scholarly journals Testing the Bed-Blocking Hypothesis: Does Nursing and Care Home Supply Reduce Delayed Hospital Discharges?

2015 ◽  
Vol 24 ◽  
pp. 32-44 ◽  
Author(s):  
James Gaughan ◽  
Hugh Gravelle ◽  
Luigi Siciliani
Keyword(s):  
Care Home ◽  
Hospital Discharges

scholarly journals COVID-19 in Scottish care homes: A metapopulation model of spread among residents and staff

2021 ◽  
Author(s):  
Matthew Baister ◽  
Ewan McTaggart ◽  
Paul McMenemy ◽  
Itamar Megiddo ◽  
Adam Kleczkowski
Keyword(s):  
General Population ◽  
Care Home ◽  
Home Visitation ◽  
Care Homes ◽  
Health Board ◽  
Reproduction Rate ◽  
Metapopulation Model ◽  
Hospital Discharges ◽  
Vulnerable Communities ◽  
The Uk

AbstractCare homes in the UK were disproportionately affected by the first wave of the COVID-19 pandemic, accounting for almost half of COVID-19 deaths over the course of the period from 6th March – 15th June 2020. Understanding how infectious diseases establish themselves throughout vulnerable communities is crucial for minimising deaths and lowering the total stress on the National Health Service (NHS Scotland). We model the spread of COVID-19 in the health-board of NHS Lothian, Scotland over the course of the first wave of the pandemic with a compartmental Susceptible - Exposed - Infected reported - Infected unreported - Recovered - Dead (SEIARD), metapopulation model. Care home residents, care home workers and the rest of the population are modelled as subpopulations, interacting on a network describing their mixing habits. We explicitly model the outbreak’s reproduction rate and care home visitation level over time for each subpopulation, and execute a data fit and sensitivity analysis, focusing on parameters responsible for intra-subpopulation mixing: staff sharing, staff shift patterns and visitation. The results suggest that hospital discharges were not predominantly responsible for the early outbreak in care homes, and that only a few such cases led to infection seeding in care homes by the 6th of March Sensitivity analysis show the main mode of entry into care homes are infections by staff interacting with the general population. Visitation (before cancellation) and staff sharing were less significant in affecting outbreak size. Focusing on the protection and monitoring of staff, followed by reductions in staff sharing and quick cancellations of visitation can significantly reduce future infection attack rates of COVID-19 in care homes.Author SummaryCOVID-19 has spread throughout care homes in the UK, leading to many deaths of those most vulnerable in our population. This has sparked the need for further understanding of how infectious diseases spread throughout vulnerable communities such as care homes. We developed a model focused on the first wave in the Scottish health board of Lothian, which indicated pathways most likely leading to COVID-19 establishment within care homes. We found that care home visitation and hospital discharges did not significantly affect total COVID-19 cases in care home residents. The most significant route of entry for COVID-19 into care homes was through staff infections from the general population. We suggest to prioritise minimising infections in this pathway to reduce the number of outbreaks in care homes. Our model indicated that care homes were three weeks behind the general population in reducing the reproduction rate of COVID-19. This delay emphasises the need for more planning and support for care homes in organising effective responses to emerging pandemics.

An Operational Definition of Cobalamin Replacement Based upon Administrative Health Data.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3147-3147
Author(s):  
David Szwajcer ◽  
William D. Leslie ◽  
A. Majid Shojania ◽  
Marina Yogendran ◽  
Colleen Metge
Keyword(s):  
Clinical Outcomes ◽  
Prescription Drugs ◽  
Care Home ◽  
Operational Definition ◽  
Health Data ◽  
Deficiency Anemia ◽  
Hospital Discharges ◽  
Post Discharge ◽  
Medical Claims ◽  
Administrative Health Data

