Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010

2014 ◽  
Vol 20 (2) ◽  
pp. 125-141 ◽  
Author(s):  
Mayur Sharma ◽  
Ashish Sonig ◽  
Sudheer Ambekar ◽  
Anil Nanda
Keyword(s):  
Household Income ◽  
Nationwide Inpatient Sample ◽  
Young Patients ◽  
High Volume ◽  
Teaching Hospitals ◽  
Median Household Income ◽  
Inpatient Mortality ◽  
Discharge Disposition ◽  
Comorbidity Index ◽  
The Mean

Object The aim of this study was to analyze the incidence of adverse outcomes and inpatient mortality following resection of intramedullary spinal cord tumors by using the US Nationwide Inpatient Sample (NIS) database. The overall complication rate, length of the hospital stay, and the total cost of hospitalization were also analyzed from the database. Methods This is a retrospective cohort study conducted using the NIS data from 2003 to 2010. Various patient-related (demographic categories, complications, comorbidities, and median household income) and hospital-related variables (number of beds, high/low case volume, rural/urban location, region, ownership, and teaching status) were analyzed from the database. The adverse discharge disposition, in-hospital mortality, and the higher cost of hospitalization were taken as the dependent variables. Results A total of 15,545 admissions were identified from the NIS database. The mean patient age was 44.84 ± 19.49 years (mean ± SD), and 7938 (52%) of the patients were male. Regarding discharge disposition, 64.1% (n = 9917) of the patients were discharged to home or self-care, and the overall in-hospital mortality rate was 0.46% (n = 71). The mean total charges for hospitalization increased from $45,452.24 in 2003 to $76,698.96 in 2010. Elderly patients, female sex, black race, and lower income based on ZIP code were the independent predictors of other than routine (OTR) disposition (p < 0.001). Private insurance showed a protective effect against OTR disposition. Patients with a higher comorbidity index (OR 1.908, 95% CI 1.733–2.101; p < 0.001) and with complications (OR 2.214, 95% CI 1.768–2.772; p < 0.001) were more likely to have an adverse discharge disposition. Hospitals with a larger number of beds and those in the Northeast region were independent predictors of the OTR discharge disposition (p < 0.001). Admissions on weekends and nonelective admission had significant influence on the disposition (p < 0.001). Weekend and nonelective admissions were found to be independent predictors of inpatient mortality and the higher cost incurred to the hospitals (p < 0.001). High-volume and large hospitals, West region, and teaching hospitals were also the predictors of higher cost incurred to the hospitals (p < 0.001). The following variables (young patients, higher median household income, nonprivate insurance, presence of complications, and a higher comorbidity index) were significantly correlated with higher hospital charges (p < 0.001), whereas the variables young patients, nonprivate insurance, higher median household income, and higher comorbidity index independently predicted for inpatient mortality (p < 0.001). Conclusions The independent predictors of adverse discharge disposition were as follows: elderly patients, female sex, black race, lower median household income, nonprivate insurance, higher comorbidity index, presence of complications, larger hospital size, Northeast region, and weekend and nonelective admissions. The predictors of higher cost incurred to the hospitals were as follows: young patients, higher median household income, nonprivate insurance, presence of complications, higher comorbidity index, hospitals with high volume and a large number of beds, West region, teaching hospitals, and weekend and nonelective admissions.

scholarly journals Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010

2013 ◽  
Vol 35 (5) ◽  
pp. E2 ◽  
Author(s):  
Mayur Sharma ◽  
Sudheer Ambekar ◽  
Bharat Guthikonda ◽  
Jessica Wilden ◽  
Anil Nanda
Keyword(s):  
Nationwide Inpatient Sample ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Case Volume ◽  
Discharge Disposition ◽  
Comorbidity Index ◽  
The Mean ◽  
The Impact ◽  
High Comorbidity ◽  
Deep Brain

Object The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure. Methods This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables. Results A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148–1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202–8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781–7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p = 0.033] and OR 2.897 [p = 0.031], respectively) were independent predictors of higher hospital cost. The mean length of hospital stay decreased from 2.03 days in 2006 to 1.55 days in 2010. There was no difference in the discharge disposition among academic versus nonacademic centers and rural versus urban hospitals (p > 0.05). Conclusions Elderly female patients with nonprivate insurance and high comorbidity index who underwent surgery at low-volume centers performed by a surgeon with a low annual case volume and the occurrence of postoperative complications were correlated with an adverse discharge disposition. High-volume, government-owned academic centers in the Northeast were associated with a lower cost incurred to the hospitals. It can be recommended that the widespread availability of this procedure across small, academic centers in rural areas may not only provide easier access to the patients but also reduces the total cost of hospitalization.

