Factors associated with emergency department presentation after total joint arthroplasty: a population-based retrospective cohort study

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

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Impact of family physician integrated care program on decreasing utilization of emergency department visit and hospital admission: a population-based retrospective cohort study

BMC Health Services Research ◽

10.1186/s12913-020-05347-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Po-Tsung Huang ◽

Pei-Tseng Kung ◽

Wen-Yin Kuo ◽

Wen-Chen Tsai

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Hospital Admission ◽

Integrated Care ◽

Emergency Department Visit ◽

Family Physician ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Program ◽

Population Based

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Indirect impact of the COVID-19 pandemic on emergency department presentations and hospital admissions for urgent early pregnancy conditions: a population-based retrospective cohort study

10.22541/au.164009415.56581064/v1 ◽

2021 ◽

Author(s):

Lisa Hui ◽

Wanyu Chu ◽

Elizabeth McCarthy ◽

Mary McCarthy ◽

Paddy Moore ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Early Pregnancy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Linear Prediction ◽

Hospital Admissions ◽

Population Based ◽

Termination Of Pregnancy ◽

The Impact

Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.

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Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study

Pediatric Research ◽

10.1038/s41390-020-0918-2 ◽

2020 ◽

Author(s):

Sofia Sagaidak ◽

Brian H. Rowe ◽

Maria B. Ospina ◽

Rhonda J. Rosychuk

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Emergency Department Crowding ◽

Outcomes For Children

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Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study

Palliative Medicine ◽

10.1177/02692163211009440 ◽

2021 ◽

pp. 026921632110094

Author(s):

Catherine R L Brown ◽

Colleen Webber ◽

Hsien-Yeang Seow ◽

Michelle Howard ◽

Amy T Hsu ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cohort Study ◽

Healthcare Utilization ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Home Visit ◽

Population Based ◽

Emergency Department Visits ◽

Care Model

Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

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