scholarly journals Validating coding for a chronic condition (Cerebral Palsy) in routinely collected hospital admissions data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Bethan Carter ◽  
Hywel Jones ◽  
Jackie Bethell ◽  
Alison Kemp ◽  
Ting Wang
Keyword(s):  
Cerebral Palsy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Hospital Data ◽  
Case Identification ◽  
Healthcare Data ◽  
Routinely Collected Data ◽  
Admission Data ◽  
Icd 10

IntroductionData-linkage provides an opportunity to evaluate healthcare utilisation of patients with chronic health conditions. However the consistency and accuracy of recording chronic conditions in routinely collected healthcare data is unclear and we aim to explore this in children and young people (CYP) with a cerebral palsy (CP). Objectives and ApproachThe study aims to validate CP case identification in routinely collected data by data-linking cases from The Northern Ireland Cerebral Palsy Register (NICPR) born 1981-2011 with routinely collected hospital admission data and cross-referencing cases between the two datasets. CP cases were identified in the administrative data using ICD-10 codes G80 (cerebral palsy), G81 (hemiplegia), G82 (paraplegia and tetraplegia) and G83.0-83.3 (diplegia and monoplegias). ResultsThere were 1,693 cases in the NICPR cohort and 1,733 cases of CP identified in the hospital admissions data, 915 of which were on the NICPR giving a positive predictive value for identifying a CP case within routinely collected data of 52.8%. Specificity was high (99.8%) however sensitivity was low (54.1%). 1,157 (68.3%) patients on the NICPR had at least one hospital admission. 914 (79.0 %) cases were coded at some time point with G80-83.3 (829 (71.7%) G80, 328 (28.3%)  G81-83.3). NICPR cases had a total 11,844 hospital admissions and a CP code was recorded during 6,397 (54.0%). The type of CP was recorded in NICPR for 1,673 (98.8%) cases whereas in the hospital admissions, data the majority (70.6%) were coded as other/unspecified CP (G80.8-9). Conclusion/ImplicationsThis study adds to understanding of CP coding practices within routinely collected hospital data, further supporting claims that coding of CP within such datasets is poor. Coding must be accurate and consistent if data are to be meaningful, comparable and useful to inform health outcome reviews and patient care.

Cardiovascular Disease-related Hospital Admissions of Patients with Inflammatory Arthritis

2014 ◽  
Vol 42 (2) ◽  
pp. 188-192
Author(s):  
Jennie Ursum ◽  
Mark M.J. Nielen ◽  
Jos W.R. Twisk ◽  
Mike J.L. Peters ◽  
François G. Schellevis ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Inflammatory Arthritis ◽  
Hospital Admissions ◽  
High Rate ◽  
Hospital Data ◽  
Cvd Risk ◽  
Dutch Hospital ◽  
Services Research ◽  
Increased Risk

Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

scholarly journals The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

2021 ◽  
Author(s):  
Kjersti Amundsen ◽  
Marie Svanes Elden ◽  
Lars Myrmel ◽  
Jörg Assmus ◽  
Audun Lange ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Information Age ◽  
Time Of Day ◽  
Ambulance Personnel ◽  
Icd 10 ◽  
Health Trust ◽  
Reason For Admission ◽  
Mental And Behavioral Disorders

Abstract BackgroundAmbulance missions do not always result in the patient being transported to a doctor or hospital after evaluation at the scene by ambulance personnel. Sometimes a patient is discharged at the scene but should have been transported for further examination and treatment. In this study, we aimed to identify and describe this group, and to investigate subsequent hospital admission within 72 hours and 30-day mortality, which may indicate the safety of leaving a patient at the scene after examination. MethodThis retrospective study was carried out in the Bergen health trust in western Norway and included ambulance missions from 2018. For each mission, we recorded the patient’s demographic information (age, gender, time of day), initial reason for contacting the emergency medical service (EMS), hospital admissions after non-transport, and time of death if within 30 days, in addition to some other variables. ResultsAmong 33,183 included acute and urgent ambulance missions, 7.3% of the patients were discharged at the scene after evaluation by ambulance personnel. The median age in this group was 47 years (IQR 28–70 years), compared to 64 years (IQR 39–80 years) for all included missions. Following a non-transport decision, 4.8% of the patients were admitted to a public hospital within 72 hours (median age, 59 years; IQR 35–76 years), with mental and behavioral disorders (ICD-10 chapter V) being the most common reason for admission (24.8%). The 30-day mortality rate following non-transport mission was 2.4%. In this group, the median age was 83 years (IQR 73–90 years), and the most common reasons for contacting EMS were breathing difficulties or lung diseases (25.4%), and injuries or fractures (18.6%). ConclusionOur present analysis revealed low rates of hospital admission within 72 hours, and 30-day mortality, among patients left at the scene following evaluation by ambulance personnel. These findings do not suggest an unsafe rate of non-transport in the Bergen EMS. There remains a need for further evaluation of the factors involved in the decision not to transport a patient, and the safety of these decisions.