scholarly journals Prevalence of periodontitis and alveolar bone loss in a patient population at Harvard School of Dental Medicine

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mohammad F. Helmi ◽  
Hui Huang ◽  
J. Max Goodson ◽  
Hatice Hasturk ◽  
Mary Tavares ◽  
...  
Keyword(s):  
Bone Loss ◽  
Household Income ◽  
Alveolar Bone ◽  
Alveolar Bone Loss ◽  
Median Household Income ◽  
Posterior Teeth ◽  
The Mean ◽  
High Household Income ◽  
Harvard School ◽  
Loss Level

Abstract Background Although several studies assessed the prevalence of alveolar bone loss, the association with several risk factors has not been fully investigated. The aim of this article is to measure the prevalence of periodontitis by calculating the mean alveolar bone loss/level of posterior teeth using bitewing radiographs among the patients enrolled in the clinics at Harvard School of Dental Medicine and address risk factors associated with the disease. Methods One thousand one hundred thirty-one patients were selected for radiographic analysis to calculate the mean alveolar bone loss/level by measuring the distance between the cementoenamel junction and the alveolar bone crest on the mesial and distal surfaces of posterior teeth. Linear regression with Multi-level mixed-effect model was used for statistical analysis adjusting for age, sex, race, median household income, and other variables. Results Mean alveolar bone level of the whole sample was 1.30 mm (±0.006). Overall periodontitis prevalence for the sample was 55.5% (±1.4%). Moderate periodontitis prevalence was 20.7% (±1.2%), while 2.8% (±0.5%) of the whole sample had severe periodontitis. Adjusted mean alveolar bone loss was higher in older age groups, males, Asian race group, ever smokers, and patients with low median household income. Conclusion The effect of high household income on the amount of bone loss can be powerful to the degree that high household income can influence outcomes even for individuals who had higher risks of developing the disease. Public health professionals and clinicians need to collaborate with policy makers to achieve and sustain high quality of healthcare for everyone.

Inpatient mortality, healthcare resource utilization, and complications of elective laparoscopic versus open colectomy in colon cancer patients: A nationwide inpatient sample analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4109-4109
Author(s):  
Ishaan Vohra ◽  
Vatsala Katiyar ◽  
Bashar Attar ◽  
Prasanth Lingamaneni ◽  
Krishna Rekha Moturi ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Resource Utilization ◽  
Laparoscopic Colectomy ◽  
Nationwide Inpatient Sample ◽  
Hospital Charge ◽  
Healthcare Resource Utilization ◽  
Inpatient Mortality ◽  
Hospital Resource ◽  
Younger Age ◽  
Comorbidity Index

4109 Background: Laparoscopic colectomy (LC) has become an accepted safe and alternative technique to open surgical colectomy (OC) as a treatment option for colon cancer. We compared inpatient mortality, hospital resource utilization and complications in patients who underwent LC vs OC. Methods: All patients with known diagnosis of colon cancer who underwent elective colonic resection were identified using Nationwide Inpatient Sample (NIS) 2017. Univariate and multivariate linear and logistic regression was performed to compare the outcomes of patients who underwent LC vs OC. Results: In our cohort, 171, 480 adult patients with colon cancer were identified. The number of males and females were equal. The mean age was 67.2 years. They were predominantly Caucasians (67.6%). OC was performed on 3,869 patients. Of 1,345 patients who underwent LC, 385 were converted to OC. As compared to OC, LC was associated with lower postoperative complications including anastomotic leak, stricture, intestinal obstruction(1% vs 10.8%, p<0.01), blood transfusion(2.2 % vs 11.2% p=0.01), malnutrition(0.2% vs 4.4% p=0.02), shock(0.7% vs 1.8%,p=0.04), ICU care(1.9% vs 5.3%), mean length of stay (5.9 days vs 8.7 days, p=0.01), lower hospital charge (88,642$ vs 106,315 $,p<0.01) and lower mortality(0.3% vs 1.9%(p=0.02). There was a trend towards decreased venous thromboembolism (0.3% vs 1.7 %, p=0.9) and post-operative ileus (0.1% vs 0.7% p=0.60) in LC as compared to OC. On multivariate analysis, independent predictors of undergoing LC were younger age, teaching and large bed-sized hospital and lower Charlson comorbidity index. Race, insurance status and income had no significant association with selection of operative approach (Table). Conclusions: In our cohort, laparoscopic colectomy was found to have better peri and post-operative clinical outcomes including decreased inpatient mortality and hospital resource utilization. It should be promoted as the curative surgical option for colon cancer whenever clinically indicated. [Table: see text]

scholarly journals A comparison of endoscopic and non-endoscopic biliary intervention outcomes in patients with prior bariatric surgery

