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PubMed1999

A population-based survey of hospitalized work-related ocular injury: diagnoses, cause of injury, resource utilization, and hospitalization outcome.

Occupational injury is a major source of ocular trauma and is often preventable. A statewide population-based survey of severe work-related ocular injury was generated by using the California Hospital discharge database to identify hospitalized ocular injury and workers compensation as principal payor to identify work-relatedness. Information concerning diagnoses, procedures, causes of injury, length of hospital stay, total hospital charges and disposition at hospital discharge were obtained for injuries occurring during the calendar year 1988. A total of 455 admissions for work-related ocular trauma were identified. The most common work-related ocular trauma diagnoses associated with hospitalizations were open globe injury (46%), adnexal wounds (20%), orbital fractures (11%), and traumatic hyphema (11%). The most common causes of work-related ocular trauma were foreign-body or projectile objects (19%), transport vehicles (18%), cutting or piercing objects (17%), and assaults (9%). Approximately 8% reported other than routine disposition at time of hospital discharge, including long-term nursing or rehabilitation services and death. Mean hospital stay when ocular trauma was the principal admitting diagnosis was 3.7 days. Results differed significantly for admissions reporting ocular trauma as the principal admitting diagnosis compared to admissions that did not. Hospitalized work-related ocular trauma is represented by a wide spectrum of injuries with substantial morbidity and economic costs. Projected to the United States population, these data indicate annual hospital charges excluding professional fees of $14.6 million when work-related ocular trauma is the principal admitting diagnosis and $40 million for admissions where ocular trauma is either a principal or secondary diagnosis.

California↗

PubMed1998

Assessment of the reproducibility of clinical coding in routinely collected hospital activity data: a study in two hospitals.

BACKGROUND: The aim of the study was to assess the reproducibility of clinical coding in two National Health Service hospitals within North West Thames region. METHODS: A retrospective audit was carried out, of clinical coding in hospital episode statistics, involving comparison of the codes assigned by local staff with those assigned by members of an external team unaware of the locally assigned codes. Where local and external coders disagreed, the records were reviewed for a third time by a further independent coder. The subjects were a random sample of 1607 non-maternity, non-psychiatric admissions occurring between 1991 and 1993, stratified for year and type of disease (asthma, diabetes, appendicitis, fractured femur and 'general'--a random selection of any diagnoses). The main outcome measures were the levels of exact agreement between local and external teams over codes for main diagnosis and procedure, and the level of approximate agreement (over the first three characters of the ICD-9 code for diagnosis and the letter and first two digits of the OPCS-4 code for procedure). For disagreements, the outcome measure was the level of agreement between the 'third' coder and the local and external coders. RESULTS: For the main diagnosis in the 'general' group at hospital A, internal and external coders agreed exactly in 43 per cent of the admissions examined and agreed 'approximately' in 55 per cent (kappa = 0.54). For hospital B the corresponding figures were 60 per cent and 72 per cent (kappa = 0.72). Approximate agreement was higher for the specific diseases considered, particularly for asthma (A: 86 per cent; B: 91 per cent) and fractured femur (A: 84 per cent; B: 89 per cent). For the main procedure at hospital A, there was exact agreement for 58 per cent and approximate agreement for 70 per cent (kappa = 0.66). For hospital B, the corresponding figures were 76 per cent and 83 per cent (kappa = 0.80). In cases of disagreement over the first three digits of the ICD-9 code for main diagnosis, the third coder disagreed with both local and external coders in 53 per cent at hospital A and 38 per cent at hospital B. Agreement was slightly better for discharges in 1992-1993 than in 1991-1992. CONCLUSIONS: The full clinical codes in NHS hospital episode statistics (HES) data should be treated with caution. The first three characters of ICD-9 codes for diagnoses and the OPCS-4 codes for procedures were more reliable. For some specific conditions such as asthma and fractured femur, reliability of the first three characters is much higher (for example, 86 per cent and 91 per cent for asthma in the two hospitals), but for the full codes can be worse. Secondary diagnoses or comorbidities may be significantly undercoded. A higher level of agreement in 1992-1993 than in 1991-1992 suggests that coding may be improving.

