scholarly journals Trading quality for quantity? Evidence from patient level data in China

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257127
Author(s):  
Jinglin Song ◽  
Chen Chen ◽  
Shaoyang Zhao ◽  
Leming Zhou ◽  
Hong Chen
Keyword(s):  
Quality Of Care ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Medical Staff ◽  
Hospital Admissions ◽  
Medical Services ◽  
Medical Quality ◽  
The Impact

In China, overcrowding at hospitals increases the workload of medical staff, which may negatively impact the quality of medical services. This study empirically examined the impact of hospital admissions on the quality of healthcare services in Chinese hospitals. Specifically, we estimated the impact of the number of hospital admissions per day on a patient’s length of stay (LOS) and hospital mortality rate using both ordinary least squares (OLS) and instrumental variable (IV) methods. To deal with potential endogeneity problems and accurately identify the impact of medical staff configuration on medical quality, the daily air quality index was selected as the IV. Furthermore, we examined the differential effects of hospital admissions on the quality of care across different hospital tiers. We used the data from a random sample of 10% of inpatients from a city in China, covering the period from January 2014 to June 2019. Our final regression analysis included a sample of 167 disease types (as per the ICD-10 classification list) and 862,722 patient cases from 517 hospitals. According to our results, the LOS decreased and hospital mortality rate increased with an increasing number of admissions. Using the IV method, for every additional hospital admission, there was a 6.22% (p < 0.01) decrease in LOS and a 1.86% (p < 0.01) increase in hospital mortality. The impact of healthcare staffing levels on the quality of care varied between different hospital tiers. The quality of care in secondary hospitals was most affected by the number of admissions, with the average decrease of 18.60% (p < 0.05) in LOS and the increase of 6.05% (p < 0.01) in hospital mortality for every additional hospital admission in our sample. The findings suggested that the supply of medical services in China should be increased and a hierarchical diagnosis and treatment system should be actively promoted.

scholarly journals Weekend Hospital Admission for Heart Failure: Influence on Quality of Care, Length of Stay, and In-Hospital Mortality

2008 ◽  
Vol 14 (6) ◽  
pp. S7-S8
Author(s):  
Tamara B. Horwich Gregg C. Fonarow ◽  
Kenneth A. LaBresh ◽  
Clyde Yancy ◽  
Nancy M. Albert ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Admission

The Impact of Hospital Overcrowding on Quality of Care: Evidence from China

2020 ◽  
Author(s):  
Chen Chen ◽  
Jinglin Song ◽  
Shaoyang Zhao ◽  
Leming Zhou ◽  
Hong Chen
Keyword(s):  
Quality Of Care ◽  
Mortality Rate ◽  
Instrumental Variable ◽  
Staffing Levels ◽  
Unit Increase ◽  
Number Of Visits ◽  
Hospital Days ◽  
The Impact ◽  
Different Levels

Abstract Background This study examines the impact of healthcare staffing levels on the quality of healthcare services. Methods We use data from a 10% random sample of inpatients in a city in China from January 2014 to June 2019, and annual reports from healthcare providers to exclude disease types related to air pollution. The final analysis uses a sample of 1122 disease types and 862,722 cases from 517 hospitals. The impact of changes in hospital admissions on length of patients’ stay in hospitals (patient hospital days) and the mortality rate of patients is analyzed by building ordinary least squares and instrumental variable measurement models and comparing the differences in the impact of healthcare staffing levels on the quality of care between different levels of hospitals. Results The patient hospital days decrease and mortality rate increases with increased attendance. Using the instrumental variable method, for every one-unit increase in the number of visits to the hospital, there is a 5.87% decrease in patient hospital days and an increase in mortality of about 0.37%. Both results are significant at the 1% level. The impact of healthcare staffing level on the quality of care varies between different levels of hospitals. The quality of care in tertiary hospitals is most affected by the number of visits, with an average decrease of 4.36% in patient hospital days and an increase of 0.27% in mortality for every one-unit increase in visits, significant at the 1% level. Conclusions Currently, China is in the transition period of a healthcare reform, and faces a large shortage of medical resources, there is considerable variation in healthcare staffing across different tiers of hospital. Continued sole reliance by hospitals on increasing the working hours of medical staff to meet patients’ medical needs is not sustainable, and may even have a negative impact on the quality of medical services.

