scholarly journals Differentiating Incident from Recurrent Stroke Using Administrative Data: The Impact of Varying Lengths of Look-Back Periods on the Risk of Misclassification

2017 ◽  
Vol 48 (3-4) ◽  
pp. 111-118 ◽  
Author(s):  
John Mark Worthington ◽  
Melina Gattellari ◽  
Chris Goumas ◽  
Bin Jalaludin
Keyword(s):  
Administrative Data ◽  
Hospital Admissions ◽  
Recurrent Stroke ◽  
Haemorrhagic Stroke ◽  
Data Sets ◽  
South Wales ◽  
Look Back ◽  
Hospital Administrative ◽  
The Impact ◽  
Risk Of Misclassification

Background/Aims: Administrative data are widely used to monitor epidemiological trends in stroke and outcomes; yet there is scant empirical guidance on how to best differentiate incident from recurrent stroke. Methods: We identified all hospital admissions in New South Wales, Australia, with a principal stroke diagnosis from July 1, 2013 to June 30, 2014, linked to 12 years of previous admissions. We calculated the proportion of cases identified with a prior stroke to determine the number of years of look-back required to minimise misclassification of incident and recurrent strokes. Results: Using the maximum available look-back period of 12 years, 1,171 out of 8,364 eligible stroke cases (14.0%) had a stroke history. A 1-year look-back period identified only 25.1% of these patients and 1 in 10 stroke cases were misclassified as incident. With a 10-year clearance period, less than 1 in 100 stroke cases were misclassified as incident. The risk of misclassification was lower in patients younger than 65 years and in those with haemorrhagic stroke. Conclusion: Hospital administrative data sets linked to prior admissions can be used to distinguish recurrent from incident stroke. The risk of misclassifying recurrent stroke cases as incident events is negligible with a look-back period of 10 years.

scholarly journals Three Essays on Adverse Events and Student Outcomes

2021 ◽  
Author(s):  
◽  
Olivia Wills
Keyword(s):  
High School ◽  
High School Students ◽  
Adverse Events ◽  
Administrative Data ◽  
Degree Completion ◽  
Student Outcomes ◽  
Fixed Effects ◽  
Hospital Admissions ◽  
The Impact ◽  
Low Ability

<p>This dissertation contains three essays on the impact of unexpected adverse events on student outcomes. All three attempt to identify causal inference using plausibly exogenous shocks and econometric tools, applied to rich administrative data.  In Chapter 2, I present evidence of the causal effects of the 2011 Christchurch earthquake on tertiary enrolment and completion. Using the shock of the 2011 earthquake on high school students in the Canterbury region, I estimate the effect of the earthquake on a range of outcomes including tertiary enrolment, degree completion and wages. I find the earthquake causes a substantial increase in tertiary enrolment, particularly for low ability high school leavers from damaged schools. However, I find no evidence that low ability students induced by the earthquake complete a degree on time.  In Chapter 3, I identify the impact of repeat disaster exposure on university performance, by comparing outcomes for students who experience their first earthquake while in university, to outcomes for students with prior earthquake exposure. Using a triple-differences estimation strategy with individual-by-year fixed effects, I identify a precise null effect, suggesting that previous experience of earthquakes is not predictive of response to an additional shock two years later.  The final chapter investigates the impact of injuries sustained in university on academic performance and wages, using administrative data including no-fault insurance claims, emergency department attendance and hospital admissions, linked with tertiary enrolment. I find injuries, including minor injuries, have a negative effect on re-enrolment, degree completion and grades in university.</p>

Rehabilitation-Related Research on Disability and Employer Practices Using Individual-Based National and Administrative Data Sets

2014 ◽  
Vol 28 (4) ◽  
pp. 242-263 ◽  
Author(s):  
Zafar E. Nazarov ◽  
William A. Erickson ◽  
Susanne M. Bruyère
Keyword(s):  
Administrative Data ◽  
National Survey ◽  
Employment Outcomes ◽  
Data Sets ◽  
Individuals With Disabilities ◽  
Policy Practice ◽  
Factors Influencing ◽  
Employer Practices ◽  
Disability Employment ◽  
The Impact