scholarly journals Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Laszlo Trefan ◽  
Ashley Akbari ◽  
Jennifer Siân Morgan ◽  
Daniel Mark Farewell ◽  
David Fone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Accurate Determination ◽  
Rate Sensitivity ◽  
Misclassification Rate ◽  
Care Utilization ◽  
Diagnostic Codes ◽  
Cohort Data ◽  
Icd 10 ◽  
Excessive Consumption

IntroductionThe excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. ObjectivesTo compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. MethodsRoutine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. ResultsThere was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. ConclusionWith the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

RCVS: Symptoms, Incidence, and Resource Utilization in a Population-Based US Cohort

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012223
Author(s):  
Jessica Magid-Bernstein ◽  
Setareh Salehi Omran ◽  
Neal S. Parikh ◽  
Alexander E. Merkler ◽  
Babak Navi ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Administrative Data ◽  
Census Data ◽  
Hospital Admissions ◽  
Population Based ◽  
Cerebrovascular Diseases ◽  
Cerebral Vasoconstriction ◽  
Icd 10 ◽  
Incidence Of Hospitalization ◽  
Age And Sex

Objective:To estimate the incidence of hospitalization for reversible cerebral vasoconstriction syndrome (RCVS), we identified RCVS-related hospital admissions across 11 U.S. states in 2016.Methods:We tested the validity of ICD-10 code I67.841 in 79 patients with hospital admissions for RCVS or other cerebrovascular diseases at one academic and one community hospital. After determining that this code had a sensitivity of 100% (95% CI, 82-100%) and a specificity of 90% (95% CI, 79-96%), we applied it to administrative data from the Healthcare Cost and Utilization Project on all ED visits and hospital admissions. Age- and sex-standardized RCVS incidence was calculated using census data. Descriptive statistics were used to analyze associated diagnoses.Results:Across 5,067,250 hospital admissions in our administrative data, we identified 222 patients with a discharge diagnosis of RCVS in 2016. The estimated annual age- and sex-standardized incidence of RCVS hospitalization was 2.7 (95% CI, 2.4-3.1) cases per million adults. Many patients had concomitant neurologic diagnoses, including subarachnoid hemorrhage (37%), ischemic stroke (16%), and intracerebral hemorrhage (10%). In the 90 days before the index admission, 97 patients had an ED visit and 34 patients a hospital admission, most commonly for neurologic, psychiatric, and pregnancy-related diagnoses. Following discharge from the RCVS hospital admission, 58 patients had an ED visit and 31 had a hospital admission, most commonly for neurologic diagnoses.Conclusions:Using population-wide data, we estimated the age- and sex-standardized incidence of hospitalization for RCVS in U.S. adults as approximately 3 per million per year.

P0783PREVALENCE AND PROGNOSIS OF HYPERKALAEMIA IN PEOPLE HOSPITALISED WITH AND WITHOUT AKI

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Andrew McLean ◽  
Corri Black ◽  
Angharad Marks ◽  
Simon Sawhney
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Kidney Diseases ◽  
Close Observation ◽  
Icd 10 ◽  
Initial Hospital ◽  
Serial Serum ◽  
Definition Of ◽  
The Relationship ◽  
Clinical Emergency

