The Impact of COVID-19 on Hospital Admissions in Croatia

Background: The COVID-19 pandemic disrupted hospital care, as hospitals had to deal with a highly infectious virus, while at the same time continuing to fulfill the ongoing health service needs of their communities. This study examines the direct effects of COVID-19 on the delivery of inpatient care in Croatia.Materials and Methods: The research is a retrospective, comparative analysis of the hospital admission rate across all Diagnosis Related Group (DRG) classes before and during the pandemic. It is based on DRG data from all non-specialized acute hospitals in Croatia, which account for 96% of national inpatient activity. The study also used COVID-19 data from the Croatian Institute of Public Health (CIPH).Results: The results show a 21% decrease in the total number of admissions [incident rate ratio (IRR) 0.8, p < 0.0001] across the hospital network during the pandemic in 2020, with the greatest drop occurring in April, when admissions plunged by 51%. The decrease in activity occurred in non-elective DRG classes such as cancers, stroke, major chest procedures, heart failure, and renal failure. Coinciding with this reduction however, there was a 37% increase (IRR 1.39, p < 0.0001) in case activity across six COVID-19 related DRG classes.Conclusions: The reduction in hospital inpatient activity during 2020, can be attributed to a number of factors such as lock-downs and quarantining, reorganization of hospital operations, the rationing of the medical workforce, and the reluctance of people to seek hospital care. Further research is needed to examine the consequences of disruption to hospital care in Croatia. Our recommendation is to invest multidisciplinary effort in reviewing response procedures to emergencies such as COVID-19 with the aim of minimizing their impact on other, and equally important community health care needs.

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The impact of the environment on patient experiences of hospital admissions in palliative care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2015-000891 ◽

2015 ◽

Vol 8 (4) ◽

pp. 485-492 ◽

Cited By ~ 6

Author(s):

Jackie Robinson ◽

Merryn Gott ◽

Clare Gardiner ◽

Christine Ingleton

Keyword(s):

Palliative Care ◽

Health Professionals ◽

Hospital Admissions ◽

Hospital Setting ◽

Prognostic Indicators ◽

Care Needs ◽

Acute Hospitals ◽

Almost All ◽

The Impact ◽

Palliative Care Needs

ObjectiveTo explore the impact of environment on experiences of hospitalisation from the perspective of patient's with palliative care needs.MethodsA qualitative study design using longitudinal semistructured, face-to-face interviews were used to elicit the views of patients with palliative care needs admitted to hospital in 1 large urban acute hospital in New Zealand. The sample comprised of 14 patients admitted to hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need.ResultsAlmost all participants described a range of factors associated with the environment which impacted negatively on their experiences of hospitalisation. This included challenges with the physical surroundings, the impact on social relationships with other patients, families and health professionals and the influence of the cultural milieu of the hospital setting.ConclusionsEmulating the ‘ideal’ environment for palliative care such as that provided in a hospice setting is an unrealistic goal for acute hospitals. Paying attention to the things that can be changed, such as enabling family to stay and improving the flexibility of the physical environment while improving the social interplay between patients and health professionals, may be a more realistic approach than replicating the hospice environment in order to reduce the burden of hospitalisations for patients with palliative care needs.

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Management of bio-psycho-social frailty to reduce hospital use and improve survival of older adults

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.605 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

G Liotta ◽

N Accarino ◽

S Orlando ◽

S Gentili ◽

E Terracciano ◽

...

Keyword(s):

Public Health ◽

Older Adults ◽

Health Outcomes ◽

Social Isolation ◽

Hospital Care ◽

Admission Rate ◽

Term Care ◽

Hospital Admission Rate ◽

Starting Point ◽

The Impact

Abstract Background Ageing of population is associated to the increase of care demand. Many health systems are still centered on hospital care, that sometime is not appropriate. The shift from hospital to community care requires a new model of service delivery. Aim of this paper is to assess the impact of a community service based on the assessment of frailty, on mortality and use of hospital care by older adults. Methods A cohort made up by 8,592 over-75 subjects (67.1% female, mean age 84.5; SD ± 5.29) has been assessed once a year for bio-psycho-social frailty by the administration of the Short Functional Geriatric Evaluation questionnaire. The enrolled subjects were involved in a Community-based pro-Active Monitoring Program which provides interventions aimed at reducing social isolation. Mortality, use of hospital care and use of residential long-term care have been recorded during the follow up and separate and cumulative incidence rate was measured. Results The sample was stratified in Robust (37.5%), Pre-frail (24.0%), Frail, (29.5%) and Very Frail (9.1%) individuals. Mortality, Hospital admission rate and Residential LTC admission rate were higher in the very frails than among the other groups. However, according to social isolation, the integrated subjects at the baseline assessment, showed the highest incidence of negative events: 29.5%, 20.8%, 21.0%, .and 20.8% for integrated, mild isolated, moderate isolated and severely isolated individuals respectively (p < 0.001). The logistic regression analysis, adjusted for age, gender and level of frailty, confirmed the protective role of reducing social isolation among isolated individuals compared with integrated ones (OR: 0.729; CL95% 0.673-0.720). Conclusions The assessment of bio-psycho-social frailty could be the starting point for effective intervention at community level, like the program mentioned above. Management of frailty may lead to an improvement of public health outcomes. Key messages Intervention dealing with social isolation are able to revert the increase of mortality related to the lack of social resources. Management of frailty may lead to an improvement of public health outcomes.

