scholarly journals ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249038
Author(s):  
Eduardo Oliveira ◽  
Amay Parikh ◽  
Arnaldo Lopez-Ruiz ◽  
Maria Carrilo ◽  
Joshua Goldberg ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Health Care System ◽  
Severity Of Illness ◽  
Icu Patients ◽  
Icu Admission ◽  
Related Mortality ◽  
Care System

Background Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. Methods Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients. Results Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5–71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7–10.4)] vs non-survivors [10 (9.1–12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8–22) vs 8.5 (IQR 5–10.8) p< 0.001], Hospital LOS [21 (IQR 13–31) vs 10 (7–1) p< 0.001] and ICU LOS [14 (IQR 7–24) vs 9.5 (IQR 6–11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. Conclusions Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19.

scholarly journals ICU Outcomes and Survival in Patients with Severe COVID-19 in the Largest Health Care System in Central Florida

2020 ◽  
Author(s):  
Eduardo Oliveira ◽  
Amay Parikh ◽  
Arnaldo Lopez-Ruiz ◽  
Maria Carrillo ◽  
Joshua Goldberg ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Health Care System ◽  
Severity Of Illness ◽  
Icu Patients ◽  
Icu Admission ◽  
Related Mortality ◽  
Care System

Background Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. Methods Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients. Results Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range {IQR}, 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p= 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) p< 0.001], Hospital LOS [21 (IQR 13-31) vs 10 (7-1) p< 0.001] and ICU LOS [14 (IQR 7-24) vs 9.5 (IQR 6-11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. Conclusions Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasize the importance of standard of care measures in the management of COVID-19.

scholarly journals Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia

2019 ◽  
Vol 10 ◽  
pp. 215013271989644
Author(s):  
Melese Merga ◽  
Tilahun Fufa Debela ◽  
Tesfamichael Alaro
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Direct Medical Cost ◽  
Health Care System ◽  
Medical Cost ◽  
Institutional Delivery ◽  
Mode Of Delivery ◽  
Hidden Cost ◽  
Bale Zone ◽  
Care System

Background: The Ethiopian health care system since 2005 has encouraged safe enhanced obstetrical care. However, hospital delivery has remained expensive for poor households due to hidden costs. Hidden costs are the costs that are not accounted for in direct hospital costs. The aim of this study was to estimate the hidden costs of institutional delivery and to identify its associated factors. Methods: A health facility–based cross-sectional study was conducted in the Bale zone from August 13 to September 2, 2018. Exit interviews were conducted among women who gave birth at the selected hospitals. A total of 390 women from 1 referral hospital and 2 general hospitals were included into the study. Systematic sampling technique was used to select study participants. Multiple linear regression analysis was done to identify the predictors of the hidden cost of institutional delivery. Result: The median hidden cost of institutional delivery was 877.5 ETB (32.03 USD). The median of the direct medical cost of normal delivery was 280 ETB (10.21 USD) while the direct nonmedical cost was 230 ETB (8.40 USD). For cesarean section, the median direct medical cost was 292 ETB (10.66 USD) while indirect costs were 591 ETB (21.60 USD). For forceps delivery, the direct medical cost was 362 ETB (13.21 USD) while the direct medical cost was 360 (13.14 USD). Distance of household from the hospital (β = 0.165), length of stay at the hospital (β = 0.050), mode of delivery (β = −0.067), and family monthly income (β = 0.201) were the explanatory variables significantly associated with the hidden cost. Conclusion: This study showed hidden cost of facility-based delivery was high. Distance, length of stay, income, and mode of delivery were the predictor of hidden cost. Ethiopian health care system should consider the hidden costs for pregnant women and their families.

Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System

2020 ◽  
Vol 10 (10) ◽  
pp. 836-843
Author(s):  
Megan Farrell ◽  
Sarah Bram ◽  
Hongjie Gu ◽  
Shakila Mathew ◽  
Elizabeth Messer ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Peripheral Blood ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Significant Difference ◽  
Contaminated Blood ◽  
The Impact ◽  
Care System

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P &lt; .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P &lt; .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.

scholarly journals Impact of a Shared Medical Appointment on Hypertension Clinical Outcomes and Medication Adherence in a Veterans Affairs Health Care System

2017 ◽  
Vol 33 (5) ◽  
pp. 177-182 ◽  
Author(s):  
Cain Eric Kirk ◽  
Autumn N. Gordon ◽  
Kelly D. Mooney ◽  
Garrett B. Aikens ◽  
Michael H. Robinson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Health Care System ◽  
Antihypertensive Medications ◽  
Access And Quality ◽  
Improve Access ◽  
Care System

Background:Shared medical appointments (SMAs) are utilized across health care systems to improve access and quality of care, with limited evidence to support the use of SMAs to improve clinical outcomes and medication adherence among hypertensive patients. Objective: Improve access and quality of care provided within a Veterans Affairs health care system via implementation of a hypertension SMA to improve clinical outcomes and medication adherence. Methods: Veterans were eligible for enrollment in the SMA if they received care within the health care system, were aged ≥18 years, were receiving at least 2 antihypertensive medications, and had systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg. A pre/post cohort design was used to evaluate the improvement in antihypertensive medication adherence as well as the change in SBP and DBP for all Veterans who attended at least 2 SMAs. Results: Twenty-one Veterans participated in at least 2 SMAs and were included in the analysis; 76.2% had a reduction in SBP with an overall average decrease of −8.3 mm Hg ( P = .02). The proportion of Veterans considered to have controlled blood pressure (BP; <140/90 mm Hg) increased from 14.3% at baseline to 42.9% during the SMA period ( P = .03). There was no significant difference found for the proportion of Veterans considered adherent to their prescribed antihypertensive medications (95.2% vs 85.7%, respectively; P = .50). Conclusions: SBP significantly improved for patients enrolled in a pharmacist-led SMA at a VA health care system, and the proportion of patients considered to have controlled BP increased significantly.

Machine Learning Based Program to Prevent Hospitalizations and Reduce Costs in the Colombian Statutory Health Care System

2018 ◽  
Vol 8 (2) ◽  
pp. 44-64
Author(s):  
Alvaro J Riascos ◽  
Natalia Serna
Keyword(s):  
Machine Learning ◽  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Prevention Program ◽  
Health Care Systems ◽  
Cost Savings ◽  
Machine Learning Techniques ◽  
Patient Treatment ◽  
Care System

Health-care systems that rely on hospitalization for early patient treatment pose a financial concern for governments. In this article, the author suggests a hospitalization prevention program in which the decision of whether to intervene on a patient depends on a simple decision model and the prediction of the patient risk of an annual length-of-stay using machine learning techniques. These results show that the prevention program achieves significant cost savings relative to several base scenarios for program efficacies greater than or equal to 40% and intervention costs per patient of 100,000 to 700,000 Colombian pesos (i.e., approximately 14% to 100% of the average cost per patient in Colombia statuary health care system). This article also shows how tree-based methods outperform linear regressions when predicting an annual length-of-stay and the final model achieves a lower out-of-sample error compared to those of the Heritage Health Prize.

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