Preoperative in-hospital mortality in neonates with critical CHD

Objective: Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. Study design: The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. Results: Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. Conclusion: Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

Quantifying the Costs to Different Funders over Five-Years for Women Diagnosed with Breast Cancer in Queensland, Australia: A Data Linkage Study

Individuals diagnosed with breast cancer have the highest rates of survival among all cancer types. Due to high survival, the costs of breast cancer to different healthcare funders are of interest. This study aimed to describe the cost to public hospital and private health funders and individuals due to hospital and emergency department (ED) admissions, as well Medicare items and pharmaceuticals over five years for Queensland women with breast cancer. We used a linked administrative dataset, CancerCostMod, limited to Queensland female breast cancer diagnoses between July 2011 and June 2013 aged 18 years or over who survived for 5 years (n = 5383). Each record was linked to Queensland Health Admitted Patient Data Collection, Emergency Department Information Systems, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between July 2011 and June 2018. Total costs for different healthcare funders as a result of breast cancer diagnoses were reported, with high costs and service use identified in the first six months following a breast cancer diagnosis. After the first six months post-diagnosis, the financial burdens incurred by different healthcare funders for breast cancer diagnoses in Queensland remain steady over a long period. Recommendations for reducing long term costs are discussed.

Utilisation of tracheostomy in patients with COVID-19 in England: patient characteristics, timing and outcomes

Objectives: We aimed to characterise the use of tracheostomy procedures for all COVID-19 critical care patients in England and to understand how patient factors and timing of tracheostomy affected outcomes. Design: A retrospective observational study using exploratory analysis of hospital administrative data. Setting: All 500 National Health Service hospitals in England. Participants: All hospitalised COVID-19 patients aged ≥ 18 years in England between March 1st and October 31st, 2020 were included. Main outcomes and measures: This was a retrospective exploratory analysis using the Hospital Episode Statistics administrative dataset. Multilevel modelling was used to explore the relationship between demographic factors, comorbidity and use of tracheostomy and the association between tracheostomy use, tracheostomy timing and the outcomes. Results: In total, 2,200 hospitalised COVID-19 patients had a tracheostomy. Tracheostomy utilisation varied substantially across the study period, peaking in April-June 2020. In multivariable modelling, for those admitted to critical care, tracheostomy was most common in those aged 40-79 years, in males and in people of Black and Asian ethnic groups and those with a history of cerebrovascular disease. In critical care patients, tracheostomy was associated with lower odds of mortality (OR: 0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR: 41.143 (95% CI 30.979 to 54.642). In patients that survived, earlier timing of tracheostomy (≤ 14 days post admission to critical care) was significantly associated with shorter length of stay. Conclusions: Tracheostomy is safe and advantageous for critical care COVID-19 patients. Early tracheostomy may be associated with better outcomes, such as shorter length of stay, compared to late tracheostomy.

Relative risk of functional dyspepsia in patients with sleep disturbance: a population-based cohort study

Increased prevalence of sleep disorders has been found in patients with functional dyspepsia; however, direction of causality remains unclear. Our aim was to compare the risk of incident functional dyspepsia between patients with and without sleep disturbance from a large population-based sample. Utilizing a nation-wide health insurance administrative dataset, we assembled an 11-year historic cohort study to compare subsequent incidence of diagnosed functional dyspepsia between adult patients with any diagnosis of sleep disturbance and age- and gender-matched controls. Hazard ratios adjusted for other relevant comorbidities and medications were calculated using Cox regression models. 45,310 patients with sleep disorder and 90,620 controls were compared. Patients with sleep apnea had a 3.3-fold (95% confidence interval: 2.82 ~ 3.89) increased hazard of functional dyspepsia compared with controls. This increased risk persisted regardless of previously diagnosed depression coexisted. Sleep disturbance was associated with an increased risk of subsequent functional dyspepsia. Potential mechanisms are discussed.

From Each According to Means, to Each According to Needs? Distributional Effects of Abolishing Asset-Based Payments for Residential Care in Austria