Abstracting and Indexing↗

PubMed1989

Inpatient psychiatric units in nonteaching general hospitals. Response to public mental health policy or hospital economics?

The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service "needs," to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals and the Massachusetts Department of Mental Health in three mental health catchment areas. Most of the teaching hospitals in the state have IPUs. The study indicated that a statistical difference exists between characteristics of IPU and non-IPU nonteaching general hospitals. The probability that a nonteaching general hospital will have an IPU is related to both market conditions and institutional characteristics of the hospital. Nonteaching general hospitals with IPUs were more likely to be located in areas with higher incomes but fewer office-based psychiatrists per capita. IPU hospitals were also more likely to be larger and to receive a higher percent of their revenues from Medicaid than their non-IPU counterparts. The study did not provide evidence that "need" as defined by traditional indicators was an influential factor in IPU existence.

Community Mental Health Services↗

PubMed1995

Estimating the hospital-wide cost differentials warranted for teaching hospitals. An alternative to regression approaches.

Under Medicare's Prospective Payment System, teaching hospitals receive additional reimbursements, vis-à-vis nonteaching hospitals, for both "direct" teaching expenses and for "indirect" expenses. They totaled $3.1 billion in fiscal year 1989. The authors propose and illustrate a non-regression-based, nonparametric method for viewing the total hospital-wide reimbursement differential warranted for teaching hospitals, a method utilizing a peer grouping of like hospitals to estimate two different "best practices" cost frontiers. The hospital's efficiently delivered cost to meet all of the hospital's actual service outputs, including its teaching mission, and delivered level of quality of care, is compared to the corresponding cost when only the teaching mission is excluded. The difference in these costs for a particular hospital can be used to estimate a suggested lump sum Medicare reimbursement add-on, in recognition of the hospital's teaching mission. The approach is illustrated using a subset of the Health Care Financing Administration's 1988 hospital data set, with comparisons of actual and suggested reimbursements provided.

Cost Allocation↗

PubMed2003

Estimating HIV prevalence and the impact of HIV/AIDS on a Ugandan hospital by combining serosurvey data and hospital discharge records.

OBJECTIVE: To estimate the disease-specific HIV prevalence in a northern Ugandan hospital and to evaluate the impact of HIV/AIDS on hospital services. DESIGN: HIV serosurvey and analysis of routinely compiled hospital records. METHODS: The serosurvey was conducted among all 352 patients admitted to the medical ward of the Lacor Hospital in March 1999 (this ward consists of 3 units: general medicine, tuberculosis, and cancer). The impact on hospital services was estimated using the hospital discharge records for all 3447 patients admitted in 1999, in combination with serosurvey data, and was expressed as the percentage of bed-days attributable to HIV-positive patients. RESULTS: The overall HIV prevalence was 42.0% (52.6, 44.6, and 13.2% in the general medicine, tuberculosis, and cancer units, respectively). The disease-specific prevalence ranged from 45-65% for patients with tuberculosis, pneumonia, malaria, and enteritis. HIV-positive patients, compared with HIV-negative patients, had a higher in-hospital mortality (14.6 vs. 3.0%) and a lower average length of stay (41.4 vs. 48.9 days). AIDS cases accounted for 5.0% of hospital admissions, 4.1% of bed-days, and 11.5% of deaths. When considering all HIV-positive patients, these accounted for 37.2% of the bed-days. CONCLUSIONS: Knowledge of disease-specific HIV prevalence and of the patterns of HIV-related diseases is crucial for early case management. The impact of HIV-positive patients on hospital services is quite high, accounting for >1/3 of the bed-days in 1999. Providing a continuum of care through inpatient, outpatient, and outreach home care services probably represents the only means of relieving the pressure on overloaded hospitals.

Adolescent↗

PubMed1991

Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions.

