scholarly journals Psychiatric Comorbidity, Length of Hospital Stays and Readmission Rates in Opiate Addicts Treated in Inpatient Service

2021 ◽  
Vol 11 (1) ◽  
pp. 24-31
Author(s):  
Bahadır Geniş ◽  
Behçet Coşar ◽  
Zehra Arıkan
Keyword(s):  
Psychiatric Comorbidity ◽  
Inpatient Service ◽  
Readmission Rates ◽  
Hospital Stays ◽  
Opiate Addicts

Health Reform and Technological Change: Shifting Hospitalization Patterns for Four Procedures in Manitoba

2000 ◽  
Vol 13 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Ruth-Ann Soodeen ◽  
Leslie L. Roos ◽  
Sandra Peterson
Keyword(s):  
Hernia Repair ◽  
Technological Change ◽  
Health Reform ◽  
New Technology ◽  
Reform Initiatives ◽  
Readmission Rates ◽  
Health Reforms ◽  
Technological Advances ◽  
Hospital Stays ◽  
The Impact

This study used Manitoba data from 1991 to 1996 to assess the effects of health reforms and technological advances on hospitalization patterns, patient mortality, and readmission rates. Cholecystectomy and hernia repair served as indicators of response to both new technology and health reforms, while appendectomy and hysterectomy helped gauge the impact of health reforms alone. Neither the introduction of new technology (i.e. laparoscopy) nor the health reform initiatives (i.e. shorter hospital stays) adversely affected surgical volumes, postsurgical mortality, or postsurgical readmissions.

Effect of Mental Disorders on Hospital Readmission for Medical/Surgical Patients

1988 ◽  
Vol 62 (2) ◽  
pp. 519-522 ◽  
Author(s):  
Ron L. Evans ◽  
Robert D. Hendricks ◽  
Kaye V. Lawrence
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Hospital Readmission ◽  
Psychiatric Comorbidity ◽  
Mental Health Problems ◽  
Surgical Patients ◽  
Index Hospitalization ◽  
Medical Problems ◽  
Readmission Rates ◽  
The Relationship

To estimate the relationship between mental health problems and use of medical resources, this study compared readmission rates of medical/surgical patients who had a comorbid psychiatric disorder with those who did not. Patients with mental disorders were no more likely to be readmitted for medical problems after their index hospitalization than patients without psychiatric comorbidity. Results may assist in determining whether to include psychiatric variables as risk factors that might predict poor outcome after medical care.

scholarly journals Methadone for Treatment of Pregnant Opiate Addicted Women: Is There a Safer Alternative? A Review of Literature

2008 ◽  
Author(s):  
Holly Tichelkamp ◽  
Thomas Parish
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Review Of Literature ◽  
Methadone Dose ◽  
Intrauterine Growth ◽  
Opiate Use ◽  
Hospital Stays ◽  
Opiate Addicts ◽  
Alternative Medications

Methadone is commonly used for the treatment of pregnant opiate-addicts. But, it can have severe effects on the neonate including Neonatal Abstinence Syndrome, increased length of stay in the neonatal intensive care unit, and intrauterine growth retardation. Neonatal Abstinence Syndrome includes neurological excitability, gastrointestinal dysfunction, and autonomic signs. Because of these adverse effects, studies have been conducted to determine what can help reduce the severe complications caused by methadone. Varied dosages of methadone and alternative medications, such as buprenorphine, slow-release morphine, and others have been studied. Most of the alternative medications, especially buprenorphine, are gaining popularity in Europe where there is a growing problem of opiate use during pregnancy. In the studies comparing methadone and buprenorphine, a slight decline in symptoms of Neonatal Abstinence Syndrome as well as shorter hospital stays for the neonates exposed to buprenorphine was noted. Studies of different dosages of methadone were conducted to determine the lowest methadone dose that is both effective for the mother and safe for the neonate. All of the studies have provided information that is helping in the search for the safest and most effective treatment for opiate addiction. What is known is that helping the mother overcome the addiction is very important. So far, the data collected are not strong enough to make a conclusion on the best choice for treatment. Further research is indicated for methadone itself and also for all its possible alternatives.

