scholarly journals Late-week surgery and discharge to specialty care associated with higher costs and longer lengths of stay after elective lumbar laminectomy

2021 ◽  
pp. 1-7
Author(s):  
Sebastian Salas-Vega ◽  
Vikram B. Chakravarthy ◽  
Robert D. Winkelman ◽  
Matthew M. Grabowski ◽  
Ghaith Habboub ◽  
...  
Keyword(s):  
Health Risks ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Home Healthcare ◽  
Rehabilitation Center ◽  
Rehabilitation Centers ◽  
Surgical Scheduling ◽  
Surgery Patient ◽  
Comorbidity Burden ◽  
Patient Health

OBJECTIVE In a healthcare landscape in which costs increasingly matter, the authors sought to distinguish among the clinical and nonclinical drivers of patient length of stay (LOS) in the hospital following elective lumbar laminectomy—a common spinal surgery that may be reimbursed using bundled payments—and to understand their relationships with patient outcomes and costs. METHODS Patients ≥ 18 years of age undergoing laminectomy surgery for degenerative lumbar spinal stenosis within the Cleveland Clinic health system between March 1, 2016, and February 1, 2019, were included in this analysis. Generalized linear modeling was used to assess the relationships between the day of surgery, patient discharge disposition, and hospital LOS, while adjusting for underlying patient health risks and other nonclinical factors, including the hospital surgery site and health insurance. RESULTS A total of 1359 eligible patients were included in the authors’ analysis. The mean LOS ranged between 2.01 and 2.47 days for Monday and Friday cases, respectively. The LOS was also notably longer for patients who were ultimately discharged to a skilled nursing facility (SNF) or rehabilitation center. A prolonged LOS occurring later in the week was not associated with greater underlying health risks, yet it nevertheless resulted in greater costs of care: the average total surgical costs for lumbar laminectomy were 20% greater for Friday cases than for Monday cases, and 24% greater for late-week cases than for early-week cases ultimately transferred to SNFs or rehabilitation centers. A Poisson generalized linear model fit the data best and showed that the comorbidity burden, surgery at a tertiary care center versus a community hospital, and the incidence of any postoperative complication were associated with significantly longer hospital stays. Discharge to home healthcare, SNFs, or rehabilitation centers, and late-week surgery were significant nonclinical predictors of LOS prolongation, even after adjusting for underlying patient health risks and insurance, with LOSs that were, for instance, 1.55 and 1.61 times longer for patients undergoing their procedure on Thursday and Friday compared to Monday, respectively. CONCLUSIONS Late-week surgeries are associated with a prolonged LOS, particularly when discharge is to an SNF or rehabilitation center. These findings point to opportunities to lower costs and improve outcomes associated with elective surgical care. Interventions to optimize surgical scheduling and perioperative care coordination could help reduce prolonged LOSs, lower costs, and, ultimately, give service line management personnel greater flexibility over how to use existing resources as they remain ahead of healthcare reforms.

scholarly journals Improving Communications With Patients and Families in Geriatric Care. The How, When, and What

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Shirley Chien-Chieh Huang ◽  
Alden Morgan ◽  
Vanessa Peck ◽  
Lara Khoury
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Tertiary Care ◽  
Care Providers ◽  
Telephone Interviews ◽  
Written Information ◽  
Geriatric Unit ◽  
Patient Health

There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.

scholarly journals Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

2014 ◽  
Vol 12 (6) ◽  
pp. 505-513 ◽  
Author(s):  
S. M. Phillips ◽  
R. E. Glasgow ◽  
G. Bello ◽  
M. G. Ory ◽  
B. A. Glenn ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Risk ◽  
Health Risk Assessment ◽  
Health Risks ◽  
Patient Health

HBV, HCV, HIV & TB Prevalence in Injection Drug Users in Major Cities of Punjab, Pakistan- a Survey-Based Research Report