OBJECTIVE: To determine the appropriateness of transfers to acute care hospitals from a nursing home. DESIGN: Nursing home and hospital records of all the nursing home residents during the 3-year study period were reviewed retrospectively to determine: number and type of transfers; problems identified in the nursing home justifying the transfers; diagnoses made at the hospitals; length of hospital stays; outcome of hospital visits. SETTING: An 80-bed public nursing home. SUBJECTS: 112 residents in the nursing home over the 3-year study period. MAIN OUTCOME MEASURES: Based on the decision of the hospital physician, those transfers resulting in hospital admissions were considered appropriate. As well, transfers to the emergency room with return to the nursing home without hospital admission were also judged to be appropriate if the problems required diagnostic and therapeutic procedures not available in the nursing home. RESULTS: During the 3-year study period, 55 residents (49%) were transferred a total of 102 times. An average of 26% of patients were transferred each year. Direct admissions to acute hospitals accounted for 17% of the transfers, transfers to the emergency room with subsequent admission for 34%, and transfers to the emergency room with subsequent return to the nursing home without admission for 45%. Four percent of patients transferred died in the emergency room. On the basis of the outcome measure, 7% of all transfers could have been diagnosed and treated in the nursing home and were considered inappropriate. CONCLUSIONS: The majority of transfers from this nursing home to acute-care hospitals were appropriate.

Aged↗

PubMed1996

Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality.

BACKGROUND AND PURPOSE: After a craniotomy for cerebral aneurysm, postoperative mortality can be significant. Previous studies have shown that hospitals performing frequent high-risk procedures (such as coronary artery bypass) have a lower mortality than hospitals where these procedures are performed infrequently. METHODS: The Statewide Planning and Research Cooperative System of the New York State Department of Health reviewed all discharges in New York State from 1987 through 1993 for the diagnoses of subarachnoid hemorrhage and/or cerebral aneurysm and for patients with the procedure code for craniotomy for ruptured or unruptured cerebral aneurysm. In-hospital mortality and length of stay were examined in relation to the volume of craniotomies for aneurysm performed at each individual hospital. RESULTS: A total of 15,376 discharges for subarachnoid hemorrhage and 5638 craniotomies for aneurysm were tabulated in 208 hospitals. For all patients who underwent craniotomy for ruptured cerebral aneurysm (n = 4034), there was a 43% (95% confidence interval, 29% to 57%) reduction in mortality rate in hospitals performing more than 30 craniotomies per year for cerebral aneurysm compared with hospitals performing less surgery (8.8% versus 15.5%, P < .0001). For all patients who underwent craniotomy for unruptured cerebral aneurysm (n = 1604), there was an identical 43% (95% confidence interval, 14% to 73%) reduction in mortality in hospitals performing more than 30 craniotomies per year for cerebral aneurysm (4.6% versus 8.1%, P = .0087). CONCLUSIONS: Hospitals that frequently perform aneurysm operations have lower mortality rates for patients undergoing craniotomy for cerebral aneurysm than hospitals that perform fewer operations.

Aneurysm, Ruptured↗

PubMed2006

Socioeconomic status and hospital utilization among younger adult pneumonia admissions at a Canadian hospital.

BACKGROUND: Although the general association between socioeconomic status (SES) and hospitalization has been well established, few studies have considered the relationship between SES and hospital length of stay (LOS), and/or hospital re-admission. The primary objective of this study therefore, was to examine the relationship of SES to LOS and early re-admission among adult patients hospitalized with community-acquired pneumonia in a setting with universal health insurance. METHODS: Four hundred and thirty-four (434) individuals were included in this retrospective, longitudinal cohort analysis of adult patients less than 65 years old admitted to a large teaching hospital in Vancouver, British Columbia. Hospital chart review data were linked to population-based health plan administrative data. Chart review was used to gather data on demographics, illness severity, co-morbidity, functional status and other measures of case mix. Two different types of administrative data were used to determine hospital LOS and the occurrence of all-cause re-admission to any hospital within 30 days of discharge. SES was measured by individual-level financial hardship (receipt of income assistance or provincial disability pension) and neighbourhood-level income quintiles. RESULTS: Those with individual-level financial hardship had an estimated 15% (95% CI -0.4%, +32%, p = 0.057) longer adjusted LOS and greater risk of early re-admission (adjusted OR 2.65, 95% CI 1.38, 5.09). Neighbourhood-level income quintiles, showed no association with LOS or early re-admission. CONCLUSION: Among hospitalized pneumonia patients less than 65 years, financial hardship derived from individual-level data, was associated with an over two-fold greater risk of early re-admission and a marginally significant longer hospital LOS. However, the same association was not apparent when an ecological measure of SES derived from neighbourhood income quintiles was examined. The ecological SES variable, while useful in many circumstances, may lack the sensitivity to detect the full range of SES effects in clinical studies.

