scholarly journals Sequence Analysis of Long-Term Readmissions among High-Impact Users of Cerebrovascular Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-12
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Sequence Analysis ◽  
Administrative Data ◽  
Retrospective Cohort ◽  
Intracranial Haemorrhage ◽  
High Impact ◽  
Chronological Order ◽  
Chest Infection ◽  
Common Causes ◽  
High Readmission Rate

Objective. Understanding the chronological order of the causes of readmissions may help us assess any repeated chain of events among high-impact users, those with high readmission rate. We aim to perform sequence analysis of administrative data to identify distinct sequences of emergency readmissions among the high-impact users. Methods. A retrospective cohort of all cerebrovascular patients identified through national administrative data and followed for 4 years. Results. Common discriminating subsequences in chronic high-impact users (n=2863) of ischaemic stroke (n=34208) were “urological conditions-chest infection,” “chest infection-urological conditions,” “injury-urological conditions,” “chest infection-ambulatory condition,” and “ambulatory condition-chest infection” (p<0.01). Among TIA patients (n=20549), common discriminating (p<0.01) subsequences among chronic high-impact users were “injury-urological conditions,” “urological conditions-chest infection,” “urological conditions-injury,” “ambulatory condition-urological conditions,” and “ambulatory condition-chest infection.” Among the chronic high-impact group of intracranial haemorrhage (n=2605) common discriminating subsequences (p<0.01) were “dementia-injury,” “chest infection-dementia,” “dementia-dementia-injury,” “dementia-urine infection,” and “injury-urine infection.” Conclusion. Although common causes of readmission are the same in different subgroups, the high-impact users had a higher proportion of patients with distinct common sequences of multiple readmissions as identified by the sequence analysis. Most of these causes are potentially preventable and can be avoided in the community.

scholarly journals Common Sequences of Emergency Readmissions among High-Impact Users following AAA Repair

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Colin Bicknell ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Readmission Rate ◽  
High Impact ◽  
Aortic Graft ◽  
Abdominal Aortic ◽  
Number Of Patients ◽  
Common Causes ◽  
High Readmission Rate

Introduction. The aim of the study was to examine common sequences of causes of readmissions among those patients with multiple hospital admissions, high-impact users, after abdominal aortic aneurysm (AAA) repair and to focus on strategies to reduce long-term readmission rate. Methods. The patient cohort (2006–2009) included patients from Hospital Episodes Statistics, the national administrative data of all NHS English hospitals, and followed up for 5 years. Group-based trajectory modelling and sequence analysis were performed on the data. Results. From a total of 16,973 elective AAA repair patients, 18% (n=3055) were high-impact users. The high-impact users among ruptured abdominal aortic aneurysm (rAAA) repair constituted 17.3% of the patient population (n=4144). There were 2 subtypes of high-impact users, short-term (7.2%) with initial high readmission rate following by rapid decline and chronic high-impact (10.1%) with persistently high readmission rate. Common causes of readmissions following elective AAA repair were respiratory tract infection (7.3%), aortic graft complications (6.0%), unspecified chest pain (5.8%), and gastrointestinal haemorrhage (4.8%). However, high-impact users included significantly increased number of patients with multiple readmissions and distinct sequences of readmissions mainly consisting of COPD (4.7%), respiratory tract infection (4.7%), and ischaemic heart disease (3.3%). Conclusion. A significant number of patients were high-impact users after AAA repair. They had a common and distinct sequence of causes of readmissions following AAA repair, mainly consisting of cardiopulmonary conditions and aortic graft complications. The common causes of long-term mortality were not related to AAA repair. The quality of care can be improved by identifying these patients early and focusing on prevention of cardiopulmonary diseases in the community.

scholarly journals Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Collin Bicknell ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Readmission Rate ◽  
High Impact ◽  
Short Term ◽  
Readmission Rates ◽  
Abdominal Aortic ◽  
High Readmission Rate ◽  
Trajectory Modelling

Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P<0.001), older age (P<0.001), and higher comorbidity score (P<0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P<0.001), heart failure (P = 0.01), peripheral vascular disease (P<0.001), female sex (P = 0.02), open repair (P<0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.

scholarly journals Exploring longitudinal care histories for looked after children: a sequence analysis of administrative social care data

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Louise McGrath-Lone ◽  
Katie Harron ◽  
Lorraine Dearden ◽  
Ruth Gilbert
Keyword(s):  
Sequence Analysis ◽  
Administrative Data ◽  
Social Care ◽  
Term Care ◽  
Analysis Methods ◽  
Short Period ◽  
The Stability ◽  
Children In Care ◽  
Care History

BackgroundOutcomes for children in care vary by the stability of their placements (for example, more placement changes have been associated with poorer educational attainment). Official statistics describing the stability of care histories for children in England are limited to placement changes within a 12-month period. These annual statistical ‘snapshots’ cannot capture the complexity of children’s experiences; however, as administrative data have been routinely collected since 1992, it is possible to reconstruct longitudinal care histories. ObjectiveTo identify distinct patterns of care history by applying sequence analysis methods to longitudinal, administrative data. MethodsWe extracted care histories from birth to age 18 for a large, representative sample of children born 1992-94 (N=16,000) from routinely-collected Children Looked After Return data. We explored the heterogeneity of  children’s care histories in terms of stability and identified sub-groups based on the number, duration and timing of placements using sequence analysis methods. ResultsChildren’s care histories were varied with the number of placements ranging from 1 to 184 (median: 2). However, six distinct sub-groups of care history were evident including; adolescent entries (17.6%), long-term instability (13.1%) and early intervention (6.9%). Overall, most children (58.4%) had a care history that could be classified as’short-term care’ with an average of 276 days in care and 2.48 placements throughout childhood. Few children (4.0%) had a care history that could be described as ‘long-term stable care’. ConclusionsSequence analyses of longitudinal data can refine our understanding of how out-of-home care is used as a social care intervention. Despite the policy focus on achieving long-term stability for children in care, the vast majority of children remain in care for a short period of time. Future work exploring how outcomes vary between the different sub-groups of care history could enable better evaluation of the effects of longitudinal care experiences.

EPISIOTOMY : A CHALLENGING OBSTETRIC INTERVENTION

2003 ◽  
Vol 42 (145) ◽  
pp. 54-58
Author(s):  
D S Malla
Keyword(s):  
Blood Loss ◽  
Pelvic Floor ◽  
Anal Sphincter ◽  
Intracranial Haemorrhage ◽  
Perineal Tear ◽  
Obstetric Intervention ◽  
Anal Sphincter Damage

ABSTRACTThe professional literatures on the development of widely practiced procedure, episiotomy through theyears from the first publication in 1742 are reviewed. It reveals the change in number of publication as wellas the contributors to the development of perception about episiotomy. So it consisted expression of opinionof doctors initially then the co-workers like nurses and researchers and clients or consumers themselvestoo. It concludes that episiotomies prevent anterior perineal tear but fails to accomplish other benefitstraditionally ascribed to pelvic floor damage and relaxation including its sequel and also protection ofnewboin from intracranial haemorrhage and intrapartum asphyxia. Episiotomy substantially increasematernal blood loss during delivery and risk of anal sphincter damage with their long term morbidity.There is an urgent need to restrict the use of episiotomy in vaginal delivery.Key Words: Episiotomy, Perineal tear, anal sphincter damage.

scholarly journals Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

2021 ◽  
pp. 1-7
Author(s):  
Francesco Paolo Bianchi ◽  
Simona Mascipinto ◽  
Pasquale Stefanizzi ◽  
Sara De Nitto ◽  
Cinzia Germinario ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Measles Vaccine
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