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 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 The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Tzu-Yuan Wang ◽  
Hsin-Hung Chen ◽  
Chun-Hung Su ◽  
Sheng-Pang Hsu ◽  
Chun-Wei Ho ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peripheral Arterial Disease ◽  
Pleural Empyema ◽  
Arterial Disease ◽  
Population Based ◽  
Rank Test ◽  
Research Database ◽  
Increased Risk ◽  
Using Data ◽  
Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

Increased risk of rheumatoid arthritis among patients with endometriosis: a nationwide population-based cohort study

Rheumatology ◽  
2020 ◽  
Author(s):  
Yu-Hao Xue ◽  
Liang-Tian You ◽  
Hsin-Fu Ting ◽  
Yu-Wen Chen ◽  
Zi-Yun Sheng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Propensity Scores ◽  
Population Based ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Potential Risks ◽  
Using Data

Abstract Objectives Autoimmunity may play a role in endometriosis. The association between endometriosis and RA remains unknown. This study was conducted to identify any evidence for this relationship. Methods This 13-year, nationwide, population-based, retrospective cohort study analysed the risk of RA in a cohort of individuals with endometriosis. We investigated the incidence of RA among patients with endometriosis using data from the Longitudinal Health Insurance Database 2000, which is maintained by the Taiwan National Health Research Institutes. We used propensity scores to match comorbidities in the two cohorts. Kaplan–Meier analysis and Cox proportional hazard model were employed to analyse the association between endometriosis and RA among patients with different potential risks. Results Patients with endometriosis [adjusted hazard ratio (HR) 1.75, 95% CI 1.27, 2.41], aged ≥45 years (adjusted HR 1.50, 95% CI 1.06–2.13) and with autoimmune disease (adjusted HR 6.99, 95% CI 2.84–17.21) had a significantly higher risk of RA. The analyses also showed that when stratified by age, comorbidities and medication use, the risk of RA in patients with endometriosis was also higher than in those without endometriosis. Conclusions This 14-year, nationwide, population-based retrospective cohort study revealed that patients with endometriosis have a higher risk of RA. In the clinical management of patients with RA, rheumatologists should be especially mindful of the possibility of underlying endometriosis.

Reasons for 30-day Postoperative Readmissions for Medicare Patients at a Community-based Teaching Hospital

2015 ◽  
Vol 81 (4) ◽  
pp. 381-386
Author(s):  
Jennifer L. Kirsch ◽  
Shanu N. Kothari ◽  
Janelle M. Ausloos ◽  
Jacob D. Gundrum ◽  
Kara J. Kallies
Keyword(s):  
Length Of Stay ◽  
Operative Time ◽  
Reform Initiatives ◽  
Readmission Rates ◽  
Community Based ◽  
Related Factors ◽  
Medicare Patients ◽  
Patient Noncompliance ◽  
American Society ◽  
American Society Of Anesthesiologists

Healthcare reform initiatives have proposed reducing reimbursement for certain 30-day readmissions among Medicare patients. Our objective was to evaluate the incidence and reasons for 30-day postoperative readmissions at our institution. The medical records of Medicare patients who underwent surgery from January 1, 2010, through May 16, 2011, were reviewed. Statistical analysis included χ2, Wilcoxon rank sum, and t tests. Two thousand eight hundred sixty-five patients were included; 199 (7%) had a 30-day readmission. The readmission group included a higher proportion of men (53.8 vs 43.6%, P = 0.005), and patients with an American Society of Anesthesiologists (ASA) Class 3 or greater (84 vs 66%, P < 0.001) versus the nonreadmission group. Mean index length of stay and operative time were longer in the readmitted versus nonreadmitted group (4.8 vs 2.8 days, P < 0.001; 122.8 vs 98.2 minutes, P < 0.001). Readmission reasons were surgically related (53%), surgically unrelated (35%), planned (7%), and patient-related (5%). Higher 30-day postoperative readmission rates were associated with male sex, higher ASA class, and longer index length of stay and operative time. Reasons for readmission included surgical- and patient-related factors. Decreased reimbursement should be discouraged for readmissions directly related to patient noncompliance.