Adolescent↗

PubMed1990

Hilton Head Hospital trustee discusses hospital finance. Interview by Karen Gardner.

Hilton Head Hospital, a 64-bed acute care hospital in Hilton Head Island, SC, was built in 1975. During its early years, the hospital struggled to meet its payroll. For the last few years, the hospital's operating margin has been so healthy that this small, general hospital is now able to contribute substantially to maintaining its sophisticated services and equipment. As vice-chairman of the hospital's board of trustees, vice-chairman of the hospital's parent corporation, and chairman of the hospital's foundation, Frederick S. Donnelly, Jr., is well aware of the governing boards' decisions that have contributed to Hilton Head Hospital's financial turnaround. He recently talked with Trustee managing editor Karen Gardner about the hospital's finances.

Financial Management↗

PubMed1991

Implementing EACHs (essential access community hospitals) and RPCHs (rural primary care hospitals) on a statewide basis: a preliminary analysis.

Declining hospital utilization has created excess hospital capacity in rural areas, has depressed occupancy rates, and threatens the financial viability of rural hospitals. Access to hospital care could be reduced and rural economies damaged if rural hospitals close. The federal Essential Access Community Hospital (EACH) demonstration program is an attempt to address these issues by establishing regional hospital networks. A preliminary analysis of the impact of state-wide implementation of the EACH program in Iowa suggests that about 60% of rural hospital beds and about 28% of all hospital beds would be eliminated. The EACH program could well prove difficult to implement because of the need to select hospitals for reduced services.

Bed Occupancy↗

PubMedDate not supplied

[Comparative analysis of nutritional status, food intake and length of hospitalization considering two hospitals: public versus private].

INTRODUCTION: To assess the nutritional status of hospitalized patients is important for the prevention of hospital malnutrition and planning of nutritional intervention. OBJECTIVE: To comparatively analyze the nutritional status of patients admitted to two hospitals, one public and another private, caring for populations with different socioeconomic profiles. CASE STUDY AND METHODS: This was a prospective study and samples were collected from patients of two hospitals, one public (PUH) and another private (PRH), which respectively represent the underprivileged and the more affluent populations. The analysis considered 51 patients from the PUH, aged between 53.9 +/- 15.6 years and 51 from the PRH, aged between 55.0 +/- 13.9 years, paired and grouped according to the following diseases: neoplasia (n+25), digestive tract disorders (n+11) and others (n+15). The statistical analysis was made by means of the T-Student test to compare PUH and PRH variables with p < 0.05, as well as to compare different variables in the same hospital, with p < 0.05; p < 0.01; p < 0.005 and p < 0.001. RESULTS: There were no statistical differences when the variables evaluated in both hospitals were compared, except for the length of hospitalization of patients with digestive tract disorders, which was longer for HPR. Upon hospitalization, 21.0% and 17.6% presented a body mass index (BMI) indicative of malnutrition. The patients with neoplasias presented current weight (CW) lower than habitual weight (HW). Both the patients with neoplasias and those with digestive tract disorders presented insufficient energy consumption in the period before hospitalization (p < 0.05). A negative correlation was found between the length of hospitalization and the current weight/habitual weight ratio (r = 0.194, 0 < 0.05, n = 102) and BMI (r=-0.186, p < 0.05, n = 102), according to Pearson's coefficient. CONCLUSION: The similarity of nutritional conditions found points to similarity of nutritional status for patients of both institutions and reflects the changes in the nutritional status of the population. The nutritional intervention should consider the nutritional needs of the population assisted.