Objective:It is useful to examine workplace factors influencing employment outcomes of individuals with disabilities and the interplay of disability, employment-related, and employer characteristics to inform rehabilitation practice.Design:A number of large national survey and administrative data sets provide information on employers and can inform this inquiry.Results:Provides an overview of 9 national survey and administrative data sets that can be used to investigate the impact of employer practices on employment outcomes for individuals with disabilities.Conclusions:Provides specific examples of disability and employment research, which can be performed with these data sets and implications for rehabilitation policy, practice, and research.

scholarly journals Measuring patient safety in New Zealand public hospitals

2021 ◽  
Author(s):  
◽  
Nicholas Bowden
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
New Zealand ◽  
Administrative Data ◽  
Risk Adjustment ◽  
Public Hospitals ◽  
Hospital Administrative ◽  
The Impact ◽  
Hospital Administrative Data

<p>In New Zealand the Ministry of Health recognises quality of care as an integral part of a high performing health system and identifies patient safety as one of the key dimensions of quality. Over recent years a greater emphasis has been placed on improving patient safety mostly as a result of increased awareness around the frequency of medical error and resulting economic cost. However tools used to measure patient safety are limited. In particular the use of hospital administrative data to measure patient safety is scarce and existing safety measures often ignore one of the major issues confronting comparative analyses of hospital safety, risk adjustment to control for the differences in populations hospitals serve.   The objective of this research is to develop comparable measures of patient safety for New Zealand public hospitals. It uses risk adjustment strategies applied to the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) with New Zealand hospital administrative data, the National Minimum Dataset 2001 to 2009. The research employs econometric techniques to address risk adjustment of the PSIs, utilising existing AHRQ models but adapting and re-estimating them with New Zealand administrative data.   The findings from the research indicate that to use the AHRQ PSIs as measures of hospital patient safety in New Zealand, risk adjustment should first be employed to ensure measures are comparable across hospitals and over time. Overall, although the impact of risk adjustment appears to be minor, it has relevance and this should be recognised. Relative hospital performance is affected by risk adjustment. In particular, it has the greatest impact on those hospitals with poor rankings. The research takes us a step closer to being able to confidently measure patient safety and quality of care in New Zealand public hospitals in an innovative way.</p>

scholarly journals Three Essays on Adverse Events and Student Outcomes

2021 ◽  
Author(s):  
◽  
Olivia Wills
Keyword(s):  
High School ◽  
High School Students ◽  
Adverse Events ◽  
Administrative Data ◽  
Degree Completion ◽  
Student Outcomes ◽  
Fixed Effects ◽  
Hospital Admissions ◽  
The Impact ◽  
Low Ability

<p>This dissertation contains three essays on the impact of unexpected adverse events on student outcomes. All three attempt to identify causal inference using plausibly exogenous shocks and econometric tools, applied to rich administrative data.  In Chapter 2, I present evidence of the causal effects of the 2011 Christchurch earthquake on tertiary enrolment and completion. Using the shock of the 2011 earthquake on high school students in the Canterbury region, I estimate the effect of the earthquake on a range of outcomes including tertiary enrolment, degree completion and wages. I find the earthquake causes a substantial increase in tertiary enrolment, particularly for low ability high school leavers from damaged schools. However, I find no evidence that low ability students induced by the earthquake complete a degree on time.  In Chapter 3, I identify the impact of repeat disaster exposure on university performance, by comparing outcomes for students who experience their first earthquake while in university, to outcomes for students with prior earthquake exposure. Using a triple-differences estimation strategy with individual-by-year fixed effects, I identify a precise null effect, suggesting that previous experience of earthquakes is not predictive of response to an additional shock two years later.  The final chapter investigates the impact of injuries sustained in university on academic performance and wages, using administrative data including no-fault insurance claims, emergency department attendance and hospital admissions, linked with tertiary enrolment. I find injuries, including minor injuries, have a negative effect on re-enrolment, degree completion and grades in university.</p>

scholarly journals Measuring patient safety in New Zealand public hospitals

2021 ◽  
Author(s):  
◽  
Nicholas Bowden
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
New Zealand ◽  
Administrative Data ◽  
Risk Adjustment ◽  
Public Hospitals ◽  
Hospital Administrative ◽  
The Impact ◽  
Hospital Administrative Data