Abstract Background and Aims Hyperkalemia is a clinical emergency associated with kidney diseases and hospital mortality. It may be apparent on initial hospital presentation, or develop during the course of admission, and can occur in the context of AKI. The prevalence of hyperkalemia across these different presentations and contexts is not well described. No work has previously described whether the prognosis of hyperkalemia varies depending on timing of presentation, or on AKI status defined by KDIGO creatinine change biochemical criteria. Method We constructed a cohort of all adult residents in Grampian (North Scotland) admitted to hospital in 2012 (n=28462). We used a validated and replicated KDIGO based definition of AKI to identify AKI using serial serum creatinine values. We determined the presence of hyperkalemia (serum potassium &gt;= 6 mEq/L) both on first blood test on presentation to hospital, and also during the course of hospital admission. We explored the outcome of 30 day mortality within subgroups of AKI status and timing of hyperkalemia. Covariates of interest included age, CKD, medications prescribed in the preceding 90 days and comorbidities (ICD-10 hospital episode codes). The relationship between hyperkalemia and 30 day mortality was determined using multivariable logistic regression. Results Of 28462 hospital admissions, 247 (0.9%) presented with hyperkalemia, whereas 560 (2.0%) had hyperkalemia during the course of hospital admission. Hyperkalemia was common in the presence of AKI (4.2% at hospital presentation, 9.3% during hospital admission and rising to 24.5% during AKI stage 3). Hyperkalemia was uncommon in the absence of AKI (0.3% and 0.7% respectively) (OR AKI vs no AKI 13.9, 11.6-16.6). Other factors associated with hyperkalemia were male gender (OR 1.5, 1.3-1.8), age &gt;70 years (OR 2.4, 2.0-2.9), CKD based on eGFR or proteinuria (5.5, 4.6-6.5), diabetes (OR 3.4, 2.8-4.0), heart failure (OR 3.0, 2.4-3.7), RAAS blockers (OR 2.4, 2.0-2.9), trimethoprim containing antibiotics (OR 2.2, 1.7-2.8)), non-RAAS antihypertensives (OR 1.7, 1.4-2.0), but not NSAIDs (OR 0.9, 0.7-1.1). Hyperkalemia mortality (AKI vs no AKI) was 31% vs 29% when presenting at admission, or 34.3% vs 27.8% when occurring during hospital admission. Although absolute risks were similar irrespective of AKI, the excess relative mortality risk associated with hyperkalemia was lower for those with AKI (OR 2.7, 2.1-3.4) than those without AKI (OR 9.5, 6.8-13.2), which may be explained by a higher mortality for those with AKI even without hyperkalemia. Conclusion Hyperkalemia is associated with a high mortality even in the absence of AKI and irrespective of the timing of presentation. Management protocols should draw attention to this poor prognosis across all clinical contexts. As hyperkalemia usually occurs within the context of AKI, it should prompt clinicians to consider ongoing close observation for emerging AKI even when AKI is not yet evident on blood tests.

scholarly journals Predicting respiratory hospital admissions in young people with cerebral palsy

2018 ◽  
Vol 103 (12) ◽  
pp. 1119-1124 ◽  
Author(s):  
Amanda Marie Blackmore ◽  
Natasha Bear ◽  
Eve Blair ◽  
Katherine Langdon ◽  
Lisa Moshovis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Young People ◽  
Hospital Admission ◽  
Respiratory Symptoms ◽  
Hospital Admissions ◽  
Oropharyngeal Dysphagia ◽  
Significant Risk ◽  
Respiratory Illness ◽  
International Statistical Classification

ObjectiveTo determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP).DesignA 3-year prospective cohort study using linked data.PatientsChildren and young people with CP, aged 1 to 26 years.Main outcome measuresSelf-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years.Results482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring.ConclusionsMost risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.

scholarly journals The epidemiology of primary and secondary adrenal malignancies and associated adrenal insufficiency in hospitalised patients: an analysis of hospital admission data, NSW, Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Lubomski ◽  
Henrik Falhammar ◽  
David J. Torpy ◽  
R. Louise Rushworth
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Adrenal Insufficiency ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Population Data ◽  
Comorbid Diagnosis ◽  
Admission Data ◽  
Hospitalised Patients ◽  
Considerable Morbidity

Abstract Background Adrenal insufficiency (AI) causes considerable morbidity but may remain undiagnosed in patients with adrenal malignancy (AM). The epidemiology of AI and adrenal crises (AC) in AM is uncertain. Methods This was a retrospective study examining hospital admission data from 2006 to 2017. All admissions to all hospitals in NSW, Australia over this period with a principal or comorbid diagnosis of an adrenal malignancy were selected. Data were examined for trends in admissions for AM and associated AI/AC using population data from the corresponding years. Results There were 15,376 hospital admissions with a diagnosis of AM in NSW over the study period, corresponding to 1281 admissions/year. The AM admission rate increased significantly over the study period from 129.9/million to 215.7/million (p < 0.01). An AI diagnosis was recorded in 182 (1.2%) admissions, corresponding to an average of 2.1/million/year. This rate increased significantly over the years of the study from 1.2/million in 2006 to 3.4/million in 2017 (p < 0.01). An AC was identified in 24 (13.2%) admissions with an AI diagnosis. Four patients (16.7%) with an AC died during the hospitalisation. Conclusion Admission with a diagnosis of AM has increased over recent years and has been accompanied by an increase in AI diagnoses. While AI is diagnosed in a small proportion of patients with AM, ACs do occur in affected patients.

scholarly journals Patient-specific record linkage between emergency department and hospital admission data for a cohort of people who inject drugs: methodological considerations for frequent presenters

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rehana Di Rico ◽  
Dhanya Nambiar ◽  
Belinda Gabbe ◽  
Mark Stoové ◽  
Paul Dietze
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Record Linkage ◽  
People Who Inject Drugs ◽  
Hospital Admissions ◽  
Time Windows ◽  
Patient Specific ◽  
Hospital Inpatient ◽  
Admission Data ◽  
Ed Visits