Eating↗

PubMed1989

The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage.

In this paper, we report the results of an analysis of hospital expenses in 43 large SMSAs between 1980 and 1984. We found that hospital rate regulation--specifically Medicare's TEFRA and PPS and state multi-payer systems--was the single most important factor leading to the slowdown in the rate of increase in hospital costs between 1980 and 1984. In 1984, hospital costs covered by Medicare's PPS were 12.5% lower than they would have been in the absence of rate regulation, and in the four states covered by all-payer rate regulation, hospital costs were between 11% and 15% lower. In contrast, changes in the proportion of people either covered by employer-group health insurance or enrolled in HMOs, reduced hospital costs by less than 1%. Measures of competition suggest that hospital costs are higher where there is more competition. We also found that almost all of the effect of regulation on costs came from gains in the efficiency of producing hospital care and/or from reductions in the quality of care. It appears that controlling hospital payment rates gave hospitals a strong incentive to provide care at lower cost.

Catchment Area, Health↗

PubMed1997

Length of hospitalization and disposition of elderly vs younger delirium patients in psychiatric hospitals.

Although it is commonly accepted that delirium patients require the full facilities of general hospitals, practical experience has shown that delirium patients of all ages continue to be admitted to psychiatric institutions. The present study was designed to detect any differences in the length of hospitalization and disposition (discharge back to the community, transfer to a general hospital, death during the index hospitalization, transfer to another psychiatric hospital) between elderly (> 65 years) and younger delirium patients admitted to psychiatric hospitalization. Our hypothesis was that the prognosis (represented in this study by the above-mentioned measures) of elderly delirium patients in a psychiatric hospital would be poorer compared with younger delirium patients. We studied psychiatric case register data of 805 patients with delirium admitted to psychiatric hospitals during the period 1984-1993. Our sample was divided into four ICD-9-CM categories: delirium in dementia, delirium tremens (DT), drug-induced delirium, and acute and subacute delirium. No significant differences in the length of hospitalization were found between < 65- and > 65-year-old patients in the categories studied. There were disposal differences between the two age groups in the acute and subacute delirium parameters, but findings in the other categories were similar. Practical implementation of the results in terms of appropriate place of management of delirium patients in a psychiatric hospital is discussed.

Adult↗

PubMed2005

The debate over specialty hospitals: how physician-hospital relationships have reached a new fault line over these "focused factories".

Within the last 20 years, the fragile symbiotic relationship between physicians and hospitals has become increasingly strained. Physicians have created new healthcare delivery systems, including a host of for-profit, physician-owned specialty hospitals. Proponents of specialty hospitals argue that they provide high quality facilities and allow for innovative treatments. Opponents, however, contend that such hospitals "cherry pick" patients who otherwise would help to subsidize general hospitals, and point to the various fraud and abuse issues raised by physician-owned specialty hospitals. This Article examines the specialty hospital phenomenon and the arguments for and against such entities. It also analyzes whether an extension of the present federal moratorium on the construction of new physician-owned specialty hospitals is in the best interests of the country's healthcare system. The author concludes that the data are unclear as the overall impact of such hospitals and that they should not be further constrained until when and if the facts are clear.

Dissent and Disputes↗

PubMed1995

U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals: 1988-1991.

