Patient-Related Factors Associated With Hospital Discharge to a Care Facility After Critical Illness

Patients recovering from critical illness are often suffering from remarkable limitations in their everyday life. The purpose of this study was to find factors associated with poor physical functioning and mental health after critical illness. The study was conducted among patients who met the inclusion criteria of our post–intensive care unit follow-up clinic. The patients were invited to the follow-up clinic three months after hospital discharge. The participants filled out a RAND-36 questionnaire, underwent a clinical examination and were stratified to those with good or poor recovery according to physical functioning and emotional wellbeing. Altogether 332 out of 351 follow-up clinic attendees had data available for analysis. In physical functioning 40% of patients achieved a poor outcome. In mental health the percentage was 8%. The patients with poor physical functioning had a longer hospital stay and were more likely to have received vasopressors. Eleven out of 16 (69%) multitrauma patients had poor physical functioning. Patients with poor physical functioning had more memories of pain, achieved worse results in a six-minute walk test and were less likely to be able to move independently. The patients with poor mental health had higher delirium incidence and fewer memories of relatives’ visits and of nurses. The conclusions of this study were that the memories of pain, multitrauma and longer hospital stay were associated with a poor physical functioning outcome. Delirium and a lack of memories of relatives and nurses were associated with a poor mental health outcome.

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Few modifiable factors predict readmission following radical cystectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.2793 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 439 ◽

Cited By ~ 14

Author(s):

Brian J Minnillo ◽

Matthew J. Maurice ◽

Nicholas Schiltz ◽

Aiswarya C. Pillai ◽

Siran M. Koroukian ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Care Facility ◽

Hospital Performance ◽

Home Healthcare ◽

Related Factors ◽

Factors Associated ◽

Discharge Disposition ◽

Modifiable Factors ◽

High Readmission Rate

Introduction: We sought to determine the patient and providerrelated factors associated with readmission after radical cystectomy (RC) for bladder cancer. In this era of healthcare reform, hospital performance measures, such as readmission, are beginning to affect provider reimbursement. Given its high readmission rate, RC could be a target for quality improvement.Methods: We reviewed bladder cancer patients who underwent RC in California’s State Inpatient Database (2005–2009) of the Healthcare Cost and Utilization Project. We examined patient- (e.g., race, discharge disposition) and provider-related factors (e.g., volume) and evaluated their association with 30-day readmission. Multivariable logistic regression was used to examine associations of interest.Results: Overall, 22.8% (n = 833) of the 3649 patients who underwent RC were readmitted within 30 days. Regarding disposition, 34.8%, 50.8%, and 12.2% were discharged home, home with home healthcare, and to a post-acute care facility (PACF), respectively. Within 30 days, 20.3%, 20.9%, and 42.3% discharged home, home with home healthcare, and to a PACF were readmitted, respectively. African Americans (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.07–2.50), having ≥2 comorbidities (OR 1.42, 95% CI 1.06–1.91), receiving a neobladder (OR 1.45, 95% CI 1.09–1.93), and discharge to a PACF (OR 3.79, 95% CI 2.88–4.98) were independent factors associated with readmission. Hospital stays ≥15 days were associated with less readmission (OR 0.43, 95% CI 0.27–0.67, p = 0.0002). Procedure volume was not associated with complication, in-hospital mortality, or readmission.Conclusions: About one-fifth of patients undergoing RC are readmitted. Patients who are discharged to a PACF, African American, and who have more extensive comorbidities tend to experience more readmissions. Increased efforts with care coordination among these patients may help reduce readmissions.

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Time to Attrition and Factors Associated among Adults enrolled in Pre-Anti- Retroviral Therapy Care in Tepi General Hospital, Ethiopia

International Journal of Health and Medicine ◽

10.24178/ijhm.2018.3.2.06 ◽

2018 ◽

Vol 3 (2) ◽

pp. 6 ◽

Cited By ~ 1

Author(s):

Tamrat Shaweno Adewo ◽

Henok Asefa ◽

Hailay Abrha Gesesew

Keyword(s):