A Prospective Study of the Impact of Psychiatric Comorbidity on Length of Hospital Stays of Elderly Medical-Surgical Inpatients

1998 ◽  
Vol 39 (3) ◽  
pp. 273-280 ◽  
Author(s):  
George Fulop ◽  
James J. Strain ◽  
Marianne C. Fahs ◽  
James Schmeidler ◽  
Stephen Snyder
Keyword(s):  
Prospective Study ◽  
Psychiatric Comorbidity ◽  
Hospital Stays ◽  
A Prospective Study ◽  
The Impact

Depression readmission risk is elevated in multiple sclerosis compared to other chronic illnesses

2021 ◽  
pp. 135245852110513
Author(s):  
Emily M Schorr ◽  
Daniel Kurz ◽  
Kyle C Rossi ◽  
Margaret Zhang ◽  
Anusha K Yeshokumar ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Psychiatric Comorbidity ◽  
International Classification Of Diseases ◽  
Chronic Illnesses ◽  
Psychiatric Disease ◽  
Readmission Rates ◽  
Hazard Ratios ◽  
Asthma Patients ◽  
Classification Of Diseases ◽  
Readmission Risk

Objective: Assess readmissions for depression or suicide attempt (SA) after MS admission versus other chronic inflammatory illnesses. Methods: This retrospective cohort study identified MS, asthma, rheumatoid arthritis (RA), depression, and SA in the 2013 National Readmissions Database by International Classification of Diseases codes. Index admissions (MS, n = 7698; asthma, n = 93,590; RA, n = 3685) and depression or SA readmission rates were analyzed. Hazard ratios (HRs) estimated 1-year depression/SA readmission hazard, comparing MS to asthma or RA, adjusting for age, sex, psychiatric comorbidity, substance abuse, tobacco use, income, and index hospitalization characteristics. Results: MS had more baseline depression (24.7%) versus asthma (15.6%) and RA (14.6%). Ninety-day depression readmission rate was higher in MS (0.5%) than asthma (0.3%) and RA (0.03%). Depression readmission HR was higher after MS admission versus asthma (HR = 1.37, 95% confidence interval (CI) = 1.00–1.86, p = 0.0485) and RA (HR = 4.68, 95% CI = 1.60–13.62, p = 0.0047). HR was not different for SA readmission across groups. Depression readmission HR was more than double in MS patients with psychiatric disease or substance abuse versus RA or asthma patients with either comorbidity. Conclusion: Depression readmission risk after MS hospitalization was elevated versus asthma/RA. Substance use and baseline psychiatric comorbidity were more strongly associated with depression readmission in MS patients.

Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy

2020 ◽  
Vol 86 (6) ◽  
pp. 643-651
Author(s):  
Maria Baimas-George ◽  
Russell C. Kirks ◽  
Allyson Cochran ◽  
Erin H. Baker ◽  
B. Lauren Paton ◽  
...  
Keyword(s):  
Cost Of Care ◽  
Acute Care Surgery ◽  
Readmission Rates ◽  
Exclusion Criteria ◽  
Common Procedure ◽  
Lengths Of Stay ◽  
Hospital Stays ◽  
Care Surgery ◽  
Procedure Codes ◽  
Complicated Patient

Background Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery. Study design Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors. Results One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created. Conclusion Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.

Acute psychiatric services: an appraisal of a major change in service delivery within one catchment area

1998 ◽  
Vol 15 (3) ◽  
pp. 84-87
Author(s):  
Miriam O'Doherty
Keyword(s):  
Psychiatric Inpatient ◽  
Major Change ◽  
Inpatient Service ◽  
Day Hospital ◽  
Readmission Rates ◽  
Duration Of Stay ◽  
The Mean ◽  
Diagnostic Profile ◽  
Mental Treatment ◽  
Major Reduction

AbstractObjectives: To investigate effects on one psychiatric inpatient service of a 40% reduction in the number of acute beds and the establishment of an acute day hospital.Method: A retrospective review of all public admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of attendance at the acute day hospital during the second study period.Results: The number of admissions actually increased by 3% from 169-174; the mean duration of stay fell from 27-17 days; and the number of brief admissions of three days duration or less almost tripled from 15-43. Although fewer patients suffering from schizophrenia were admitted in the second study period than in the first, their mean duration of stay and the frequency of re-admission within 28 days of discharge changed little, while patients with diagnoses of mild/moderate depression and substance misuse experienced significantly shorter admissions and higher readmission rates. The use of temporary orders under the Mental Treatment Act (1945) doubled, and the readmission rates within 28 days increased by over 60%.The acute day hospital treated 98 patients who had a diagnostic profile similar to that of the inpatients; 53% of them required admission before and/or after attendance at the day hospital.Conclusions: The major reduction in the number of acute inpatient beds and the opening of an acute day hospital resulted in greater concentration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in admissions and may have a complex aetiology and merits further investigation.

scholarly journals Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service

2017 ◽  
Vol 13 (9) ◽  
pp. e738-e748 ◽  
Author(s):  
Richard F. Riedel ◽  
Kim Slusser ◽  
Steve Power ◽  
Christopher A. Jones ◽  
Thomas W. LeBlanc ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Health System ◽  
Solid Tumor ◽  
Medical Oncology ◽  
Inpatient Service ◽  
Readmission Rates ◽  
Fully Integrated

