters (60.5%). Mean age at death was 85 years. 36.5% had a primary diagnosis of cancer and 16.3% respiratory disease. 80/661 (12.1%) attended ED ≥3 times, accounting for 43% of all end of life attendances. From the multivariable model, respiratory disease (reference cancer) and ≥2 comorbidities (reference 0) were associated with frequent ED attendance (adjusted prevalence ratio 2.12, 95% CI 1.21–3.71 and 1.81, 1.07–3.06). Those with ≥7 community nursing contacts (reference 0 contacts) were more likely to frequently attend ED (2.65, 1.49–4.72), whereas those identifying a key health professional were less likely (0.58, 0.37–0.88). Analysis of free-text found inadequate community support, lack of coordinated care and untimely hospital discharge were key issues. Conclusions assigning a key health professional to older people at increased risk of frequent end of life ED attendance, e.g. those with respiratory disease and/or multiple comorbidities, may reduce ED attendances by improving care coordination.

scholarly journals Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

2018 ◽  
Vol 8 (4) ◽  
pp. 166-170
Author(s):  
Jerina Nogueira ◽  
Pedro Abreu ◽  
Patrícia Guilherme ◽  
Ana Catarina Félix ◽  
Fátima Ferreira ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Intracerebral Hemorrhage ◽  
Hospital Discharge ◽  
Transitional Care ◽  
Neurological Impairment ◽  
Emergency Department Visits ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Ed Visits

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

scholarly journals Physician-related factors associated with unscheduled revisits to the emergency department and admission to the intensive care unit within 72 h

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chao-Sheng Chang ◽  
Kuo-Hsin Lee ◽  
Hung-Yuan Su ◽  
Cheuk-Kwan Sun ◽  
I-Ting Tsai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Related Factors ◽  
Factors Associated

scholarly journals P.119 Emergency Department Use in Children with Cerebral Palsy: A Data Linkage Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S53-S53
Author(s):  
O Fortin ◽  
P Ng ◽  
M Dorais ◽  
L Koclas ◽  
N Pigeon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cerebral Palsy ◽  
Low Socioeconomic Status ◽  
Motor Impairment ◽  
Linkage Study ◽  
Administrative Databases ◽  
Chi Square ◽  
Increased Risk ◽  
Children With Cerebral Palsy ◽  
Ed Visits

Background: Improved understanding of factors predictive of emergency department (ED) visits in children with cerebral palsy (CP) can help optimize healthcare use. We sought to identify the pattern of ED consultations in these children. Methods: Data from the Registre de paralysie cérébrale du Québec and provincial administrative databases were linked. The CP cohort was comprised of children born between 1999 and 2002. Data pertaining to ED presentations between 1999 and 2012 were obtained. Relative risks were calculated to identify factors associated with increased ED visits. Peers without CP were selected from administrative databases and matched in a 20:1 ratio. Chi-square tests and Student’s T-tests were used to compare the two cohorts. Results: 301 children with CP and 6040 peer controls were selected. Ninety-two percent (92%) of the CP cohort had at least one ED visit, compared to 74% amongst controls. Children with CP had an increased risk of high ED use compared to peers (RR 1.40 95% CI 1.30-1.52). Factors predictive of high ED use were comorbid epilepsy, severe motor impairment and low socioeconomic status. Conclusions: Children with CP have a higher need for urgent health assessments than their peers, resulting in increased use of ED services. System factors and barriers should be investigated.

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