Primary payer status, individual patient characteristics, and hospital-level factors affecting length of stay and total cost of hospitalization in total laryngectomy

Head & Neck ◽  
2016 ◽  
Vol 39 (2) ◽  
pp. 311-319 ◽  
Author(s):  
Vikas Mehta ◽  
José M. Flores ◽  
Richard Will Thompson ◽  
Cherie-Ann Nathan
Keyword(s):  
Length Of Stay ◽  
Total Laryngectomy ◽  
Patient Characteristics ◽  
Hospital Level ◽  
Factors Affecting ◽  
Total Cost ◽  
Primary Payer

Factors affecting hospital admission and length of stay of poisoned patients in the North East of England

1996 ◽  
Vol 15 (11) ◽  
pp. 915-919 ◽  
Author(s):  
Shl Thomas ◽  
S. Lewis ◽  
L. Bevan ◽  
S. Bhattacharyya ◽  
MG Bramble ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Patient Characteristics ◽  
Case Mix ◽  
Prolonged Stay ◽  
Factors Affecting ◽  
North East ◽  
The North ◽  
The Impact

1 Poisoning is a common reason for presentation to hospital and hospital admission but there is no agreed policy for managing these patients. This study exam ined the management of patients presenting with poisoning and the factors affecting the probability of hospital admission and prolonged stay. 2 Data on all cases of poisoning presenting to six Accident and Emergency departments in the North East of England over 12 weeks in 1994 was collected prospectively from A&E notes. Length of stay and outcome were recorded from hospital computer records. 3 Overall, 73% of patients were admitted to a medical ward. Probability of admission was not independently affected by age or gender but was increased in those with intentional poisoning (Odds Ratio (OR) 3.3 [95% CI 1.8, 6.1]), a history of self harm (OR 1.7, [1.0, 2.9]) or potentially hazardous poisoning (OR 3.7 [2.1, 6.6]). There were significant variations between hospitals (50 - 80%) which could not be attributed to case mix. 4 Prolonged stay ( > 2 nights) was more common in patients over 65 years (OR 6.8 [2.9, 16.1]), those with intentional poisoning (OR 2.7 [1.1, 6.6]) and those with potentially hazardous poisoning (OR 2.6 [1.4, 4.9]). Mean hospital stay was 1.5 days and varied signifi cantly between hospitals from 0.8 to 2.1 days and this was independent of case mix. 5 There are appreciable variations in the management of poisoning between hospitals which are not explained by patient characteristics. Savings would occur if rates of admission and duration of stay were reduced by those hospitals where admission is more frequent or hospital stay is longer. However, the impact of this on long term morbidity is unknown.

Hospital-level quality indicators for kidney cancer surgery: A Veteran’s Affairs national health system validation of concept.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 667-667
Author(s):  
Diego Aguilar Palacios ◽  
Brigid Wilson ◽  
Olli Saarela ◽  
Mustafa Ascha ◽  
Sunah Song ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Quality Indicators ◽  
Kidney Cancer ◽  
Surgical Care ◽  
Case Mix ◽  
Hospital Level ◽  
Total Cost ◽  
Surgical Admission

667 Background: Validation and implementation of quality indicators (QIs) for oncological surgical care is imperative in national health care systems. However, QIs must be adjusted for significant case-mix variations among hospitals and to capture disparate patient outcomes. Here, we explore and validate a compound quality score (CQS) as a metric for hospital-level quality of care in kidney cancer patients. Methods: Kidney cancer patients (n = 8233) treated at the VA (2005-2015) were identified. Two previously described and validated process QIs were explored: the proportion of patients with a) T1a tumors undergoing partial nephrectomy; and b) T1-T2 tumors undergoing minimally invasive radical nephrectomy. Demographics, comorbidity, tumor characteristics and treatment year were used for case-mix adjustment using indirect standardization / multivariable regression models. The predicted vs observed ratio of cases was calculated to generate each QI score. CQS represents the sum of both QIs scores. Ninety-six hospitals were benchmarked by CQS and patient-level outcomes were regressed on CQS levels to assess for length of stay (LOS), 30 days complications/readmission, 90 days overall mortality and total cost of surgical admission. Results: CQS identified 25, 33 and 38 hospitals with higher, lower and average performance, respectively. Total CQS score was independently associated with LOS [β = -0.04, p< 0.01, predicted LOS 0.84 days shorter for CQS = 2 vs. CQS = -2], 30 days surgical complications [OR = 0.88, p < 0.01] or 30 days medical complications [OR = 0.93, p < 0.01] and total cost of surgical admission [β = -0.014, p< 0.01, predicted 12% lower cost for CQS = 2 vs. CQS = -2]. No association was found between CQS and 30 day readmissions or 90 days mortality (all p>0.05), although low event rates were observed (8.9% and 1.7%, respectively). Conclusions : Variability in quality of surgical care at a hospital-level can be captured with the CQS among kidney cancer patients. CQS is associated with length of stay, post-operative complications and total cost of surgical admission. Quality indicators should be used to identify, audit and implement quality improvement strategies across health systems.