BackgroundMost countries in Europe require out-of-pocket payments (OPPs) for nursing homes based on users’ income and often assets. This was also the case in Austria until 2018 when asset-based contributions to residential care —denoted the ‘Pflegeregress’ – were abolished, leaving a shortfall in revenue. We aim to determine how the Pflegeregress was distributed across different groups in Austria prior to 2018, what the distributional consequences of its abolishment were, and what the distributional impact of different financing alternatives would be.MethodsCircumventing data availability issues, we construct a micro-simulation model using a matched administrative dataset on residential care users receiving the Austrian care allowance (Pflegegeldinformation, PFIF, HVB, and Pflegedienstleistungsstatistik, Statistik Austria) and survey data (SHARE, wave 6). Using this model, we estimate the expected duration of residential care and OPPs under the Pflegeregress of a representative sample of older people aged 65+ in Austria, as well as OPPs under budgetary neutral financing alternatives to the abolished asset-based contribution, namely an inheritance tax and a social insurance scheme. The distributional impact of abolishing the Pflegeregress and these alternative scenarios is assessed through a number of measures, such as ability to pay, Concentration Indices (CI) and a needs-standardized measure.ResultsWe find that lower income individuals and homeowners disproportionately contributed to asset-based OPPs for residential care prior to 2018 due in large part to their higher use of residential care and the low asset-exemption thresholds. These groups were therefore the largest beneficiaries of its abolishment. The alternative financing scenarios tested would result in a more progressive distribution of payments (i.e. concentrated on more affluent individuals). ConclusionOur findings indicate the limited ability of asset-based OPPs to target those with higher assets, thus questioning the fairness of these instruments for financing residential care facilities for older people in Austria. Findings also suggest that the parameterization of such OPPs (such as asset exemption thresholds) and patterns of residential care use are key variables for assessing the distribution of asset-based OPPs for residential care use. Policy alternatives that decouple payments from use would entail greater transfers from healthy to less healthier individuals.

Hospital-acquired complications in critically ill patients

BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019) administrative dataset abstracted from medical records. SETTING: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. PARTICIPANTS: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). MAIN OUTCOME MEASURES: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). RESULTS: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2–7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05–0.11). CONCLUSIONS: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.

Performance Assessment Across Different Care Settings of A Novel Heart Failure Hospitalisation Risk Score For Type 2 Diabetes Patients Developed Using Administrative Claims Only

Predicting the risk of cardiovascular complications, in particular heart failure hospitalisation (HHF), can improve the management of type 2 diabetes (T2D). Most predictive models proposed so far rely on clinical data not available at the higher Institutional level. Therefore, it is of interest to assess the risk of HHF in people with T2D using administrative claims data only, which are more easily obtainable and could allow public health systems to identify high-risk individuals. In this paper, the administrative claims of >175,000 patients with T2D were used to develop a new risk score for HHF based on Cox regression. Internal validation on the administrative data cohort yielded satisfactory results in terms of discrimination (max AUROC=0.792, C-index=0.786) and calibration (Hosmer-Lemeshow test p-value<0.05). The risk score was then tested on data gathered from two independent centers (one diabetes outpatient clinic and one primary care network) to demonstrate its applicability to different care settings in the medium-long term. Thanks to the large size and broad demographics of the administrative dataset used for training, the proposed model was able to predict HHF without significant performance loss concerning bespoke models developed within each setting using more informative, but harder-to-acquire clinical variables.

Factors Affecting Learners’ Academic Success in Online Liberal Arts Courses Offered by a Traditional Korean University

This study aimed to empirically examine the factors affecting full-time undergraduate students’ satisfaction and academic performance measured by grades using an existing large administrative dataset. The sample consisted of 21,662 undergraduate students who took online liberal arts courses offered by a large traditional Korean university in the spring semester of 2020. The theoretical framework of this study was formulated by selectively adopting and slightly modifying some of the factors from Choi’s conceptual model for adult dropout from online degree programs. The findings indicated that gender, previous GPA, campus, type of online course, the relevance of the course, adequacy of assignments and assessments, learner-instructor interaction, and learner-content interaction significantly affect students’ degree of satisfaction with online liberal arts courses. This study also found that students who considered the course less relevant to their goals or interests, had a low previous GPA, had frequent learner-instructor interactions, few learner-content interactions, and a low level of course satisfaction are more likely to earn a grade of B, C, or lower than to receive an A in online liberal arts courses.

Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore

Background and objectiveLittle is known about the epidemiology and cost of bronchiectasis in Asia. This study describes the disease burden of bronchiectasis in Singapore.MethodsA nationwide administrative dataset was used to identify hospitalisations with bronchiectasis as a diagnosis. Population statistics and medical encounter data were used to estimate the incidence, mortality, prevalence and direct medical costs associated with hospitalisation-requiring bronchiectasis.ResultsThere were 420 incident hospitalised bronchiectasis patients in 2017, giving an incidence rate of 10.6/100 000. Age-standardised incidence declined on average by 2.7% per year between 2007 and 2017. Incidence rates increased strongly with age in both men and women. Tuberculosis was a secondary diagnosis in 37.5% of incident hospitalisations in 2007, but has declined sharply since then. Patient survival was considerably lower in both men (5-year Relative Survival Ratios (RSR) of 0.63 (95% CI, 0.59 to 0.66)) and women ((5-year RSR of 0.75 (95% CI, 0.72 to 0.78)). The point prevalence of bronchiectasis was 147.1/100,000 in 2017, and increased sharply with age, with more than 1% of people aged 75 years and older having bronchiectasis. Total first-year costs among incident bronchiectasis patients in 2016 varied widely, with an average of $7331 (standard deviation of $8863). About 10% of the patients admitted in 2016 had total first-year costs of more than $14 380.ConclusionBronchiectasis is common and imposes a substantial burden on health care costs and survival rates of patients in Singapore.