Use of a comparative database to identify excessive hematology/medical oncology hospital days and readmissions.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 131-131
Author(s):  
Brian Halbert ◽  
Jessica A. Zerillo
Keyword(s):  
Length Of Stay ◽  
Medical Oncology ◽  
Diagnosis Related Groups ◽  
Third Party ◽  
Clinical Database ◽  
Readmission Rates ◽  
Resource Manager ◽  
Diagnostic Categories ◽  
Expected Length ◽  
Hospital Days

131 Background: Reducing length of stay and readmissions are important goals to improve healthcare quality and decrease costs. We identified diagnostic categories accounting for excessive hospital days and readmissions on our hematology/medical oncology (HO) service. Methods: We used a third-party comparative clinical database (Vizient Inc, Clinical Data Base/Resource Manager) to identify discharges from our HO service in 2015. Cases were categorized by All Patients Refined Diagnosis Related Groups (APR DRG), and we calculated excess hospital days attributed to each using the number of cases and their observed/expected length of stay. We also collected 30-day readmission rates for each APR DRG on our HO service and hospital wide. Readmission rates were compared using Fisher exact tests. Results: We identified 1,361 discharges from our HO service with 134 APR DRG codes and 880.5 excess hospital days. Fourteen APR DRGs accounted for over 80% of the excess hospital days. Readmission rates ranged from 0% to 66.7%, and were generally higher than rates hospital wide. Readmissions for septicemia and major operating room (OR) procedures for lymphatic neoplasms were significantly higher on the HO service. Conclusions: Relatively few APR DRGs accounted for the majority of our excess hospital days, and also had high readmission rates. We will conduct additional review of these APR DRGs to identify opportunities to improve quality and reduce cost. [Table: see text]

scholarly journals 91 Management and Outcomes of Appendicitis in The Pre-COVID-19, COVID-19 And Post-COVID-19 Periods

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Abeywickrema ◽  
C Patel ◽  
A K Ghumman ◽  
A Krishan ◽  
P Puventhiranathan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lower Proportion ◽  
Surgical Approaches ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Readmission Rates ◽  
Surgical Guidance

Abstract Aim The COVID-19 pandemic resulted in an upheaval of national surgical guidance on appendicitis, which has previously favoured surgical over conservative approaches. We analysed how these guidelines altered management and outcomes of appendicitis. Method A retrospective cohort study at Heartlands Hospital, Birmingham of all appendicitis admissions around and during the first COVID-19 peak was conducted, with analysis of electronic patient records using the acute surgical worklist. Results 48 admissions for appendicitis during the two-month period from 01/02/20 to 25/03/20 prior to the COVID-19 peak and 28 admissions in the two months during the peak itself from 30/03/20 to 24/05/20 were identified. Prior to the COVID-19 peak, a lower proportion of cases was managed conservatively (18.8%) compared to the latter (67.9%, p &lt; 0.0001). This change also coincided with a switch from laparoscopic to open approaches in those managed surgically. We studied a further period post-COVID-19 peak from 01/06/20 to 26/07/20, where proportions of patients managed conservatively versus surgically did not significantly change following the COVID-19 peak, although surgical preference reverted from open to laparoscopic approaches. During the COVID-19 period, a reduced length of stay was seen in cases managed conservatively (1.65 days) compared to those managed surgically (4 days, p = 0.024). Differences in readmission rates were not statistically significant. Conclusions A reduction in numbers of appendicitis presentations as well as a switch to conservative approaches was seen during COVID-19. These findings furthermore support non-inferiority of conservative over open surgical approaches in most appendicitis cases at a time where laparoscopy was deemed unfeasible.

DRGs and Australian Psychiatry

1994 ◽  
Vol 28 (1) ◽  
pp. 114-120 ◽  
Author(s):  
Christine E. Hunter ◽  
Alexander C. McFarlane
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Functional Status ◽  
Gold Standard ◽  
Diagnosis Related Groups ◽  
Standard Of Care ◽  
The United States ◽  
Treatment Needs ◽  
Readmission Rates ◽  
Data Bases

The introduction of diagnosis related groups (DRGs) as a basis for funding in the United States has revealed several shortcomings in current DRG systems. Overall, DRGs have proven to be poor predictors of cost, accounting for approximately one third of the variation in cost and length of stay for surgical DRGs and falling to less than 10% for medical DRGs. Their ability to contain costs also remains uncertain, with savings associated with reductions in length of stay being offset by increased readmission rates. Given the increasing commitment of government to casemix approaches to funding it is suggested that psychiatry should participate in the process of solving the problems so far identified with DRG systems. Participation would, it is hoped, create a focussed debate about the provision of a “gold standard” of care for all patients. The evaluation and refinement of existing DRGs is urgently needed and could utilise a number of comprehensive data bases which already exist across the country. Alternatives to diagnosis such as functional status and treatment needs should also be explored.

