THE IMPACT OF THE ROCHESTER NEIGHBORHOOD HEALTH CENTER ON HOSPITALIZATION OF CHILDREN, 1968 TO 1970

PEDIATRICS ◽  
1973 ◽  
Vol 51 (5) ◽  
pp. 833-839
Author(s):  
Michael Klein ◽  
Klaus Roghmann ◽  
Kenneth Woodward ◽  
Evan Charney
Keyword(s):  
Health Center ◽  
Comparison Group ◽  
Admission Rate ◽  
Team Approach ◽  
Target Area ◽  
Admission Rates ◽  
Respiratory Infectious Diseases ◽  
Physician Availability ◽  
Hospital Days ◽  
The Impact

The admission patterns of children to area hospitals was studied. The study design allowed for comparisons between actual users of the health center, nonusers who lived in the target area and a comparison group. During the second year of operation, the admission rate of health center users was only 33 versus 67 per thousand for nonusers and 39 per thousand for the comparison group. Comparing the first two years, hospital days per thousand among users dropped by approximately half. Due to higher admission rates and longer average stays, nonusers had a rate of 2.5 times that of the users for hospital days per thousand. The rate for the comparison group remained constant. Users had fewer admissions for respiratory infectious diseases and more admissions for surgical restorative procedures. These trends were not present for the nonusers or for the comparison group. Despite extensive outreach, physician availability, and the team approach, the health center continued to have a large number of child admissions who reached the hospital without referral (the "leakers").

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

scholarly journals MP31: Safely reducing emergency physician admission rate through audit and feedback

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S53-S54
Author(s):  
N. Barclay
Keyword(s):  
Permutation Test ◽  
Cochrane Review ◽  
Admission Rate ◽  
Audit And Feedback ◽  
P Value ◽  
Emergency Physicians ◽  
Admission Rates ◽  
The Individual ◽  
The Impact ◽  
Bounce Back

Background: Most admissions to hospitals occur through the emergency department (ED). The impact of emergency physicians’ decisions to admit a patient to hospital can have wide ranging effects on health care spending, hospital congestion and patient outcomes. A growing body of evidence shows that outpatient management of conditions such as diverticulitis, heart failure and pulmonary embolism is both safe, effective and can reduce costs. Aim Statement: To support emergency staff in making safe, informed decisions to appropriately reduce admission rates without increasing the rate of patients returning and being admitted. Measures & Design: Significant variability in admission rates between emergency physicians exists and no correlation between actual and self-reported admission rates is observed. One means to change behavior is through audit and feedback, however a Cochrane review on this topic concluded that it was only effective if specific conditions were met; findings which were incorporated into this project. An audit tool was created comparing individual physicians’ admission and “bounce back” rates to their peers. The tools contained averages for the individual and site for admission and bounce back rates and were shared with physicians every 2 months. Physicians were divided into three equal groups, low, medium and high admitters and targets established. Department heads met with high admitters. Evaluation/Results: The project was started in September 2016. Admission rates in the three physician groups were compared in the ten months before September 2016 (prior) and after January 2017 (post). September to December 2016 was considered the “rollout” period and not included in the analysis. Significance was tested using a Permutation test and a p-value cut off level of 5%. Nine emergency departments took part. Seven sites experienced a significant decrease in the admission rate of top admitters, three showed a significant increase in the rate of low admitters and two showed a significant increase in the rate of medium admitters. Pooled results showed a decrease in the admission rates of the top admitters and no significant change to the medium or low admitters. Discussion/Impact: Comparing the pre- and post-periods yielded a decrease in admissions of 773 patients on an annualized basis. The impact of the change in the top five highest admitters at the biggest three hospitals estimated an annualized beds savings of 25.3 beds.

Prospective Descriptive Study to Evaluate the Impact of Clinical Pharmacist in Antiplatelet Utilization and Safety in Coronary Heart Disease Patients

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Hisham Ah Nematalla ◽  
Rasha Wafaie ◽  
Enas Abd Elaziz ◽  
Asser Ghoneem ◽  
Ahmed Abd Elaaty
Keyword(s):  
Adverse Effects ◽  
Clinical Pharmacist ◽  
Heart Diseases ◽  
Admission Rate ◽  
Team Approach ◽  
Bleeding Events ◽  
Coronary Insufficiency ◽  
Coronary Heart Diseases ◽  
Significant Difference ◽  
The Impact