Abstract Background: A large clinical dataset of vitamin B12 measurements (over 12,000 patients) and Schilling tests (over 700 patients) has been assembled from participating Manitoba laboratories (1995–2000) in order to assess clinical outcomes (as defined from administrative health data) in relation to tests of cobalamin [Cbl] deficiency. In order to control for Cbl replacement, it is necessary to confirm that Cbl replacement can be accurately determined from administrative data sources such as the Drug Program Information Network (DPIN) and/or medical claims for therapeutic injections. DPIN is known to be reliable for oral prescription drugs, but parenteral Cbl may be more difficult to identify and non-prescription oral Cbl would not be recorded. We believe that the preferred route of Cbl administration in Manitoba was parenteral during 1995–2000, but this needs to be confirmed. Methods: Cases (expected to have a high likelihood for Cbl replacement) consisted of all adult hospital discharges between 1995 and 2000 with a diagnosis of pernicious anemia or other Cbl deficiency anemia (ICD-9-CM 281.0, 281.1) who survived for at least one year post-discharge without personal care home admission (n=388). Matched controls (3 controls for each case) with a low likelihood for Cbl replacement were similarly defined from hospital discharges without any ICD-9-CM neurologic or haematologic diagnosis (n=1,164). Controls were matched with cases for gender, birth year and hospitalization year. For each case and control the number of Cbl dispensations (ATC code B03BA01) and therapeutic injections (tariff code #8954) were tabulated during the first three years post-discharge. Sensitivities (fraction of cases receiving Cbl replacement) and specificities (fraction of controls not receiving Cbl replacement) were calculated for different cutoffs of Cbl dispensations, therapeutic injections and combinations according to year of diagnosis (YOD) and overall. Weighted linear regression between YOD and sensitivity was performed to look for an effect of recent oral Cbl replacement. Results: Sensitivity for the a priori operational definition (≥2 Cbl dispensations) was 0.59±0.02 with specificity 0.96±0.01. Using one or more Cbl dispensations improved sensitivity to 0.71±0.02 with similar specificity of 0.95±0.01. Therapeutic injections alone were less useful (≥1 injection sensitivity of 0.65±0.02 with specificity of 0.92±0.01, ≥2 injections sensitivity of 0.61±0.02 with specificity of 0.95±0.01). The combination that maximized sensitivity + specificity was ≥1 dispensation or ≥2 therapeutic injections (sensitivity 0.80±0.02, specificity 0.93±0.01). Sensitivity measurements did not show any significant relationship with YOD. Conclusions: The optimal definition for Cbl therapy based upon administrative health data appears to be at least one Cbl dispensation identified in the DPIN database or at least two therapeutic injections identified from medical claims. In assessing clinical outcomes in relation to Cbl testing and replacement, we propose to validate findings derived with the primary combined definition through secondary analyses using independent definitions of Cbl replacement (≥1 dispensation alone or ≥2 therapeutic injections alone). Overall sensitivity was lower than expected but may reflect that some cases are not prescribed Cbl replacement post-discharge. Sensitivity was unrelated to YOD arguing against oral Cbl replacement as the explanation.

Stroke Prevention in Non-Valvular Atrial Fibrillation

1997 ◽  
Vol 17 (03) ◽  
pp. 166-169
Author(s):  
Judith O’Brien ◽  
Wendy Klittich ◽  
J. Jaime Caro
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Care Home ◽  
Relevant Literature ◽  
Clinical Trial Data ◽  
Outcome Data ◽  
Sensitivity Analyses ◽  
Bleeding Events ◽  
Discharge Data ◽  
The Cost

SummaryDespite evidence from 6 major clinical trials that warfarin effectively prevents strokes in atrial fibrillation, clinicians and health care managers may remain reluctant to support anticoagulant prophylaxis because of its perceived costs. Yet, doing nothing also has a price. To assess this, we carried out a pharmacoe-conomic analysis of warfarin use in atrial fibrillation. The course of the disease, including the occurrence of cerebral and systemic emboli, intracranial and other major bleeding events, was modeled and a meta-analysis of the clinical trials and other relevant literature was carried out to estimate the required probabilities with and without warfarin use. The cost of managing each event, including acute and subsequent care, home care equipment and MD costs, was derived by estimating the cost per resource unit, the proportion consuming each resource and the volume of use. Unit costs and volumes of use were determined from established US government databases, all charges were adjusted using cost-to-charge ratios, and a 3% discount rate was applied to costs incurred beyond the first year. The proportions of patients consuming each resource were estimated by fitting a joint distribution to the clinical trial data, stroke outcome data from a recent Swedish study and aggregate ICD-9 specific, Massachusetts discharge data. If nothing is done, 3.2% more patients will suffer serious emboli annually and the expected annual cost of managing a patient will increase by DM 2,544 (1996 German Marks), from DM 4,366 to DM 6,910. Extensive multiway sensitivity analyses revealed that the higher price of doing nothing persists except for very extreme combinations of inputs unsupported by literature or clinical standards. The price of doing nothing is thus so high, both in health and economic terms, that cost-consciousness as well as clinical considerations mandate warfarin prophylaxis in atrial fibrillation.

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