2021 ◽  
Author(s):  
Ghafran Ali ◽  
Kanza Ashfaq
Keyword(s):  
Hepatitis B ◽  
Injection Drug Users ◽  
Drug Users ◽  
Injection Drug ◽  
Intravenous Drug ◽  
Research Report ◽  
Intravenous Drug Users ◽  
Rehabilitation Center ◽  
Rehabilitation Centers ◽  
Hep B

Hepatitis-B,C,HIV and TB among intravenous drug users continues to be a serious explanation for disease and death, this study was conducted to survey the prevalence of Hepatitis-B,C,HIV and TB in rehabilitation center of Punjab, Pakistan. A telephonic and visited survey of 78 rehabilitation centers in Punjab Pakistan to assess their treatment. An analysis of 21 responded that returned useable data revealed that only 7.2% patients of responded rehabilitation centers are positive for HEP-B. 33.23% patients are positive for HEP-C, 8.74% patients are positive for HIV and 0.87% patients are positive for TB. Majority of the respondent of whom doctors, psychologists believe that the patient, partner of the patient and their children should be offered for HEP-B,C,HIV and TB screening regularly.

scholarly journals Construção e validação de indicadores interdisciplinares em um centro de reabilitação

2020 ◽  
Vol 20 (80) ◽  
Author(s):  
Darlene Vieira Candido Zarbinati ◽  
Camila Reis Paris Servoni ◽  
Alessandro José Pereira ◽  
Eduardo Federighi Baisi Chagas ◽  
Pedro Marco Karan Barbosa
Keyword(s):  
Health Care ◽  
Organizational Structures ◽  
Patient Care Team ◽  
Consensus Conference ◽  
Rehabilitation Center ◽  
Work Processes ◽  
Rehabilitation Centers ◽  
Third Stage ◽  
Management Of Rehabilitation ◽  
Care Health

O uso de indicadores caracteriza-se como uma estratégia que possibilita a busca da eficácia e eficiência das estruturas organizacionais, dos processos de trabalho e dos resultados da assistência, permitindo que os profissionais monitorem e avaliem todo o processo. Portanto, para estruturar um indicador é necessário que haja participação de vários profissionais, tendo em vista a interdisciplinaridade. Desse modo, este trabalho tem por objetivo propor uma matriz de indicadores de processo e resultado na assistência em saúde com enfoque interdisciplinar no âmbito do atendimento ambulatorial em reabilitação. Estudo quanti-qualitativo realizado no Centro de Reabilitação Lucy Montoro da Unidade de Marília - SP, com amostra intencional, dividida em 2 grupos: construção dos indicadores e validação dos indicadores. Para a construção dos indicadores, participaram 33 profissionais de saúde, entre eles enfermeiros, nutricionistas, psicólogos, terapeutas ocupacionais, fonoaudiólogos, assistentes sociais, educadores físicos e fisioterapeutas. Foram constituídas 3 etapas, sendo a primeira uma oficina de planejamento, na qual foi apresentado o conceito de indicador e os critérios para a construção. A segunda etapa foram as oficinas de trabalho com os terapeutas de cada setor utilizando a técnica de brainstorm, definindo as principais práticas assistenciais empregadas no centro de reabilitação que se correlacionassem entre os setores para a elaboração dos indicadores, segundo o modelo proposto por Donabedian. Na terceira etapa os indicadores foram submetidos à juízes especialistas para validação de conteúdo através da técnica de conferência de consenso. A validação foi realizada por 5 juízes, e todos os 10 indicadores elaborados foram validados. Acredita-se que o emprego desse instrumento colabore com a avaliação e gestão da qualidade nos serviços de reabilitação.Palavras-chave: Avaliação da qualidade dos cuidados de saúde. Assistência à saúde. Centros de reabilitação. Equipe de assistência ao paciente. ABSTRACTThe use of indicators is characterized as a strategy that enables the search for the effectiveness and efficiency of organizational structures, work processes and care results, allowing professionals to monitor and evaluate the entire process. Therefore, to structure an indicator it is necessary to participate several professionals, in view of interdisciplinarity. Thus, this work aims to propose a matrix of process and result indicators in health care with an interdisciplinary focus in the scope of outpatient care in rehabilitation. Quantitative-qualitative study conducted at the Lucy Montoro Rehabilitation Center of the Marília Unit - SP, with an intentional sample, divided into 2 groups: construction of indicators and validation of indicators. To construct the indicators, 33 health professionals participated, including nurses, nutritionists, psychologists, occupational therapists, speech therapists, social workers, physical educators and physiotherapists. Three stages were constituted, the first being a planning workshop, in which the concept of indicator and the criteria for construction were presented. The second stage were the workshops with the therapists of each sector using the brainstorm technique, defining the main care practices employed in the rehabilitation center that correlated between the sectors for the elaboration of indicators, according to the model proposed by Donabedian. In the third stage, the indicators were submitted to expert judges for content validation through the Consensus Conference technique. The validation was performed by 5 jurors, and all 10 indicators elaborated were validated. It is believed that the use of this instrument collaborates with the evaluation and quality management of rehabilitation services.Keywords: Evaluation of the quality of health care. Health care. Rehabilitation centers. Patient care team