Abstract Aim To evaluate the interventions associated with integration of a clinical pharmacist for antiplatelets best utilization and safety as multidisciplinary team approach is recommended to improve patient outcomes. Methods prospective observational study on coronary heart diseases patients (stable angina, unstable angina, MI, post PCI or post CABG) on antiplatelets therapy (single antiplatelet; SAPT, or dual antiplatelet; DAPT) at governmental and private hospitals. Detailing pharmacist-initiated interventions targeting pharmacotherapy optimization (Dose, duplicate and interactions), also adverse effects detection, and hospital re-admission (re-event of coronary insufficiency). Collecting patients' data by interviews and hospital records using validated check list. Statistical software IBM SPSS software package version 20.0, The Kolmogorov-Smirnov was used to verify the normality of distribution of variables, Mann Whitney test was used to compare between two categories for not normally distributed quantitative variables. Kruskal Wallis test was used to compare different categories for abnormally distributed quantitative variables. Spearman coefficient was used to correlate between quantitative variables. Linear Regression was used to detect the most affecting factor for affecting DAPT score and Precise DAPT. Significance of the obtained results was judged at the 5% level, calculate sample size by G Power3. Results There is a significant correlation between cardiac related readmission and Precise DAPT score (P = 0.013).A statistically significant correlation is found between smoking and DAPT score (p = 0.015) but not with precise DAPT (P = 0.152). Also a significant linear association exists between DAPT type and DAPT score, for Aspirin + Clopidogrel (P = 0.010) (95%CI=-1.000 (-1.754 – -0.246), Aspirin + Ticagrilor (P = 0.012) (95%CI= 1.001 (0.228 – 1.774). The highly significant influencing variable in both scores, is the dose value, for DAPT score (P = 0.038), Precise DAPT (P = 0.001). The distribution of Myocardial infarction as cardiac related readmission and smoking are higher in males than females without statistically significant difference (P = 0.08), (P = 0.39), the absence of adverse effects and bleeding events is statistically significant in DAPT score (P = 0.041, 95%CI=1.706 (0.071 – 3.341) & precise DAPT score (P = 0.002, 95% CI= -15.95 (-25.832 – -6.074). Conclusions Impact of a clinical pharmacist within cardiology department generated substantial pharmacotherapy optimization which improve the medication adherence, safety and clinical outcomes. Our study suggests pre-calculating DAPT and precise DAPT for all patients before treatment and commitment on DAPT period administration may decrease re-admission rate of patients.

scholarly journals 152 Implementation of Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Comfort Adedokun ◽  
Rosa McNamara ◽  
Nessa O’Herlihy
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Older People ◽  
Rapid Assessment ◽  
Admission Rate ◽  
Clinical Decision ◽  
Admission Rates ◽  
Clinical Decision Unit ◽  
Medical Referral ◽  
The Impact

Abstract Background The Emergency Department (ED) is where most people, including older adults in crises, seek care. OPRAH was introduced in order to meet the needs of our changing population. The unit was developed out of existing resources within the ED and cohorts both older patients and staff to an area more suitable to carry out assessments. Methods We used a quality improvement framework to develop our service. OPRAH is led by an ED GEM (Geriatric Emergency Medicine) consultant, staffed using the existing ED team, housed within footprint of the ED as part of the Clinical Decision Unit (CDU) with the addition of an HCA (healthcare assistant) as required. To determine the impact of the service on admissions of older adults, we collated patient records prospectively. These were reviewed and coded by senior ED professionals blinded to outcomes, to determine medical-referral rate for admission in these cohort. Results In the first 3 weeks of implementation, 76 patients were assessed. Four were admitted and 2 transferred to other hospitals. Mean age was 83 years ranging 66-103 years with an average of 262 minutes in the ED prior to OPRAH admission. Blinded coders review determined 53 (76%) of these patients would have been referred for admission. The majority of the remainder would have completed their care in the ED, as they were not eligible for admission to CDU. Conclusion Introduction of OPRAH to the ED has improved access for older people to short-stay ED led care and reduced admission rates. We have identified a trend towards fewer episodes where care by in-house teams is completed within the ED. We are in an early phase of this project. Nonetheless, it is evident that by redesigning how we assess older people in the ED and using available outpatient resources, we could impact on admission rate and length of stay in the ED without compromising patient care. Implementation has increased the use of the integrated care team, hospital and community MDT (multidisciplinary team).

scholarly journals The bimodal rise and fall acute coronary syndromes curves paralleling COVID-19 outbreaks

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Trabattoni ◽  
G Teruzzi ◽  
P M Ravagnani ◽  
G Santagostino Baldi ◽  
P Montorsi ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Acute Coronary Syndromes ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Nasopharyngeal Swab ◽  
Admission Rates ◽  
Coronary Syndromes ◽  
The Impact

