Contrary To Cost-Shift Theory, Lower Medicare Hospital Payment Rates For Inpatient Care Lead To Lower Private Payment Rates

Background: Drugs with anticholinergic properties are known to be associated with deleterious effects on cognition in older adults. There is a paucity of literature in this aspect in older adults with psychiatric disorders. Objective: To examine the anticholinergic cognitive burden and its predictors in hospitalised older adults having psychiatric disorders. Methods: Case records of older adults who sought inpatient care under the Geriatric Psychiatry Unit from January, 2019 to June, 2019 were reviewed. The anticholinergic burden was assessed with Anticholinergic Cognitive Burden (ACB) scale updated version, 2012. Results: Sample included 129 older adults with an almost equal number of males (53.48%) and females (46.52%) having a mean age of 67.84 (SD = 6.96) years. The diagnostic spectrum included depression (34.89%), dementia (31.01%), mania (10.85%), psychosis (13.95%), delirium (6.20%) and others (3.1%). 60.47% of the patients had more than one medical illness. 48.84% of the older adults had clinically relevant anticholinergic cognitive burden ( ACB score ≥ 3). Use of 3 or more psychotropic drugs (OR = 4.88), diagnosis of psychosis/ mania (OR = 7.62) and dementia/ delirium (neurocognitive disorders group) (OR = 5.17) increased the risk of ACB score ≥ 3. Conclusion: Nearly half of the older adults in psychiatry in-patient setting had clinically relevant anticholinergic burden, which was associated with higher use of psychotropics. Our study highlights the importance of monitoring for anticholinergic effects of psychotropics in older adults.

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HUBUNGAN SUPERVISI DAN MOTIVASI DENGAN PEMBERIAN CAIRAN INFUS SESUAI SPO OLEH PERAWAT PELAKSANA

Jurnal Endurance ◽

10.22216/jen.v2i3.1708 ◽

2017 ◽

Vol 2 (3) ◽

pp. 280

Author(s):

Susi Widiawati ◽

Ona Apriana ◽

Diah Merdekawati

Keyword(s):

Medical Care ◽

Inpatient Care ◽

Univariate Analysis ◽

Care Facility ◽

P Value ◽

Intravenous Therapy ◽

Operational Procedure ◽

High Motivation

<p><em>Intravenous therapy (VI) is the therapy frequently used on medical care. More than 60% of clients treated at hospital applied the therapy. The problem found was inappropriate standard operational procedure in applying Intravenous therapy. The purpose of this study was to know the correlation of supervision and motivation in applying Intravenous therapy based on standard operational procedure done by nurse at inpatient care facility of Siloam Hospital, Jambi.Populations were all nurses worked at the hospital. The samples were 51 nurses; it was a total sampling. The result of univariate analysis revealed that the number of respondents who had a good supervision was 30 nurses (58.9%). Meanwhile, the respondents having high motivation were 26 (51%), and the respondents who applied intravenous therapy based on standard operational procedure were 43 nurses (64.3%). The biavariate showed that there was a significant correlation between supervision and applying intravenous therapy based on standard operational procedure (p-value 0.034<0.05) and there was a significant correlation between motivation and applying intravenous therapy based on standard operational procedure (p-value 0.018<0.05). In summary, there was a significant correlation of supervision and motivation in applying Intravenous therapy based on standard operational procedure done by nurse at inpatient care facility of Siloam Hospital Jambi.</em></p>

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Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

BMJ Open ◽

10.1136/bmjopen-2021-049721 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049721

Author(s):

Ioannis Bakolis ◽

Robert Stewart ◽

David Baldwin ◽

Jane Beenstock ◽

Paul Bibby ◽

...

Keyword(s):

Mental Health ◽

Inpatient Care ◽

Service Use ◽

Regression Discontinuity ◽

Mental Healthcare ◽

Service Level ◽

Community Services ◽

Mental Health Service Use ◽

Healthcare Data ◽

Early Intervention In Psychosis

ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participantsMental healthcare data were extracted from 10 UK providers.Outcome measuresDaily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.ResultsPooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.ConclusionsMH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

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Clinical care and other categories posters: Inpatient care

Diabetic Medicine ◽

10.1111/dme.38_14556 ◽

2021 ◽

Vol 38 (S1) ◽

Keyword(s):

Inpatient Care ◽

Clinical Care

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Rights, Redistribution, and the Rise of the “Litigation State”: The Case of Disability Discrimination Laws

Law & Social Inquiry ◽

10.1017/lsi.2020.25 ◽

2021 ◽

pp. 1-38

Author(s):

David Freeman Engstrom ◽

David K. Hausman

Keyword(s):

Empirical Test ◽

State Level ◽

Welfare Programs ◽

Cost Shifting ◽

Disability Discrimination ◽

Social Welfare Programs ◽

Disability Law ◽

Fresh Perspective ◽

Legislative Choice ◽

Cost Shift

Critics have long maintained that the rights revolution and, by extension, the postwar turn to litigation as a regulatory tool, are the product of a cynical legislative choice. On this view, legislators choose rights and litigation over alternative regulatory approaches to shift costs from on-budget forms (for example, publicly funded social provisions, public enforcement actions by prosecutors or agencies) to off-budget forms (for example, rights-based statutory duties, enforced via private lawsuits). This “cost-shift” theory has never been subjected to sustained theoretical scrutiny or comprehensive empirical test. This article offers the first such analysis, examining a context where the cost-shift hypothesis is at its most plausible: disability discrimination laws, which shift costs away from social welfare programs by requiring that employers hire and “accommodate” workers with disabilities. Using a novel dataset of state-level disability discrimination laws enacted prior to the federal-level Americans with Disabilities Act (ADA) and a range of archival and other materials drawn from state-level legislative campaigns, we find only limited support for the view that cost shifting offered at least part of the motivation for these laws. Our findings offer a fresh perspective on long-standing debates about American disability law and politics, including judicial interpretation of the ADA and its state-level analogues and the relationship of disability rights activism to other rights-based political movements.

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