scholarly journals The Regional · Local Accountable Care Hospital System and Public Healthcare Network Plan

2021 ◽  
Vol 5 (1) ◽  
pp. e15
Author(s):  
Mi-young Kwak ◽  
Geu-rum Song ◽  
Kyung-eun Jo
Keyword(s):  
Public Healthcare ◽  
Care Hospital ◽  
Accountable Care ◽  
Hospital System ◽  
Healthcare Network

scholarly journals 2440. Using a geospatially explicit agent-based model of a regional healthcare network to assess varied antibiotic risk on Clostridioides difficile infection incidence

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S843-S844
Author(s):  
Sarah Rhea ◽  
Kasey Jones ◽  
Georgiy Bobashev ◽  
Breda Munoz ◽  
James Rineer ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Agent Based ◽  
Healthcare Network ◽  
Clostridioides Difficile ◽  
Unit Increase ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Different antibiotic classes are associated with different Clostridioides difficile infection (CDI) risk. The impact of varied antibiotic risk on CDI incidence can be explored using agent-based models (ABMs). ABMs can simulate complete systems (e.g., regional healthcare networks) comprised of discrete, unique agents (e.g., patients) which can be represented using a synthetic population, or model-generated representation of the population. We used an ABM of a North Carolina (NC) regional healthcare network to assess the impact of increasing antibiotic risk ratios (RRs) across network locations on healthcare-associated (HA) and community-associated (CA) CDI incidence. Methods The ABM describes CDI acquisition and patient movement across 14 network locations (i.e., nodes) (11 short-term acute care hospitals, 1 long-term acute care hospital, 1 nursing home, and the community). We used a sample of 2 million synthetic NC residents as ABM microdata. We updated agent states (i.e., location, antibiotic exposure, C. difficile colonization, CDI status) daily. We applied antibiotic RRs of 1, 5, 8.9 (original model RR), 15, and 20 to agents across the network to simulate varied risk corresponding to different antibiotic classes. We determined network HA-CDI and CA-CDI incidence and percent mean change for each RR. Results In this simulation study, HA-CDI incidence increased with increasing antibiotic risk, ranging from 11.3 to 81.4 HA-CDI cases/100,000 person-years for antibiotic RRs of 1 to 20, respectively. On average, the per unit increase in antibiotic RR was 33% for HA-CDI and 6% for CA-CDI (figure). Conclusion We used a geospatially explicit ABM to simulate increasing antibiotic risk, corresponding to different antibiotic classes, and to explore the impact on CDI incidence. The per unit increase in antibiotic risk was greater for HA-CDI than CA-CDI due to the higher probability of receiving antibiotics and higher concentration of agents with other CDI risk factors in the healthcare facilities of the ABM. These types of analyses, which demonstrate the interconnectedness of network healthcare facilities and the associated community served by the network, might help inform targeted antibiotic stewardship efforts in certain network locations. Disclosures All authors: No reported disclosures.

Resilience of the Canterbury Hospital System to the 2011 Christchurch Earthquake

2014 ◽  
Vol 30 (1) ◽  
pp. 533-554 ◽  
Author(s):  
Caitlin C. Jacques ◽  
Jason McIntosh ◽  
Sonia Giovinazzi ◽  
Thomas D. Kirsch ◽  
Thomas Wilson ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Fault Tree Analysis ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Contributing Factors ◽  
Hospital System ◽  
Nonstructural Components ◽  
Survey Tool ◽  
Future Performance ◽  
Hospital Safety

The paper analyzes the performance of a hospital system using a holistic and multidisciplinary approach. Data on impacts to the hospital system were collected using a standardized survey tool. A fault-tree analysis method is adopted to assess the functionality of critical hospital services based on three main contributing factors: staff, structure, and stuff. Damage to utility networks and to nonstructural components was found to have the most significant effect on hospital functionality. The functional curve is integrated over time to estimate the resilience of the regional acute-care hospital with and without the redistribution of its major services. The ability of the hospital network to offer redundancies in services after the earthquake increased the resilience of the Christchurch Hospital by 12%. The resilience method can be used to assess future performance of hospitals, and to quantify the effectiveness of seismic retrofits, hospital safety legislation, and new seismic preparedness strategies.

scholarly journals EPIDEMIOLOGY AND TRANSMISSION OF CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE IN A HEALTHCARE NETWORK OF AN ACUTE HOSPITAL AND ITS AFFILIATED INTERMEDIATE- AND LONG-TERM CARE FACILITIES IN SINGAPORE