Abstract Introduction Preliminary reports from the early phase of COVID-19 epidemic in Italy reported a dramatic reduction in hospital admission rates for acute coronary syndromes (ACS) coupled with longer times from symptoms onset to hospital presentation. Purpose To assess the impact of COVID-19 on hospital admission rates and ACS patterns, as well as time to presentation and clinical outcomes, following the acute pandemic phase in 2020 compared to previous year. Methods We conducted a single institution retrospective analysis conducted in a cardiovascular hub serving a large metropolitan area in Italy. Number and monthly distribution of hospital admissions for ACS from January 1 to December 31, 2020 were compared to the respective figures in 2019. Baseline clinical features, time from symptoms onset to hospital admission and main clinical outcomes were collected. Results A total of 599 ACS cases were recorded in 2020 vs. 386 cases in 2019, with a net 55% increase. ACS presentation rate in 2020 showed a bimodal pattern, paralleling the most contagious outbreak periods (Figure 1). SARS-CoB-2 nasopharyngeal swab or specific antibody tests were positive in 34 (5.7%) patients. Time from symptoms onset to hospital presentation tended to be longer in 2020 than in 2019, being two-fold longer during the peak epidemic phase (February 21-May 3, 2020; median time 2.0 vs. 5.0 hours, p=0.030). The proportion of late-presenting STEMI (>8 hrs from symptoms onset) was higher in 2020 compared to 2019 (30% vs. 18%, p=0.003),as well as higher was in-hospital mortality (15% in 2020 vs 6% in 2019, p=0.001), partly due to a three-fold increase in cardiogenic shock on ACS presentation. Conclusions ACS admission rate significantly increased during the 2020 COVID-19 epidemic outbreak for several reasons only partially explained by a SARS-CoV-2 infection trigger effect on ACS. Longer presentation times and higher rates of cardiogenic shock and mortality were observed, urging the need health-care systems to keep a high priority on cardiovascular emergencies response networks. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Users and Nonusers of Hospitals

PEDIATRICS ◽  
1973 ◽  
Vol 52 (5) ◽  
pp. 754-756
Author(s):  
Gordon T. Moore
Keyword(s):  
Hospital Admission ◽  
Health Center ◽  
Target Population ◽  
Hospital Utilization ◽  
Admission Rates ◽  
The Impact

In their article examining the impact of the Rochester Neighborhood Health Center on hospitalization of children, Klein et al.1 demonstrated no overall change in hospital admission rates for the target population, but demonstrate a significant decrease in hospital utilization for the health center users. The fact that health center user rates fell while the nonuser rates rose during the study suggests a methodologic artifact as the cause of their findings. Two possible explanations can explain their observations.

scholarly journals Impact of the introduction of a universal childhood influenza vaccination programme on influenza-related admissions to paediatric intensive care units in England

2018 ◽  
Vol 5 (1) ◽  
pp. e000297 ◽  
Author(s):  
Pia Hardelid ◽  
Melpo Kapetanstrataki ◽  
Lee Norman ◽  
Sarah J Fleming ◽  
Paula Lister ◽  
...  
Keyword(s):  
Intensive Care ◽  
Influenza Vaccination ◽  
Vaccination Programme ◽  
Winter Season ◽  
Admission Rate ◽  
Paediatric Intensive Care ◽  
Childhood Vaccination ◽  
Admission Rates ◽  
Significant Difference ◽  
The Impact

IntroductionA universal childhood influenza vaccination programme was introduced in the UK in September 2013. We examine the impact of the gradual introduction of this programme on influenza-related paediatric intensive care unit (PICU) admission rates in England.MethodsWe extracted data on all influenza-related admissions to PICUs in England in resident children aged 0–15 years old between October 2003 and March 2017 from the Paediatric Intensive Care Audit Network (PICANet) database. We estimated influenza-associated PICU admission rates per 100 000 children by age group, sex and winter season (October to March), and used Poisson regression models to estimate incidence rate ratios (IRRs) in the winter seasons since the introduction of universal childhood vaccination compared with the two winters before the introduction of the programme (2011–2013).ResultsWe identified 929 influenza-related PICU admissions among 873 children. 48.3% of admissions were among children aged less than 2 years old. The influenza-associated PICU admission rate was 1.32 per 100 000 children (95% CI 1.23 to 1.40). We identified a significant increase in influenza PICU admissions in the winters following the introduction of the universal childhood vaccination programme compared with the winters of 2010/2011–2012/2013 among children aged <5 years old: IRR 1.58 (1.05, 2.37) in children <1 year, 2.71 (1.43, 5.17) in 1 year-olds and 1.98 (1.18, 3.31) in children 2–4 years old. No significant difference was found among children aged 5–15 years.ConclusionThe universal childhood influenza vaccination has not yet reduced the influenza-associated burden on PICUs in England during its early phase of introduction. Monitoring of influenza PICU admission rates needs to continue in England to assess the long-term impact of universal paediatric influenza vaccination. Linkage between PICANet and national infection surveillance databases would better enable such monitoring.