Macrolide use and the risk of vascular disease in HIV-infected men in the Multicenter AIDS Cohort Study

Sexual Health ◽  
2007 ◽  
Vol 4 (2) ◽  
pp. 111 ◽  
Author(s):  
Ian J. Woolley ◽  
Xiuhong Li ◽  
Lisa P. Jacobson ◽  
Frank J. Palella ◽  
Lars Ostergaard
Keyword(s):  
Cohort Study ◽  
Highly Active Antiretroviral Therapy ◽  
Lipid Lowering ◽  
Independent Effect ◽  
Multicenter Aids Cohort Study ◽  
Vascular Events ◽  
Highly Active ◽  
Increased Risk ◽  
Traditional Risk Factors ◽  
Using Data

Background: There has been increasing concern that HIV-infected individuals may be more at risk for cardiovascular events in the highly-active antiretroviral therapy (HAART) era. This study examined the risk of thromboembolic events in HIV-infected and non-infected individuals and the effect of macrolide prophylaxis on those outcomes. Methods: A subcohort analysis was undertaken using data collected in the Multicenter AIDS Cohort Study to examine the relative risk of vascular events (myocardial infarction, unstable angina and ischaemic stroke). Cox proportional hazard model using age as the time scale with time varying cofactors obtained at each semi-annual visit were used to assess the independent effect of macrolide use. Results: Controlling for other significant effects including race and smoking, HIV-infection was not independently associated with vascular events. Increased risk was observed among those who used HAART (relative hazard 1.09, 95% confidence intervals 1.00–1.19 in multivariate model), antihypertensive treatment (1.81 [1.26–2.60]), lipid-lowering medication (1.65 [1.12–2.42]), and antibiotics (1.72 [1.25–2.36]). The protective association of macrolide use for a vascular event in the HAART era was also significant (0.10 [0.01–0.75]). Conclusions: Traditional risk factors are important in the pathogenesis of vascular events in HIV-infected individuals. Macrolide antibiotics may have a protective effect in the HIV-infected individuals in the HAART era.

scholarly journals Prediction of Length of Stay Following Elective Percutaneous Coronary Intervention

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Abdissa Negassa ◽  
E. Scott Monrad
Keyword(s):  
New York ◽  
Length Of Stay ◽  
New York State ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Classification Model ◽  
Risk Scores ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Using Data

There have been published risk stratification approaches to predict complications following percutaneous coronary interventions (PCI). However, a formal assessment of such approaches with respect to predicting length of stay (LOS) is lacking. Therefore, we sought to assess the performance of, an easy-to-use, tree-structured prognostic classification model in predicting LOS among patients with elective PCI. The study is based on the New York State PCI database. The model was developed on data for 1999-2000, consisting of 67,766 procedures. Validation was carried out, with respect to LOS, using data for 2001-2002, consisting of 79,545 procedures. The risk groups identified by the model exhibited a strong progressively increasing relative risk pattern of longer LOS. The predicted average LOS ranged from 3 to 9 days. The performance of this model was comparable to other published risk scores. In conclusion, the tree-structured prognostic classification is a model which can be easily applied to aid practitioners early on in their decision process regarding the need for extra resources required for the management of more complicated patients following PCI, or to justify to payors the extra costs required for the management of patients who have required extended observation and care after PCI.

scholarly journals A Validation Study on the Frequency and Natural History of Miscarriages Using the Spanish Primary Care Database BIFAP

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 596
Author(s):  
Sara Sanchez Ortiz ◽  
Consuelo Huerta ◽  
Ana Llorente-García ◽  
Paloma Ortega ◽  
Paloma Astasio ◽  
...  
Keyword(s):  
Natural History ◽  
Drug Utilization ◽  
Drug Exposure ◽  
Risk Groups ◽  
Incidence Rates ◽  
Predictive Values ◽  
Kaplan Meier ◽  
Increased Risk ◽  
History Of ◽  
Using Data

(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan–Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68–11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8–12). The IR according to age was: 2.71 (CI 95% 2.59–2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55–9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.

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