Improve Healthcare Quality Through Mortality Committee: Retrospective Analysis of Bambino Gesù Children Hospital’s Ten Years’ Experience 2008-2017

2019 ◽  
Vol 20 (8) ◽  
pp. 635-642 ◽  
Author(s):  
Caterina Offidani ◽  
Maria Lodise ◽  
Vittorio Gatto ◽  
Paola Frati ◽  
Stefano D'Errico ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Healthcare Quality ◽  
Mortality Rates ◽  
Mortality Data ◽  
Systematic Analysis ◽  
Mortality Review ◽  
Hospital Deaths ◽  
The Impact

Background: Healthcare quality improvements are one of the most important goals to reach a better and safer healthcare system. Reviewing in-hospital mortality data is useful to identify areas for improvement, and to monitor the impact of actions taken to avoid preventable cases, such as those related to healthcare associated infections (HAI). Methods: In this paper, we present the experience of the Mortality Committee of Bambino Gesù Children Hospital (OPBG). OPBG has instituted a process of systematic revision of all in-hospital deaths conducted by a multidisciplinary team. The goal is to identify system-wide issues that could be improved to reduce in-hospital preventable deaths. In this way, the mortality review goes alongside all the other risk management activities for the continuous quality improvement and patient safety. Results: In years 2008-2017, we performed a systematic analysis of 1148 inpatient deaths. In this time period, the overall mortality rate was 0.4%. Forty-seven deaths were caused due to infections, 10 of which involved patients with HAI transferred to OPBG from other facilities or patients with community- acquired infections. Six deaths related to HAI were followed by claims compensations. All these cases were not followed by compensation because the onset of HAI was considered an inevitable consequence of the underlying disease. Conclusion: Introduction of the mortality review committee has proved to be a valid instrument to improve the quality of the care provided in a hospital, allowing early identification of care gaps that could lead to an increase in mortality rates. Article Highlights Box: Reduction of preventable deaths is one of the most important goals to be achieved for any health-care system and to improve the quality of care. • Several studies have shown that analysis of morbidity and mortality rate helps to detect any factors that can lead to an increase in in-hospital mortality rates. • The review of in-hospital deaths allows to learn how to improve the quality and safety of care through identification of critical issues that lead to an increase in mortality ratio. • In some medical areas, such as intensive care units or surgery, the implementation of the conference on mortality and morbidity is more useful for assessing procedures at high risk of errors. • The implementation of existing databases with data deriving from the systematic review of medical records and in-hospital deaths appears to be desirable. • Mortality Review Committees can represent a very useful tool for all the health facilities for the reduction of preventable deaths, such as those related to HAI.

Integrated emergency care reduces hospital admissions and reduces in hospital mortality

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A4.4-A4
Author(s):  
Adrian Boyle
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Hospital Mortality ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Slight Reduction ◽  
Independent Analysis

IntroductionWe closed our Medical Admissions Unit and relocated the staff into an enlarged Emergency Department. We streamlined our assessment processes to reduce duplication of effort. We aimed to evaluate the effect of this on mortality, admission ratios and quality of care.MethodsWe evaluated the effectiveness of this approach using multiple routinely collected measures. We studied the 3 years before the change and 3 years afterward in our centre. We obtained an independent analysis of our standardised admission ratios by the Dr Foster unit. We evaluated mortality with Dr Foster data. We evaluated quality of care by comparing the numbers of complaints, incident forms and re-admissions.ResultsThere was a decline in the standardised admissions ratios from 105.8 (95% CI 104.9 to 106.6) in 2003 to 89.5 (95% CI 88.8 to 90.2) in 2009. Hospital Mortality for non-elective admissions also fell slightly. All measures of quality improved or were unchanged after the change.DiscussionIntegrating Emergency Care in one place is associated with substantial reductions in admissions. This system is associated with a slight reduction in mortality and improved quality of care measures.

scholarly journals Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marc-Antoine Sanchez ◽  
Albert Vuagnat ◽  
Olivier Grimaud ◽  
Emmanuelle Leray ◽  
Jean-Marc Philippe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Healthcare Facility ◽  
Mortality Rates ◽  
National Database ◽  
Icu Patients ◽  
Transfer Distance ◽  
Transferred Patients ◽  
The Impact

Abstract Background The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. Method A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. Results In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period. Conclusions Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients.

scholarly journals Trends and seasonal variation of hospitalization and mortality of interstitial lung disease in the United States from 2006 to 2016

2020 ◽  
Author(s):  
An Ho ◽  
Artem Shmelev ◽  
Edward Charbek
Keyword(s):  
Seasonal Variation ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Lung Disease ◽  
Seasonal Variations ◽  
Hospital Admissions ◽  
Mortality Rates ◽  
Admission Rates

Abstract BackgroundIn the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016.MethodFrom the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition.ResultsFrom 2006 to 2016, there was a downtrend in all cause hospital admissions but in-hospital mortality rate did not change, with or without the presence of pneumonia. Highest hospital admission rates of ILD per 100000 of population were from January to May. The average number of hospitalizations in spring, summer, fall and winter months were 7447.9 ± 932.0, 6643.0 ± 840.5, 6551.3 ± 922.6 and 7110.3 ± 866.1 respectively. All-cause in-hospital mortality ranges from 7.13% ± 0.79% in the summer to 8.13% ± 0.60% in the winter with winter months having the highest mortality rate (p=0.018). The seasonal variations of hospital admission and mortality was not changed when infectious pneumonia cases were ruled out.ConclusionFrom 2006 to 2016, admission rates of ILD declined but in-hospital mortality remained unchanged. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospital admissions are highest in the period from January to May, in-hospital death was highest in the winter.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

Sign in / Sign up

Export Citation Format

Share Document