Assessment of the impact of factors of the working environment on the health of workers in oil refining based on the analysis of morbidity

2020 ◽  
pp. 600-600 ◽  
Author(s):  
I. V. Ginko ◽  
T. M. Sushinskaya ◽  
A. L. Rybina
Keyword(s):  
Comparison Group ◽  
Main Group ◽  
Working Environment ◽  
Oil Refinery ◽  
Oil Refining ◽  
Production Environment ◽  
The Impact

Studies have been conducted to assess the impact of factors of the production environment on employees of the oil refinery ofJSC «Naftan». Significant differences with the comparison group on the indicators of SVT were revealed. Priority nosological forms of employees of the main group are identified.

HUBUNGAN PEMBERIAN ASI EKSKLUSIF DENGAN KEJADIAN STUNTING PADA BALITA USIA 1-5 TAHUN DIPUSKESMAS SUKAHENING KECAMATAN SUKAHENING KABUPATEN TASIKMALAYA

2020 ◽  
Vol 13 (2) ◽  
pp. 109
Author(s):  
Yuyun Sarinengsih
Keyword(s):  
Public Health ◽  
Health Center ◽  
Exclusive Breastfeeding ◽  
Growth Failure ◽  
Sampling Technique ◽  
Not Given ◽  
Chi Square ◽  
Cross Sectional ◽  
Public Health Center ◽  
The Impact

ABSTRAKStunting yaitu keadaan gagal tumbuh akibat dari kekurangan gizi kronis. Prevalensi stunting di Kabupaten Tasikmalaya menempati urutan keempat, dimana kecamatan Sukahening menempati urutan pertama tertinggi dengan jumlah 155 balita mengalami stunting. Faktor yang dapat mempengaruhi kejadian stunting yaitu pengasuhan anak yang kurang baik dimana tidak diberikannya ASI secara Ekslusif. Pencegahan stunting yaitu pada 1000 hari kehidupan dimana salah satunya pemberian ASI secara Ekslusif.Penelitian ini bertujuan untuk mengetahui hubungan antara pemberian ASI Ekslusif dengan kejadian stunting pada balita 1-5 tahun di Puskesmas Sukahening Kecamatan Sukahening Kabupaten Tasikmalaya.Jenis Penelitian yang digunakan adalah deskriptif korelasional dengan pendekatan cross-sectional. Populasi total sampling sebanyak 95 responden menggunakan teknik purposive sampling.Hasil Penelitian diperoleh lebih dari setengah responden 51,6% tidak diberikan ASI secara Ekslusif, dan sebagian besar 65,3% balita mengalami stunting. Hasil perhitungan chi-square diperoleh ρ.value (0,000<0,05) maka H0 ditolak sehingga terdapat hubungan antara Pemberian ASI Ekslusif dengan kejadian stunting pada balita 1-5 tahun di Puskesmas Sukahening Kecamatan Sukahening Kabupaten Tasikmalaya.Hasil penelitian ini diharapkan dapat memberi informasi yang bermanfaat dan perlu dilakukan pendidikan kesehatan ulang yang terjadwal terkait nutrisi yang terjangkau dan sehat sehingga dapat meningkatkan cakupan ASI Ekslusif dan dapat menurunkan angka stunting.Kata Kunci : ASI Ekslusif, StuntingDaftar Pustaka : 25 buku (2010-2018)9 jurnal (2013-2019)2 Website (2010-2017) ABSTRACTStunting is a condition of growth failure due to chronic malnutrition. The stunting prevalence in Tasikmalaya Regency was at the fourth place where Sukahening sub-district was at the highest with 155 stunting. Factor that can influence the occurrence of stunting is a poor parenting where exclusive breastfeeding is not given. The best prevention of stunting is on 1000 days of life where exclusive breastfeeding is given. The impact, if the baby is not given exclusive breastfeeding, they will lack of nutrition and also will have an impact on the growth or inappropriate height. This aims of the research is to determine the relationship between exclusive breastfeeding and the incidence of stunting on toddler under 5 years of at Sukahening Public Health Center, Sukahening Sub district, Tasikmalaya Regency. The type of research used is descriptive correlation with a cross-sectional approach. The total samplings were 95 respondents which used purposive sampling technique. The results of the research were obtained more than half of the respondents 51.6% were given exclusive breastfeeding, and most 65.3% of children under five had stunting. The chi-square calculation results obtained that ρ.value (0,000 <0,05) then H0 is rejected so that there is a relationship between exclusive breastfeeding and the incidence of stunting on toddlers under 5 years in Sukahening Public Health Center, Sukahening Sub district, Tasikmalaya Regency. Performed the health education related to affordable and healthy nutrition so that it can increase the coverage of exclusive breastfeeding and can reduce stunting rates. Keywords : Exclusive breastfeeding, Stunting Bibliography : 25 books (2010-2018) 9 journals (2013-2019) 2 Websites (2010-2017) 

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