General Hospital ◽

Care Facility ◽

Health Care Facility ◽

Attrition Rate ◽

Rank Test ◽

Related Factors ◽

Factors Associated ◽

Cotrimoxazole Prophylaxis ◽

Patient Attrition

Pre-antiretroviral therapy (Pre-ART) patient attrition is a growing concern in Ethiopia. Nevertheless, there is little information that assesses the magnitude and its related factors. This study assessed time to attrition and factors associated among adults enrolled in pre ART care at Tepi General Hospital in South West Ethiopia. Records of adult pre-ART patients enrolled at Tepi General Hospital from October 2010 to September 2013 were reviewed to find factors linked with time to attrition. We defined time to attrition as the period a patient was enrolled in pre-ART service till attrition. We Used Kaplan Meir curve to estimate survival time, and log-rank test to compare the time to attrition among different categories of patients. We used Cox hazard model to assess factors related with time to attrition. We followed 652 pre-ART patients for 337.6 person years of follow-up from start up to pre-ART outcomes. Of these, 179 patients were lost to follow up and 37 patients died, contributing to an overall attrition of 33.13%. During the early six months the attrition rate was 89.8%. Not starting cotrimoxazole prophylaxis (AHR=1.51, 95% CI, 1.02-2.25), being co-infected with tuberculosis (TB) (AHR=2.16, 95%CI, 1.35-3.45), living further than 10 km away from the hospital (AHR=1.44, 95%CI, 1.07-2.0), and not disclosed status of HIV(AHR=3.04) were factors significantly associated with time to attrition. Pre-ART patient attrition rate was high among clients not using cotrimoxazole prophylaxis, TB/HIV co-infected, living > 10 km from a health care facility and with undisclosed HIV status. Close follow-up of clients during the early months' follow-up period is greatly recommended.

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Demographic, psychosocial, and health- and disability-related factors associated with psychological distress among people with physical disabilities.

Rehabilitation Psychology ◽

10.1037/rep0000206 ◽

2018 ◽

Vol 63 (3) ◽

pp. 392-399 ◽

Cited By ~ 1

Author(s):

Maya Kagan ◽

Michal Itzick ◽

Patricia Tal-Katz

Keyword(s):

Psychological Distress ◽

Physical Disabilities ◽

Related Factors ◽

Factors Associated ◽

People With Physical Disabilities

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Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19644 ◽

2020 ◽

Vol 32 (4) ◽

pp. 523-532 ◽

Cited By ~ 1

Author(s):

Praveen V. Mummaneni ◽

Mohamad Bydon ◽

John Knightly ◽

Mohammed Ali Alvi ◽

Anshit Goyal ◽

...

Keyword(s):

Body Mass Index ◽

Acute Care ◽

Body Mass ◽

Care Facility ◽

Older Age ◽

Quality Outcomes ◽

Acute Care Facility ◽

Factors Associated ◽

Patient Reported ◽

The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

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Faculty Opinions recommendation of Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717950653.793455955 ◽

2012 ◽

Author(s):

Ariana Smith

Keyword(s):

Urinary Continence ◽

Burch Colposuspension ◽

Related Factors ◽

Factors Associated ◽

Fascial Sling

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Management of Recurrent or Progressing Skull Base Chondrosarcomas: Predictors of Long-Term Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701523 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jonathan D. Breshears ◽

Franco DeMonte ◽

Ahmed Habib ◽

Paul W. Gidley ◽

Shaan M. Raza

Keyword(s):

Natural History ◽

Skull Base ◽

Radiation Treatment ◽

Systemic Disease ◽

Primary Treatment ◽

Salvage Treatment ◽

Low Grade ◽

Related Factors ◽

Factors Associated ◽

Initial Recurrence

Abstract Background Skull base chondrosarcomas (CSA) are difficult tumors to cure and there is little data regarding salvage therapy. Objective This study aims to identify presentation and treatment-related factors which impact the progression free survival (PFS) and disease specific survival (DSS) for recurrent CSA, and to identify salvage treatment factors associated with successful restoration to the natural history following primary treatment. Methods This single-institution retrospective review included patients with recurrent/progressive CSA over a 25-year period. Survival analysis for factors impacting PFS and DSS was performed. Salvage treatment factors associated with achieving PFS ≥newly diagnosed median PFS were identified using univariate statistics. Analysis was performed on first recurrences and all recurrences combined. Results A total of 47 recurrence/progression events were analyzed from 17 patients (median two events/patient, range = 1–8). The overall PFS and DSS for the initial recurrence was 32 (range = 3–267) and 79 (range = 3–285) months, respectively. Conventional grade III or mesenchymal histology significantly predicted shorter PFS and DSS (p < 0.0001). After stratification by histology, previous radiation predicted shorter PFS for low-grade tumors (p = 0.009). Gross total resection (GTR) after a first time recurrence was significantly associated with successful salvage treatment (p < 0.05); however, this was rare. Conclusion In this series, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes, while GTR was associated with restoration to natural history following primary treatment. Careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can optimize the outcomes of salvage intervention.

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