scholarly journals Kajian Tipologi Bangunan pada Pusat Rehabilitasi Mental Disorder

2020 ◽  
Vol 3 (2) ◽  
pp. 53-67
Author(s):  
Karlina Rahadatul Aisy ◽  
Anisa Anisa
Keyword(s):  
Mental Disorder ◽  
Stable Condition ◽  
Physical Aspect ◽  
Rehabilitation Center ◽  
Unstable Condition ◽  
The Public ◽  
Form And Function ◽  
Rehabilitation Centers ◽  
Building Typology ◽  
And Function

This study is aimed to describe typologies in building mental rehabilitation rehabilitation centers. Building typology is obtained through analysis based on form and function. Typological analysis is useful as input in the design of buildings, and rehabilitation center. The research method used is descriptive interpretative qualitative, to get the typology after identifying the activities, functions, and shapes of buildings. As a first step of the patient's activity and space are identified first. The conclusions obtained from the typology study of mental disorder rehabilitation center are the physical arrangement of the rehabilitation center mass: (1) multi-mass and scattered; (2) the zone is divided into several, namely the public in the outermost, semi-public for patient activities, and private for therapy and patient rest. From the physical aspect, it refers to the forms of simple facades, openings that are given a trellis or passive, as well as simple rooms and furniture that do not endangering the patient. In the unstable condition of the patient, an isolation room is controlled by the nurse. In a stable condition, patients can learn a variety of plans which are carried out inside or outside the room.

scholarly journals 1420. Descriptive Epidemiology of UTI Hospitalizations in the US, 2018

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S794-S794
Author(s):  
Marya Zilberberg ◽  
Brian Nathanson ◽  
Kate Sulham
Keyword(s):  
Antimicrobial Resistance ◽  
Hospital Admissions ◽  
Survey Methods ◽  
Cleveland Clinic ◽  
Care Facility ◽  
Research Support ◽  
Indwelling Catheter ◽  
Comorbidity Burden ◽  
The Us ◽  
Tract Infections