2018 ◽  
Vol 06 (01) ◽  
pp. E11-E28
Author(s):  
Amrit Kamboj ◽  
Victorio Pidlaoan ◽  
Mohammad Shakhatreh ◽  
Alice Hinton ◽  
Darwin Conwell ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Nationwide Inpatient Sample ◽  
Cost Effective ◽  
Hospital Charges ◽  
Endoscopic Management ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Cost Effective Approach ◽  
History Of ◽  
The Mean

Abstract Background and study aims Endoscopic biliary intervention (BI) is often difficult to perform in patients with prior bariatric surgery (BRS). We sought to analyze outcomes of patients with prior BRS undergoing endoscopic and non-endoscopic BI. Patients and methods The Nationwide Inpatient Sample (2007 – 2011) was reviewed to identify all adult inpatients (≥ 18 years) with a history of BRS undergoing BI. The clinical outcomes of interest were in-patient mortality, length of stay (LOS), and total hospital charges. Results There were 7,343 patients with prior BRS who underwent BIs where a majority were endoscopic (4,482 vs. 2,861, P < 0.01). The mean age was 50±30.8 years and the majority were females (80.5 %). Gallstone-related disease was the most common indication for BI and managed more often with primary endoscopic management (2,146 vs. 1,132, P < 0.01). Inpatient mortality was not significantly different between patients undergoing primary endoscopic versus non-endoscopic BI (0.2 % vs. 0.7 %, P = 0.2). Patients with sepsis were significantly more likely to incur failed primary endoscopic BI (OR 2.74, 95 % CI 1.15, 6.53) and were more likely to be managed with non-endoscopic BI (OR 2.13, 95 % CI 1.3, 3.5). Primary non-endoscopic BI and failed endoscopic BI were both associated with longer LOS (by 1.77 days, P < 0.01 and by 2.17 days, P < 0.01, respectively) and higher hospitals charges (by $11,400, P < 0.01 and by $ 14,200, P < 0.01, respectively). Conclusion Primary endoscopic management may be a safe and cost-effective approach for patients with prior BRS who need BI. While primary endoscopic biliary intervention is more common, primary non-endoscopic intervention may be used more often for sepsis.

Community emergency response teams and the wealth of communities in New Jersey

2006 ◽  
Vol 4 (6) ◽  
pp. 11
Author(s):  
Scott Phelps, JD, MPH, CEM, CBCP, Paramedic
Keyword(s):  
New York ◽  
New York City ◽  
New Jersey ◽  
Emergency Management ◽  
Emergency Response ◽  
York City ◽  
Household Income ◽  
Median Household Income ◽  
On Demand ◽  
The Mean

This study examined median household income (MHI) of communities with community emergency response teams (CERTs). Preliminary data from New York City showed that in three of five counties, the mean MHI in CERT communities exceeded countywide MHI by up to $19,000. The research was then expanded to New Jersey, where, of 18 counties with CERTs, the mean MHI exceeded the countywide MHI in 15 counties (83 percent of the time). In counties where the mean CERT-community MHI was higher, it exceeded the county MHI by $6,060. Mean CERT-community MHI also exceeded the state’s MHI by over $5,000 ($60,745 versus $55,146). Given recent examples of the vulnerability of poor and working-class communities, emergency management agencies at all levels need to target CERT resources based on need, not on demand.

scholarly journals Elective Splenectomy in Immune Thrombocytopenic Purpura: An Analysis of National Inpatient Sample (NIS) Database between Years 2006 and 2014

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4672-4672
Author(s):  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
Rohit Kumar ◽  
Prasanth Lingamaneni ◽  
Leila Khaddour ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Immune Thrombocytopenic Purpura ◽  
Charlson Comorbidity Index ◽  
Geographic Region ◽  
Teaching Hospitals ◽  
Insurance Status ◽  
Inpatient Mortality ◽  
Thrombocytopenic Purpura ◽  
Comorbidity Index ◽  
Income Quartile