Multivariable analysis of factors affecting length of stay and hospital charges after single-level corpectomy

2017 ◽  
Vol 44 ◽  
pp. 279-283 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
Meic H. Schmidt ◽  
Andrew T. Dailey ◽  
Erica F. Bisson
Keyword(s):  
Length Of Stay ◽  
Multivariable Analysis ◽  
Hospital Charges ◽  
Factors Affecting ◽  
Single Level

scholarly journals Impact of Patient Characteristics on Hospital-Level Outcomes Assessment in Congenital Heart Surgery

2015 ◽  
Vol 100 (3) ◽  
pp. 1071-1077 ◽  
Author(s):  
Sara K. Pasquali ◽  
Marshall L. Jacobs ◽  
Sean M. O’Brien ◽  
Xia He ◽  
J. William Gaynor ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Outcomes Assessment ◽  
Patient Characteristics ◽  
Congenital Heart Surgery ◽  
Hospital Level

scholarly journals Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Mary Davoren ◽  
Orla Byrne ◽  
Paul O’Connell ◽  
Helen O’Neill ◽  
Ken O’Reilly ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Setting ◽  
Factors Affecting ◽  
Forensic Hospital

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

Abstract TP300: Implementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and Mortality

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jayme Strauss ◽  
Andrew Waisbrot ◽  
Daniel D'Amour ◽  
Amy K Starosciak
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Readmission Rate ◽  
Clinical Pathways ◽  
Transitions Of Care ◽  
Fiscal Year ◽  
Variable Cost ◽  
Total Cost ◽  
Iv Tpa ◽  
Order Set

Introduction: Acute stroke is a major contributor to healthcare costs. In 2012, estimated direct costs associated with stroke was $71B, which is projected to double to $184B by 2030. As healthcare evolves and reimbursements decrease, cost control in disease specific populations is critical. In November 2017, length of stay (LOS) peaked at 5.78 days, as did variable and total cost/case (Table). In fiscal year 2017 the 30-d readmission rate was 9% and the mortality rate was 12%. Compliance with stroke admission order sets was at 55%. Methods: A multidisciplinary committee was formed in February 2017 to develop standardized, evidence-based clinical pathways for three populations: Ischemic stroke (IS) treated with IV tPA, TIA/IS without IV tPA, and intracerebral hemorrhage. The team met biweekly to standardize clinical pathways, decrease time to follow-up imaging, focus on physician order set utilization, and control costs. A comprehensive education program for all clinical staff was completed; official implementation of the pathways was in November 2017. A stroke financials team meets monthly to continue to look at opportunities and transitions of care. We reviewed a retrospective financial report of all in-hospital cases coded as MS-DRG 61-69 from 12/2017 through 7/31/2019 and compared it the 11/2017 report. Results: A total of 83 cases were available for 12/2017 and 2192 for 1/2018 through 7/2019. There was a reduced LOS by 26% (4.34 days), reduced variable cost/case by 24% ($5,958), reduced total cost/case by 23% ($13,790), reduced the 30-d readmission rate to 6%, and reduced the mortality rate to 4%. Case mix index was 12% higher at 1.3272 (vs. 1.2055 previously). Order set compliance improved to 94% (Table). A total cost saving dollar realization of $4.5 million. Discussion: Standardization of stroke clinical pathways led to improved order set compliance, almost 1/4 reduction in variable and total costs per case, shortened LOS, and reduced mortality and readmission rates.

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