2021 ◽  
Author(s):  
Aung-Hein Aung ◽  
Kala Kanagasabai ◽  
Jocelyn Koh ◽  
Pei-Yun Hon ◽  
Brenda Ang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Cross Sectional ◽  
Term Care ◽  
Healthcare Network ◽  
Care Facilities ◽  
Facility Type

BACKGROUND Movement of patients in a healthcare network poses challenges for the control of carbapenemase-producing Enterobacteriaceae (CPE). We aimed to identify intra- and inter-facility transmission events and facility type-specific risk factors of CPE in an acute care hospital (ACH) and its intermediate-term and long-term care facilities (ILTCFs). METHODS Serial cross-sectional studies were conducted in June-July of 2014-2016 to screen for CPE. Whole genome sequencing was done to identify strain relatedness and CPE genes (blaIMI; blaIMP-1; blaKPC-2; blaNDM-1; blaOXA-48). Multivariable logistic regression models, stratified by facility type were used to determine independent risk factors. RESULTS Of 5357 patients, half (55%) were from the ACH. CPE prevalence was 1.3% in the ACH and 0.7% in ILTCFs (p=0.029). After adjusting for socio-demographics, screening year, and facility type, the odds of CPE colonization increased significantly with hospital stay ≥ 3 weeks (aOR 2.67, 95%CI 1.17-6.05), penicillins use (aOR 3.00, 95%CI 1.05–8.56), proton pump inhibitors use (aOR 3.20, 95%CI 1.05–9.80), dementia (aOR 3.42, 95%CI 1.38–8.49), connective tissue disease (aOR 5.10, 95%CI 1.19-21.81), and prior carbapenem-resistant Enterobacteriaceae (CRE) carriage (aOR 109.02, 95%CI 28.47–417.44) in the ACH. For ILTCFs, presence of wound (aOR 5.30, 95%CI 1.01–27.72), respiratory procedures (aOR 4.97, 95%CI 1.09-22.71), vancomycin-resistant Enterococci carriage (aOR 16.42, 95%CI 1.52–177.48), and CRE carriage (aOR 758.30, 95%CI 33.86-16982.52) showed significant association. Genomic analysis revealed only possible intra-ACH transmission, and no evidence for ACH-to-ILTCFs transmission. CONCLUSIONS Although CPE colonization was predominantly in the ACH, risk factors varied between facilities. Targeted screening and precautionary measures are warranted.

Abstract T P271: Establishment of Stroke Ward Results in Immediate Reduction of Major Complications

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Naveed Akhtar ◽  
S Kamran ◽  
R Singh ◽  
D Deleu ◽  
P Bourke ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Phase 1 ◽  
Tertiary Care ◽  
Multidisciplinary Care ◽  
Care Hospital ◽  
Phase 2 ◽  
Hospital System ◽  
Major Complications ◽  
Medical Wards

Background and Purpose: Randomized controlled trials have consistently shown that stroke units decrease both mortality and morbidity compared with conventional care in general medical wards. There are however limited data on the specific types of in-hospital medical complications and their effect on outcomes. The objective of this study was to determine whether establishing a specialized geographically defined Stroke Ward results in reducing the major complications in patients suffering from acute stroke within the same hospital system. Methods: This is a prospective study from January 2014 till July 2014. Data was collected from a web-based stroke registry in two phases. In phase 1 (from January 1, 2014 till March 08, 2014), we collected data of stroke patients admitted at in the medical wards. In phase 2, a protocol-based multidisciplinary care Stroke Ward became operational where most of the patients were admitted. Outcomes measures were number and type of complications, mortality, discharge disposition, and length of stay, and were adjusted for age, sex, and medical co-morbidities. Results: There were 130 admissions in phase 1 and 345 in phase 2. Commonest complications included, aspiration pneumonia 29% vs 12% (p<0.001) and pressure ulcers in 35% vs 11% (p<0.001). Average length of stay decreased from 12 days to 4 days (p<0.001). In phase 1, 70 % of patients were discharged home, while 23% were transferred to rehabilitation while in phase 2, 75% of patients were discharged home, while 18% patients were sent to rehabilitation. Ninety percent of complications happened in medical wards, mainly in patients who over stayed in emergency department (more than 8 hours) waiting for bed in Stroke Ward or medical floor. Conclusion: A protocol based multidisciplinary care Stroke Ward care significantly reduces common early complications of acute stroke. It also helps in significantly reducing the length of stay, saving total bed days at a tertiary care hospital, hence improving the overall care of these patients.

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