Abstract Background People who inject drugs (PWID) have been identified as frequent users of emergency department (ED) and hospital inpatient services. The specific challenges of record linkage in cohorts with numerous administrative health records occurring in close proximity are not well understood. Here, we present a method for patient-specific record linkage of ED and hospital admission data for a cohort of PWID. Methods Data from 688 PWID were linked to two state-wide administrative health databases identifying all ED visits and hospital admissions for the cohort between January 2008 and June 2013. We linked patient-specific ED and hospital admissions data, using administrative date-time timestamps and pre-specified linkage criteria, to identify hospital admissions stemming from ED presentations for a given individual. The ability of standalone databases to identify linked ED visits or hospital admissions was examined. Results There were 3459 ED visits and 1877 hospital admissions identified during the study period. Thirty-four percent of ED visits were linked to hospital admissions. Most links had hospital admission timestamps in-between or identical to their ED visit timestamps (n = 1035, 87%). Allowing 24-h between ED visits and hospital admissions captured more linked records, but increased manual inspection requirements. In linked records (n = 1190), the ED ‘departure status’ variable correctly reflected subsequent hospital admission in only 68% of cases. The hospital ‘admission type’ variable was non-specific in identifying if a preceding ED visit had occurred. Conclusions Linking ED visits with subsequent hospital admissions in PWID requires access to date and time variables for accurate temporal sorting, especially for same-day presentations. Selecting time-windows to capture linked records requires discretion. Researchers risk under-ascertainment of hospital admissions if using ED data alone.

ESTIMATING PREVALENCE AND TIME COURSE OF SARS-CoV-2 BASED ON NEW HOSPITAL ADMISSIONS AND PCR TESTS: Data posted in the COVID 19 tracking website for RT-PCR (PCR) results and hospital admissions are used to estimate the prevalence of the SARS-CoV-2 pandemic in the United States (1). Hospital admissions mitigate positive sampling bias in PCR tests due to their initially limited test numbers and application as a diagnostic, instead of a surveying tool. As of July 31, the United States' cumulative recovered population is estimated at 47% or 155 million. The remaining susceptible population is 53%, or 47% excepting the 6% infectious population. The estimated mortality rate of the cumulative recovered population is 0.09% death per case. New (Preprint)

2020 ◽  
Author(s):  
Jose Gonzalez
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Hospital Admission ◽  
Time Course ◽  
Hospital Admissions ◽  
Sampling Bias ◽  
The United States ◽  
Rt Pcr ◽  
Admission Data ◽  
Eastern Seaboard

BACKGROUND Serological testing for SARS-CoV-2 antibodies showed a lack of response in close to 50% of formerly afflicted patients. In addition, antibodies were found to be transient, and concentration index to disease severity. These findings made this classical method for the estimation of the recovered population from COVID-19 of limited value. The method presented on this paper relying on % RT-PCR testing and controlling for sampling bias with new hospital admission data provides an effective alternative for estimation of the extent and time course of the SARS-CoV-2 epidemic. OBJECTIVE The method presented on this paper relying on % RT-PCR testing and controlling for sampling bias with new hospital admission data provides an effective alternative for estimation of the extent and time course of the SARS-CoV-2 epidemic. METHODS Daily results for %RT-PCR, Total Test Results, Hospitalized Currently, Hospitalized Cumulative available at COVID-19 Tracking Project are used to estimate mitigation of sampling bias of RT-PCR results and daily Hospital Admissions. Since at high daily testing levels and low % positives RT-PCR evidence of sampling bias disappears, it is correlated to daily Hospital Admissions and this correlate value used to mitigate the % RT-PCR findings where sampling bias is present. This information is used to estimate time course of the infection. Knowing that the disease lasts for an average of 20 days allows the integration of the time course values to obtain cumulative recovered population. RESULTS Prevalence and time course of the SARS-CoV-2 pandemic in the United States are estimated. The recovered population amounts to 47%. The states of the eastern seaboard, as exemplified by New York and Massachusetts, display a sudden early onslaught of the pandemic. While California, Texas, and Florida lagged. Mortality rate is twice higher in the eastern seaboard states compared to the entire nation and the other presented states. Given the large number of the convalescent population mortality is about 0.09% nationwide. CONCLUSIONS Novel approach to estimating time course and prevalence shows that the recovered population is much larger, and consequently, mortality rate (0.09%) about a factor of 10 lower than currently recognized.

scholarly journals Changing patterns of hospital admission for asthma, 1981–97

Thorax ◽  
2001 ◽  
Vol 56 (9) ◽  
pp. 687-690
Author(s):  
D S Morrison ◽  
P McLoone
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Hospital Admission Rate ◽  
Admission Rates ◽  
Lengths Of Stay ◽  
Icd 10 ◽  
Changing Patterns ◽  
Bed Days ◽  
Age And Sex

BACKGROUNDHospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland.METHODSLinked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45–6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex.RESULTSThere were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children.CONCLUSIONSAfter a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

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