Abstract Background In parallel with an increase in antimicrobial resistance, urinary tract infections (UTI), one of the most common diagnoses among hospitalized patients in the US, have been on the rise. Though mostly emphasized as a hospital-acquired complication among patients with an indwelling catheter, quantification of the full contemporary burden of UTI-associated hospitalizations is limited. Methods We conducted a cross-sectional multicenter study within the National Inpatient Sample (NIS) database, a 20-percent stratified sample of discharges from US community hospitals, from 2018, to explore characteristics of patients discharged with a UTI diagnosis. We divided UTI into mutually exclusive categories of complicated (cUTI), uncomplicated (uUTI), and catheter-associated (CAUTI). We applied survey methods to develop national estimates. Results Among 2,837,385 discharges with a UTI code, 77.9% were uUTI, 17.6% cUTI, and 4.4% CAUTI. Compared to patients with uUTI (mean age 69.0 years), those with CAUTI and cUTI were older (70.1 and 69.7 years), but had same comorbidity burden (mean Charlson 4.3) as cUTI (4.3) and lower than CAUTI (4.6). Compared to other geographic regions, the Northeast had the lowest proportion of uUTI (74.6%) and highest of cUTI (20.8%) while the South had highest uUTI (80.2%) and lowest cUTI (15.7%). Over 60% of all UTI, regardless of type, were in large, and nearly ½ in urban teaching, institutions, and >80% came through the emergency department. Antimicrobial resistance codes were infrequent, but extended spectrum beta-lactamase organisms were more common in CAUTI (2.7%) and cUTI (2.1%) than in uUTI (1.6%). Among the 83.0% of discharges whose UTI was a secondary diagnosis, sepsis was the most common principal diagnosis, ranging from 17.7% in uUTI to 22.3% in cUTI. Although relatively low across the board, hospital mortality was lowest in cUTI (2.8%) and highest in uUTI (3.9%). Discharges to a chronic care facility were most common in CAUTI (46.7%) and least common in cUTI (33.3%). Conclusion There are nearly 3 million hospital admissions with a UTI, comprising fully 8% of all annual admissions in the US. Though most are considered uncomplicated, there are few differences in characteristics or outcomes across the categories. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant)

scholarly journals An Architectural Model on Employment Opportunities as Aftercare Program

2019 ◽  
Vol 8 (9S2) ◽  
pp. 538-541
Keyword(s):  
Drug Users ◽  
System Development ◽  
Drug Abusers ◽  
Drug Rehabilitation ◽  
Rehabilitation Center ◽  
Rehabilitation Centers ◽  
Job Opportunities ◽  
Architectural Model ◽  
Residential Rehabilitation ◽  
Selection Of

The aftercare program of a drug rehabilitation center is a continuing treatment receive by ex-drug abusers immediately after being discharged from a residential rehabilitation center. This program caters services that help in the development of skills of ex-drug abusers as they move out from the facility of the rehabilitation center for them earn for living. The rehabilitation centers offer opportunities for employment as they allow other agencies to offer job and training and seminar services for ex-drug abusers. In the implementation of the job opportunities as an aftercare program, the selection of ex-drug abuser who is ready to work, ready to be trained, and ready for a further referral is a crucial decision. To this end, an architectural model that can match ex-drug users profile and relevant jobs, training, and referrals were needed. The developed architecture will serve as their basis for a decision support system development

scholarly journals ARCHITECTURAL ENVIRONMENT OF REHABILITATION CENTERS FOR CHILDREN AND ADOLESCENTS

2019 ◽  
Vol 4 (4) ◽  
pp. 110-121
Author(s):  
Т. Колесникова ◽  
T. Kolesnikova ◽  
К. Багданова ◽  
K. Bagdanova ◽  
С. Ильвицкая ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Children With Disabilities ◽  
Pilot Project ◽  
Anthropogenic Factors ◽  
Rehabilitation Center ◽  
Disabled Children ◽  
Systematic Method ◽  
Number Of Children ◽  
Rehabilitation Centers

The urgency of the issue under study is due to dynamics of the number of children with disabilities in the country and in particular regions. For instance, the total number of disabled children in Russia receiving social pensions between the ages of 0 and 18 was more than 655 thousand, as of January 1, 2018. At the same time, an increase of this indicator is observed constantly. The need to develop scientifically based recommendations for the establishment of rehabilitation centers is due to the fact, that in most cases this assistance is provided in the adapted premises. It is not possible to carry out correctional work effectively. The article’s purpose is to identify factors in the formation of architectural environment of rehabilitation centers for children and adolescents with various disabilities. The systematic method of analyzing the objects in question is the leading approach to studying this problem. Identified factors are divided into external and internal. The external are natural, climatic and anthropogenic factors. Internal include functional and technological, medical and ergonomic, sanitary and hygienic, architectural and stylistic factors. All factors are interrelated. This is reflected in a pilot project of a rehabilitation center for children and adolescents in the Oryol Region. The materials of the article can be useful for architects when designing rehabilitation centers for children and adolescents with various disabilities.

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