<p>In New Zealand the Ministry of Health recognises quality of care as an integral part of a high performing health system and identifies patient safety as one of the key dimensions of quality. Over recent years a greater emphasis has been placed on improving patient safety mostly as a result of increased awareness around the frequency of medical error and resulting economic cost. However tools used to measure patient safety are limited. In particular the use of hospital administrative data to measure patient safety is scarce and existing safety measures often ignore one of the major issues confronting comparative analyses of hospital safety, risk adjustment to control for the differences in populations hospitals serve.   The objective of this research is to develop comparable measures of patient safety for New Zealand public hospitals. It uses risk adjustment strategies applied to the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) with New Zealand hospital administrative data, the National Minimum Dataset 2001 to 2009. The research employs econometric techniques to address risk adjustment of the PSIs, utilising existing AHRQ models but adapting and re-estimating them with New Zealand administrative data.   The findings from the research indicate that to use the AHRQ PSIs as measures of hospital patient safety in New Zealand, risk adjustment should first be employed to ensure measures are comparable across hospitals and over time. Overall, although the impact of risk adjustment appears to be minor, it has relevance and this should be recognised. Relative hospital performance is affected by risk adjustment. In particular, it has the greatest impact on those hospitals with poor rankings. The research takes us a step closer to being able to confidently measure patient safety and quality of care in New Zealand public hospitals in an innovative way.</p>

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Seed production and seedling emergence of Giant Parramatta grass on the north coast of New South Wales

1996 ◽  
Vol 36 (3) ◽  
pp. 299 ◽  
Author(s):  
TS Andrews ◽  
RDB Whalley ◽  
CE Jones
Keyword(s):  
Seed Production ◽  
Seed Bank ◽  
New South ◽  
New South Wales ◽  
Seed Banks ◽  
North Coast ◽  
The North ◽  
South Wales ◽  
Seed Fall ◽  
The Impact

Inputs and losses from Giant Parramatta grass [GPG, Sporobolus indicus (L.) R. Br. var. major (Buse) Baaijens] soil seed banks were quantified on the North Coast of New South Wales. Monthly potential seed production and actual seed fall was estimated at Valla during 1991-92. Total potential production was >668 000 seeds/m2 for the season, while seed fall was >146000 seeds/m2. Seed fall >10000 seeds/m2.month was recorded from January until May, with further seed falls recorded in June and July. The impact of seed production on seed banks was assessed by estimating seed banks in the seed production quadrats before and after seed fall. Seed banks in 4 of the 6 sites decreased in year 2, although seed numbers at 1 damp site increased markedly. Defoliation from mid-December until February, April or June prevented seed production, reducing seed banks by 34% over 7 months. Seed banks in undefoliated plots increased by 3300 seeds/m2, although seed fall was estimated at >114 000 seeds/m2. Emergence of GPG seedlings from artificially established and naturally occurring, persistent seed banks was recorded for 3 years from bare and vegetated treatment plots. Sown seeds showed high levels of innate dormancy and only 4% of seeds emerged when sown immediately after collection. Longer storage of seeds after collection resulted in more seedlings emerging. Estimates of persistent seed banks ranged from 1650 to about 21260 seeds/m2. Most seedlings emerged in spring or autumn and this was correlated with rainfall but not with ambient temperatures. Rates of seed bank decline in both bare and vegetated treatment plots was estimated by fitting exponential decay curves to seed bank estimates. Assuming no further seed inputs, it was estimated that it would take about 3 and 5 years, respectively, for seed banks to decline to 150 seeds/m2 in bare and vegetated treatments.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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