Background: Over the years, splenectomy has dropped out of favor as a treatment option for Immune Thrombocytopenic Purpura (ITP) and is now considered only for patients who have failed multiple lines of therapy. One of the major concerns is surgical morbidity. We aim to study in-hospital outcomes following elective splenectomy in this population Methods: This is a retrospective cohort analysis of NIS database (years 2006 to 2014). Patients ≥18 years of age, who had an elective admission associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure code for splenectomy were included in the study. Our cohort of interest was patients with ITP who underwent elective splenectomy (ITP ES). ICD-9-CM diagnosis codes were used to identify patients with ITP. All other patients who underwent elective splenectomy were labeled as non-ITP ES. Utilization of intensive care services was identified by procedure codes associated with vasopressor use, cardiopulmonary resuscitation, mechanical ventilation and initiation of dialysis in the absence of pre-existing end stage renal disease. Primary outcome was inpatient mortality and secondary outcome was length of stay (LOS). Associated factors were analyzed using multivariate logistic regression analysis. A p-value <0.05 was considered significant. We used STATA for statistical analysis. Results: A total of 102,698 admissions for elective splenectomies (ES) in adults were identified between the years 2006 and 2014,of which 11.36% (n= 11,668) were ITP ES. Inpatient mortality and mean LOS for all patients undergoing ES was 2.53% and 8.51 days respectively. Inpatient mortality and mean LOS in the ITP ES cohort was 0.86% and 4.37 days respectively. In the entire cohort of ES, inpatient mortality was lower in those with ITP versus non-ITP (OR 0.36, p<0.001). Also females had lower mortality when compared to men (OR 0.50, p<0.001). Inpatient mortality was higher with increasing age (OR 1.03, p<0.001) and Charlson Comorbidity Index (CCI) ≥3 vs 0 (OR 1.54, p <0.001). Mean length of stay was lower in those with ITP vs non ITP by 3.3 days (p<0.001). Within the ITP-ES cohort, mortality was higher with increasing age (OR 1.12, p <0.001), CCI ≥3 vs 0 (OR 18.39, p< 0.0001) and CCI 2 vs 0 (OR 8.61, p 0.008). Inpatient mortality was lower in teaching hospitals compared to non-teaching hospitals with a trend towards significance (OR 0.35, p 0.05). Gender, insurance status, income quartile, geographic region and hospital size did not affect odds of inpatient mortality in this cohort. Length of stay (LOS) in ITP ES cohort had positive correlation with age (coefficient 0.038, p<0.001), income quartile 51-75th vs 0-25th percentile (coefficient 0.81, p 0.03), CCI ≥3 vs 0 (coefficient 3.29, p<0.001), CCI 2 vs 0 (coefficient 2.11, p<0.001), CCI 1 vs 0 (coefficient 0.86, p<0.001). There was no association of gender, insurance status and geographic region with LOS within this cohort. Conclusion: Inpatient mortality and length of stay in admissions for elective splenectomy was significantly lower in ITP patients compared to non ITP patients. Also, in ITP patients undergoing elective splenectomy, older age and a charlson comorbidity index of 2 or above were associated with higher odds of dying in the same admission.These findings from real world data have practical implications for clinicians and patients, as they weigh the pros and cons of splenectomy as a treatment option for ITP. Table Disclosures Donthireddy: Viracta: Other: PI for Clinical Trial.

Patterns of care in adjuvant systemic therapy of patients with stage III melanoma: A U.S. population-based study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8595-8595
Author(s):  
Boyu Hu ◽  
Henry B. Koon ◽  
Julian Kim
Keyword(s):  
Overall Survival ◽  
Adjuvant Therapy ◽  
Systemic Therapy ◽  
Household Income ◽  
Adjuvant Systemic Therapy ◽  
Stage Iii ◽  
Teaching Hospitals ◽  
Median Household Income ◽  
Study Population ◽  
Stage Iii Melanoma