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Invasive Devices and Sensors for Remote Care of Heart Failure Patients

Sensors ◽

10.3390/s21062014 ◽

2021 ◽

Vol 21 (6) ◽

pp. 2014

Author(s):

Sumant P. Radhoe ◽

Jesse F. Veenis ◽

Jasper J. Brugts

Keyword(s):

Heart Failure ◽

Remote Monitoring ◽

Hospital Admissions ◽

Acute Decompensated Heart Failure ◽

Admission Rate ◽

Decompensated Heart Failure ◽

Hospital Admission Rate ◽

Remote Care ◽

New Sensors ◽

Near Future

The large and growing burden of chronic heart failure (CHF) on healthcare systems and economies is mainly caused by a high hospital admission rate for acute decompensated heart failure (HF). Several remote monitoring techniques have been developed for early detection of worsening disease, potentially limiting the number of hospitalizations. Over the last years, the scope has been shifting towards the relatively novel invasive sensors capable of measuring intracardiac filling pressures, because it is believed that hemodynamic congestion precedes clinical congestion. Monitoring intracardiac pressures may therefore enable clinicians to intervene and avert hospitalizations in a pre-symptomatic phase. Several techniques have been discussed in this review, and thus far, remote monitoring of pulmonary artery pressures (PAP) by the CardioMEMS (CardioMicroelectromechanical system) HF System is the only technique with proven safety as well as efficacy with regard to the prevention of HF-related hospital admissions. Efforts are currently aimed to further develop existing techniques and new sensors capable of measuring left atrial pressures (LAP). With the growing body of evidence and need for remote care, it is expected that remote monitoring by invasive sensors will play a larger role in HF care in the near future.

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Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

International Cardiovascular Forum Journal ◽

10.17987/icfj.v1i4.50 ◽

2015 ◽

Vol 1 (4) ◽

pp. 184 ◽

Cited By ~ 2

Author(s):

Caroline Magri ◽

Robert Xuereb ◽

Sandra Distefano ◽

Neville Calleja ◽

Victor Grech

Keyword(s):

Hospital Admissions ◽

Public Awareness ◽

Age Groups ◽

Admission Rate ◽

Coronary Heart Disease Mortality ◽

Smoking Ban ◽

Annual Data ◽

Public Areas ◽

Coronary Syndromes ◽

The Impact

Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on ACS morbidity and mortality. Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed. The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular death. Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was noted. Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the adverse effects of smoking. Key words: Coronary heart disease; Mortality; Prevention; Smoking.

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Hospitalization rates among patients with cystic fibrosis using pancreatic enzyme replacement therapy

Chronic Respiratory Disease ◽

10.1177/1479973119900612 ◽

2020 ◽

Vol 17 ◽

pp. 147997311990061 ◽

Cited By ~ 1

Author(s):

Bruce C. Trapnell ◽

Su Chen ◽

Rupal Khurmi ◽

Amit Bodhani ◽

Mudra Kapoor ◽

...

Keyword(s):

Cystic Fibrosis ◽

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Hospital Admissions ◽

Pancreatic Enzyme ◽

Admission Rate ◽

Hospital Admission Rate ◽

Enzyme Replacement ◽

Pancreatic Enzyme Replacement Therapy ◽

Annual Total

We investigated the relationship between self-reported adherence to pancreatic enzyme replacement therapy (PERT), nutritional status, and all-cause hospitalization in cystic fibrosis (CF) patients with a record of PERT use. Association of self-reported annual PERT use rate (adherence) with annual hospital admission rate (HAR) and annual total hospital nights (THNs) were analyzed for 5301 children (2000–2012) and 13,989 adults (2000–2013) from the CF Foundation Patient Registry. Multivariate linear regression was used to determine the association of HAR and THN with mean annual PERT use rate, cumulative PERT use rate, mean body mass index (BMI) (adult) or BMI percentile (pediatric), age, and sex. The median annual PERT use rate was 87% in children and 80% in adults. Statistically, higher annual PERT use, longer cumulative PERT, and higher BMI percentile (children) or BMI (adults) were significantly ( p < 0.0001) associated with lower annual HAR and fewer annual THN in children and adults. Female sex was associated with higher annual HAR and more annual THN in children and adults ( p < 0.05). Results indicate self-reported adherence to PERT, increased BMI, and male sex were associated with fewer hospital admissions and annual hospital nights in CF patients.