Purpose: Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation. Methods: We conducted a retrospective, longitudinal, pre- and postintervention cohort study at Duke University Hospital. Pre- and postintervention cohorts were defined as all patients admitted to the solid tumor inpatient service from September 1, 2009, to June 30, 2010, and September 1, 2011 to June 30, 2012, respectively. We extracted patient data, including demographics, cancer diagnosis, disease status, length of stay, intensive care unit transfer rate, discharge disposition, time to emergency department return, time to readmission, and 7- and 30-day emergency department return and readmission rates. Nursing and physician surveys assessed satisfaction. Descriptive statistics, and Kruskal-Wallis and Χ2 tests were used to describe and compare cohorts. A generalized estimating equation accounted for repeated measures. Results: Pre- and postintervention analysis cohorts included 731 and 783 patients, respectively, representing a total of 1,514 patients and 2,353 encounters. Cohorts were similar in baseline characteristics. Statistically significant lower odds in 7-day readmission rates were observed in the postintervention cohort (adjusted odds ratio, 0.76; 95% CI, 0.58 to 1.00; P = .0482). Patients in the postintervention group had a decrease in mean length of stay (−0.30 days; 95% CI, −0.62 to 0.02); P = .0651). We observed a trend for increasing hospice referrals ( P = .0837) and a 15% decrease in intensive care unit transfers ( P = .61). Physicians and nurses universally favored the model. Conclusion: A fully integrated inpatient partnership between PC and medical oncology is associated with significant and clinically meaningful improvements in key health system–related outcomes and indicators of quality cancer care.

scholarly journals SAT-156 Shorter Hospital Stays Are Not Associated with Increased Readmission or Complication Rates in Patients Undergoing Laparoscopic Adrenalectomies

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rahul K Sharma ◽  
Bernice Huang ◽  
James A Lee ◽  
Jennifer H Kuo
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Laparoscopic Adrenalectomy ◽  
Regression Models ◽  
Complication Rates ◽  
Readmission Rates ◽  
Same Day Discharge ◽  
Postoperative Diagnosis ◽  
Hospital Stays ◽  
Male Sex

Abstract Background : Traditionally, elective adrenalectomies have been performed as an inpatient procedure. However, the adoption of laparoscopic adrenalectomy as the gold standard has allowed for shorter postoperative stays. Our objective was to assess the safety of same-day discharge for patients undergoing laparoscopic adrenalectomy. Methods : A retrospective cohort study of patients who underwent laparoscopic adrenalectomy from 2011-2017 was conducted using The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. Demographic data was obtained. Multivariable logistic regression models to assess the association between length of stay and both postoperative complication rates and 30-day readmission rates were regressed on age, sex, race, comorbidities, functional status, postoperative diagnosis, and operative time. Statistical significance was defined as p&lt;.05. Results : 5,611 unique patients who underwent a laparoscopic adrenalectomy were identified. 1,564 patients had a postoperative diagnosis of a pheochromocytoma (27.9%), 162 with Cushing’s syndrome (2.9%) and 210 (3.7%) had metastatic disease to the adrenal glands. The average postoperative length of stay was 2.4 days (SD=3.9). 93 patients (1.7%) were discharged on the same day as their surgery (POD0). 2,509 (44.7%) were discharged on postoperative day 1 (POD1), 1,558 (27.8%) on postoperative day 2 (POD2), and 1,451 (25.9%) after POD2. Longer hospital stays were predicted by male sex, non-white race, longer operating time, and postoperative complications in regression models. 351 patients (6.26%) experienced a complication postoperatively. Complication rates were 3.23% for patients discharged on POD0, 1.67% for those discharged on POD1, 3.27% for those discharged on POD2, and 17.57% for those discharged after POD2 (p&lt;.01). An increased risk of postoperative complications was also associated with male sex, impaired functional status and the presence of multiple comorbidities in regression models. 290 patients (5.17%) experienced a readmission. Readmission rates were 4.30% for patients discharged on POD0, 3.67% for those discharged on POD1, 4.49% for those discharged on POD2, and 8.55% for those discharged after POD2 (p&lt;.01). Multiple comorbidities, African American race, and post-operative complications were associated with higher readmission rates. Length of hospital stay was not associated with readmission rates in regression models. Conclusions : Readmission rates were not significantly different for patients discharged on POD0 than POD1 after a laparoscopic adrenalectomy. Readmission rates were higher for patients who had complications or multiple comorbidities. Therefore, low-risk patients with uncomplicated laparoscopic adrenalectomies can be considered for same day discharge to potentially reduce hospital spending and resource utilization.

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