8595 Background: Use of adjuvant systemic therapy in patients with stage III melanoma is widely known to be variable based upon multiple factors such as patient age and comorbidities as well as the preference and even geographic location of the oncologist and patient. The purpose of this study was to compare the use of adjuvant therapy among patients treated in teaching hospitals and community hospitals. Methods: The study population consisted of patients with stage III melanoma enrolled into the National Cancer Database (NCDB) between 2000-2008. Patients were selected based upon surgery as the first course of therapy which resulted in a total of 27,353 eligible for analysis. The study population was then categorized into those who were treated at Teaching Hospitals (TH) including National Cancer Institute-designated cancer centers or Community Hospitals (CH). Multiple variables including age, median household income, insurance status, race and overall survival were compared between patients in the two hospital groups. Results: The overall proportion of stage III patients who received adjuvant systemic therapy was approximately 30%. There was no difference in the proportion of patients receiving adjuvant systemic therapy between patients treated in TH as compared to CH, and there was no obvious trend towards increased use over time. Of interest was that the cohort of patients designated as being treated at TH had a higher proportion of patients less than 70 years old as compared to CH. Median household income was found to be higher in patients treated at TH. Finally, despite the observation that the proportion of patients who received adjuvant therapy was not different, there a significantly higher 5-year overall survival in patients treated at TH as compared to CH. Conclusions: Although the proportion of patients who received adjuvant systemic therapy was comparable in TH and CH, there was a significant increase in 5-year overall survival within TH. Additional factors such as age, lesser comorbidities, more favorable socioeconomic factors or other unmeasured factors such as type of adjuvant therapy or whether adjuvant therapy was completed may have contributed to the improved survival in patients treated at TH.

Characterizing the costs of complications after cystectomy: Can we target the primary drivers?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 304-304
Author(s):  
Matthew Mossanen ◽  
Ross E Krasnow ◽  
Matthew Ingham ◽  
Adam S Kibel ◽  
Mark A Preston ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Volume ◽  
Healthcare Research ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Discharge Disposition ◽  
The Us ◽  
Clinical Classification Software ◽  
Primary Driver ◽  
Continent Diversion

304 Background: Radical Cystectomy (RC) is subject to substantial morbidity and patients face complication rates as high as 64% at 90-days. Understanding the costs of complications after RC is essential to improving care. We studied the financial cost of different categories of complications after RC in order to identify drivers of expenditures. Methods: Using the Premier Hospital Database we identified adult patients who underwent RC for bladder cancer from 600 hospitals across the US from 2003-2013. Ninety-day complications were captured using ICD9 codes. Complications were categorized according to Agency for Healthcare Research and Quality Clinical Classification Software. The primary outcome was cost of complication and secondary outcomes were mortality, length of stay (LOS), and discharge disposition. A generalized liner model conforming to a gamma distribution was used to evaluate cost data. Analyses were survey weighted, and all models were adjusted for patient (age, race, obesity, marital status, payer), hospital (bed size, teaching affiliation, rural, region), and surgery characteristics (lymphadenectomy, continent diversion, robotic, operative time, transfusion, surgeon volume, hospital volume) and clustered by hospital. Results: We identified 9,137 RC patients, representing a weighting population of 57,553 patients. The top four most costly complications were venous thromboembolism (VTE $17547), soft tissue ($13523), gastrointestinal (GI $8663), and infectious (non-wound, i.e. sepsis, $7930). Pharmacy related costs were the primary driver of VTE costs. LOS was increased in each complication by 1.7 days for infectious, 4.5 days for soft tissue, 3.5 days for GI, and 3 days for VTE. Being married, having fewer comorbidities, larger hospitals, teaching hospitals, shorter operations, lack of transfusions, high volume hospitals, and high volume surgeons were associated with statistically significantly lower costs of complications after cystectomy. Conclusions: VTE, soft tissue, and GI complications are the most expensive complications after cystectomy, and thereby highlight potential candidates for future quality improvement initiatives.

Measuring Patients’ Perceived Empathy of Clinical Nurses

2021 ◽  
Author(s):  
Ali Mohammadi ◽  
Koorosh Kamali
Keyword(s):  
Interpersonal Communication ◽  
Young Patients ◽  
Personal Characteristics ◽  
Intermediate Level ◽  
Three Dimensions ◽  
Teaching Hospitals ◽  
Systematic Sampling ◽  
Cross Sectional ◽  
Clinical Nurses ◽  
The Mean