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The Effect of the COVID Pandemic Lockdown Measures on Surgical Emergencies: Experience and Lessons Learned from A Greek Tertiary Hospital.

10.21203/rs.3.rs-165222/v1 ◽

2021 ◽

Author(s):

Emmanouil Pikoulis ◽

Nikolaos Koliakos ◽

Dimitrios Papaconstantinou ◽

Nikolaos Pararas ◽

Andreas Pikoulis ◽

...

Keyword(s):

Brain Injuries ◽

Hospital Admissions ◽

Motor Vehicle ◽

Admission Rate ◽

Lessons Learned ◽

University Hospital ◽

Long Term Effects ◽

Hospital Admission Rate ◽

Surgical Department ◽

Number Of Patients

Abstract Background: The COVID-19 pandemic caused a rise in healthcare demands and has necessitated a significant restructuring of hospital Emergency Departments.The present study aims to determine the pandemic lockdown's impact on the number of patients seeking assessment in the Surgical Emergency Department (SED) with General Surgery emergencies. Methods: Since the start of the Covid pandemic in Greece (1 March, 2020) and up to 15 December 2020, the charts of all patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A; 1/3/2020 to 30/4/2020 and period D; 16/10/2020 to 15/12/2020) and two interim (period B; 1/5/2020 to 15/6/2020 and period C; 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019.Results:The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2020 to 1819 in 2019). During the first lockdown, there was a statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). A rise in the rate of traumatic brain injuries (p<0.001), abdominal pain (p=0.04) and hospital admissions (p=0.002) was also evident. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02).Conclusion: The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, implemented lockdown measures significantly impacted the SED attendance rates, the clinical characteristics of the attending patients and the overall hospital admission rate. The long-term effects on national health systems remain to be seen.

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Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr01110 ◽

2013 ◽

Vol 1 (11) ◽

pp. 1-138 ◽

Cited By ~ 13

Author(s):

M Gott ◽

C Ingleton ◽

C Gardiner ◽

N Richards ◽

M Cobb ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Care Transitions ◽

Case Note ◽

Hospital Inpatient ◽

Care Needs ◽

Retrospective Case ◽

Acute Hospitals ◽

Palliative Care Needs ◽

Case Note Review

BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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34 Geriatricians in Intermediate Care Settings: A Modern Approach to Geriatric Medicine

Age and Ageing ◽

10.1093/ageing/afz184.01 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i9-i10

Author(s):

P Enwere ◽

R Mahmood ◽

A Aranda-Martinez ◽

A Manzoor ◽

E Wilkinson ◽

...

Keyword(s):

Hospital Admissions ◽

Care Delivery ◽

Geriatric Medicine ◽

Care Needs ◽

Older Population ◽

Modern Approach ◽

North West ◽

Complex Needs ◽

Acute Hospitals ◽

Hub Model

Abstract Introduction Due to growing older population with increasing medical complexity and care needs, over-reliance on acute hospitals for care delivery, disconnect between social and medicalised care and challenging national health services (NHS) financial climate, it is essential to provide much of this care to our older patients outside the acute hospital before they reach crisis point. This prevents unnecessary hospital admissions and outpatient referrals especially to our geriatric services. Therefore, newer and innovative care models are required to cater the needs of our aging population especially within the community settings. The North West Surrey clinical commissioning group (CCG) catchment area is divided into three localities, namely SASSE Locality in Spelthorne, Thames Medical Locality in Runnymede/West Elmbridge, and the Woking Locality (Bedser hub) in Woking. Locality hub model of integrated care led by GP with multidisciplinary (MDT) input along with wellbeing coordinators was introduced to address above issue. Objectives Our mission was to find a way to manage the challenges we face from a growing older population within an integrated GP-led community service and in a manner that promotes independence, reduce social isolation, improve patient experience and safely deliver appropriate acute care in the community whilst reducing dependency on regional acute hospitals. A fully qualified geriatrician input was introduced within the hub model at Bedser hub. Results Total savings: £16,484, Geriatricians input cost: £16,500 Cost neutral intervention Conclusions Newer models of collaborative healthcare within the community dwellings with GP and geriatrician input along with multidisciplinary approach are essential to deliver safe and high quality care to our older population, thus reducing reliance on our ever so stretched local acute NHS hospitals. Our intervention has resulted in reduction of referrals to geriatric outpatient clinic and enabled us to provide the required care to our older population closer to home. It has also led GPs to build their skills in managing the very frail patients with complex needs safely and effectively. In the long run, the intervention will be cost effective with further projected reduction in referrals.