Hospitals are a major provider of resources for individuals with HIV-related conditions. With the changing nature of HIV, tracking the dependence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents HIV inpatient care in U.S. hospitals during 1991 by surveying 1,931 acute care institutions (19% of all acute care institutions). In addition, this report documents changes in HIV care in 124 teaching hospitals between 1988 and 1991. Of the 1,081 hospitals completing the 1991 survey (56%), 773 reported treating at least one HIV inpatient and a total of 58,211 inpatients. Northeastern and public hospitals provided significantly more care. Public-related payer sources financed almost 90% of care in public institutions and > 60% in private institutions. Hospitals reported an average loss of $ 92,025 and an estimated total cost-based loss of $ 71.1 million among all responding institutions. The number of HIV inpatients increased 68% between 1988 and 1991. During these years, substantial increases in revenue and modest reductions in per patient use led to a decrease in total inpatient losses of $ 540,748 to $ 260,331 per hospital. Results show that HIV-associated inpatient care is extensive and increasing and that support for care has become a predominantly public sector responsibility. Teaching hospitals' increase in care suggests that they have become "magnets" for patients with HIV-related disease. However, treatment economies and reimbursement rate improvements have worked to lower losses. Any HIV financing policies should work to balance support for non-hospital care with the continuing need for inpatient treatment.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Hospital resource consumption and outcome. Route of admission and age for hospitalized otolaryngology patients.

Hospitals and physicians face new payment mechanisms that provide incentives to study health policy, management, and economics. The purpose of this study was to analyze hospital resource consumption and outcome based on age and the route of hospital admission (emergency [ER] vs nonemergency [non-ER]). We analyzed all adult otolaryngology hospital admissions (N = 1589) during a three-year period (1985 through 1987) to a large northeastern academic medical center. Hospital resource consumption, measured by hospital length of stay and total hospital cost per patient, rose with age for ER and non-ER admissions. Severity of illness, clinical resource utilization, and mortality demonstrated these same characteristics. Diagnosis related group prospective hospital payment generated financial risk for ER admissions and elderly patients. Analysis demonstrated ER admission as more predictive of subsequent hospital resource consumption and outcome with changes in age compared with non-ER admission. Our findings suggest that in the future physicians and hospitals may find that age and the route of admission may be useful in stratifying patients regarding cost and outcome.

Academic Medical Centers↗

PubMed1993

Length of hospital stay and outcome after femoral neck fracture: a prospective study comparing the performance of two hospitals.

Length of hospital stay and outcome after femoral neck fracture were compared in a prospective study between two adjacent hospitals. In matched populations, mean length of stay was 30.8 days at Hospital X and 15.7 days at Hospital Y. Need for rehousing, age over 80 years and new nursing home placement prolonged length of stay at Hospital X, but not at Hospital Y. Hospital X had an orthopaedic rehabilitation ward and returned 88 per cent of patients to their own home, placing 9 per cent admitted from home in nursing homes. Hospital Y returned 76 per cent of patients to their own home and 19 per cent to nursing homes. The rapid discharge policy of Hospital Y saved significant resources within the acute hospital at the expense of returning significantly fewer patients to their own homes.

Aged↗

PubMed1984

Nasal carrier rates and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital populations, Addis Ababa.

Surgical staff of five different hospitals and university biology students were screened for nasal carriage of Staphylococcus aureus: 32.4% of the surgical staff and 21.6% of the students were carriers. The rate for the hospital staff was significantly higher (chi 2 = 9.2, P less than 0.01). The carrier rates among the surgical staff varied between 59.1% for surgeons and 22.7% for other surgical staff. 195 S. aureus strains were isolated: 109 from surgical staff and 86 from students. All were tested for their resistance to antibiotics. Resistance to penicillin was 86.2% and 74.4%, respectively, for hospital and non-hospital isolates. Resistance to erythromycin, gentamicin, kanamycin or co-trimoxazole was not detected among the non-hospital isolates. All isolates were sensitive to vancomycin, cephalothin and clindamycin. Over 96% and 88% of hospital and non-hospital isolates, respectively, were resistant to at least one antibiotic. About 45% of the hospital isolates and 2.3% of the non-hospital isolates showed multiple resistance. The rate of multiple resistance among the hospital staff isolates was considered high and indicative of still higher rates among clinical isolates. Further studies are suggested in order to take appropriate measures against bacterial resistance to antibiotics.

Anti-Bacterial Agents↗