Background: Empathy is the perception of patients’ feelings and experiences; in other words, nurses can understand their patients’ feelings by considering themselves in their position. Empathic relationship in patient care can lead to considerable interpersonal communication and as a result, better outcomes for patient health. Thus, the purpose of this study was to assess patients’ perceived empathy of clinical nurses.  Methods: This cross-sectional study was carried out at teaching hospitals of Zanjan city in 2018 -2019. A sample including 285 inpatients of teaching hospitals in Zanjan city were selected by systematic sampling.  To collect data, the Scale of Patient-Perceived Empathy from Nurses (SPPEN) was used. Descriptive statistics (Mean and frequency) and multivariate analyses were applied to describe empathy relationships with personal characteristics. Results: The factor analysis on 15 items of SPPEN led to three factors with eigenvalue>1 that totally explained 74.5 percent of the variance. Three dimensions of nurses’ expression, patients’ feedbacks and patients’ expectations were identified as effective factors on patients’ perceived empathy. The mean score of overall SPPEN was at upper intermediate level (m=4.98). The mean score of overall SPPEN and its dimensions in young patients were higher than patients aged 45 years and over. Differences in mean scores of overall SPPEN and its dimensions (Except nurses’ expression) were statistically significant on the base of age characteristics (p<0.05). Furthermore, there were significant differences at mean scores of patients’ feedback and patients’ expectations dimensions on the base of inpatients ward variable (p<0.05). The highest mean score of patients’ feedbacks (5.34±1.05) and patients’ expectations (6.05±1.1) were related to gynecology and surgery wards, respectively. Conclusion: The findings of the present study indicate that inpatients’ perception score of nurses’ empathy was at upper intermediate level. According to the findings, nurses’ empathy and communicative skills must be promoted by establishing training workshops for empathy development.

scholarly journals Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

2019 ◽  
Vol 47 (5) ◽  
pp. E9 ◽  
Author(s):  
Oliver Y. Tang ◽  
James S. Yoon ◽  
Anna R. Kimata ◽  
Michael T. Lawton
Keyword(s):  
Pediatric Trauma ◽  
High Volume ◽  
Neurosurgical Procedures ◽  
Inpatient Mortality ◽  
Case Volume ◽  
Discharge Disposition ◽  
High Volume Hospital ◽  
Wide Range ◽  
Level I ◽  
National Databases

OBJECTIVEPrevious research has demonstrated the association between increased hospital volume and improved outcomes for a wide range of neurosurgical conditions, including adult neurotrauma. The authors aimed to determine if such a relationship was also present in the care of pediatric neurotrauma patients.METHODSThe authors identified 106,146 pediatric admissions for traumatic intracranial hemorrhage (tICH) in the National Inpatient Sample (NIS) for the period 2002–2014 and 34,017 admissions in the National Trauma Data Bank (NTDB) for 2012–2015. Hospitals were stratified as high volume (top 20%) or low volume (bottom 80%) according to their pediatric tICH volume. Then the association between high-volume status and favorable discharge disposition, inpatient mortality, complications, and length of stay (LOS) was assessed. Multivariate regression modeling was used to control for patient demographics, severity metrics, hospital characteristics, and performance of neurosurgical procedures.RESULTSIn each database, high-volume hospitals treated over 60% of pediatric tICH admissions. In the NIS, patients at high-volume hospitals presented with worse severity metrics and more frequently underwent neurosurgical intervention over medical management (all p < 0.001). After multivariate adjustment, admission to a high-volume hospital was associated with increased odds of a favorable discharge (home or short-term facility) in both databases (both p < 0.001). However, there were no significant differences in inpatient mortality (p = 0.208). Moreover, high-volume hospital patients had lower total complications in the NIS and lower respiratory complications in both databases (all p < 0.001). Although patients at high-volume hospitals in the NTDB had longer hospital stays (β-coefficient = 1.17, p < 0.001), they had shorter stays in the intensive care unit (β-coefficient = 0.96, p = 0.024). To determine if these findings were attributable to the trauma center level rather than case volume, an analysis was conducted with only level I pediatric trauma centers (PTCs) in the NTDB. Similarly, treatment at a high-volume level I PTC was associated with increased odds of a favorable discharge (OR 1.28, p = 0.009), lower odds of pneumonia (OR 0.60, p = 0.007), and a shorter total LOS (β-coefficient = 0.92, p = 0.024).CONCLUSIONSPediatric tICH patients admitted to high-volume hospitals exhibited better outcomes, particularly in terms of discharge disposition and complications, in two independent national databases. This trend persisted when examining level I PTCs exclusively, suggesting that volume alone may have an impact on pediatric neurotrauma outcomes. These findings highlight the potential merits of centralizing neurosurgery and pursuing regionalization policies, such as interfacility transport networks and destination protocols, to optimize the care of children affected by traumatic brain injury.

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