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Previous Comorbidity and Lack of Patient Free Choice of Technique Predict Early Mortality in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080902900208 ◽

2009 ◽

Vol 29 (2) ◽

pp. 150-157 ◽

Cited By ~ 20

Author(s):

José Portolés ◽

Gloria del Peso ◽

M. José Fernández-Reyes ◽

M. Auxiliadora Bajo ◽

Paula López-Sánchez

Keyword(s):

Peritoneal Dialysis ◽

Prognostic Factors ◽

Hospital Admission ◽

Hospital Admissions ◽

Risk Estimation ◽

Admission Rate ◽

Individual Characteristics ◽

Hospital Admission Rate ◽

Predialysis Patient ◽

Choice Of Technique

Objective To study the prognostic factors for mortality and hospital admission for patients on peritoneal dialysis (PD). Method Biannual data on individual characteristics, clinical and analytical progress, treatment, and events were studied for a cohort of incident patients undergoing PD (2003-2006) in a reference area of 8.8 million people. Results 489 patients (age 53.58 years, 61.6% male) with 3-year follow-up were included. They presented at inclusion with Charlson Comorbidity Index (CCI) of 5.25; previous cardiovascular (CV) event, 23.7%; diabetes mellitus (DM), 19.1%; and hypertension (HT), 89.9%. Annual hospitalization rate per patient-year at risk was 0.6. The variables that predicted admission were CCI [odds ratio (OR) 1.14 per point], DM (OR 1.66), and previous CV event (OR 1.90). Anemia maintained significance when corrected for CCI: hemoglobin, 0.79 per 1 g/dL Hb; CCI, 1.15 per point. Annual mortality rate was 5.4%. Those that died were older (67.47 vs 52.78 years) and had a higher CCI (8.35 vs 5.0), a lower initial Hb (11.5 vs 12.2 g/dL), a higher hospital admission rate, a higher annual rate of peritonitis, more previous CV events (50.0% vs 22.1%), and higher prevalence of DM (38.5% vs 17.9%). Survival analysis identified the following prognostic factors: CCI [hazard ratio (HR) 1.51 per point], CV event (HR 2.85), DM (HR 2.52), age (HR 1.06 per year), and mandatory referral to PD (HR 6.54). The effect of CV events and DM persisted after correction for age, and that of choice of technique after correcting for CCI and/or age. Conclusions The CCI is useful for risk estimation in PD patients. Previous CV event, DM, and age are the most relevant risk factors. Control of anemia has prognostic value for hospital admissions. Mandatory referral to PD is associated with higher mortality. The prognosis in PD depends on predialysis patient management.

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Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service

BMJ Open ◽

10.1136/bmjopen-2018-026927 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026927 ◽

Cited By ~ 2

Author(s):

Anne-Marie Burn ◽

Frances Bunn ◽

Jane Fleming ◽

David Turner ◽

Chris Fox ◽

...

Keyword(s):

Service Use ◽

Hospital Admissions ◽

Case Finding ◽

Dementia Case ◽

Quality Of Life Scale ◽

Acute Hospitals ◽

Discharge From Hospital ◽

Unplanned Admissions ◽

The Impact

ObjectiveBetween 2012 and 2017 dementia case finding was routinely carried out on people aged 75 years and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services. This study explored the impact of dementia case finding on older people and their families and on their use of services.DesignThematic content analysis was conducted on qualitative interview data and costs associated with service use were estimated. Measures included the Mini-Mental State Examination, the EuroQol quality of life scale and a modified Client Service Receipt Inventory.SettingFour counties in the East of England.ParticipantsPeople aged ≥75 years who had been identified by case finding during an unplanned hospital admission as warranting further investigation of possible dementia and their family carers.ResultsWe carried out 28 interviews, including 19 joint patient-carer(s), 5 patient only and 4 family carer interviews. Most patients and carers were unaware that memory assessments had taken place, with many families not being informed or involved in the process. Participants had a variety of views on memory testing in hospital and had concerns about how hospitals carried out assessments and communicated results. Overall, case finding did not lead to general practitioner (GP) follow-up after discharge home or lead to referral for further investigation. Few services were initiated because of dementia case finding in hospital.ConclusionsThis study shows that dementia case finding may not lead to increased GP follow-up or service provision for patients after discharge from hospital. There is a need for a more evidence-based approach to the initiation of mandatory initiatives such as case finding that inevitably consume stretched human and financial resources.

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