scholarly journals The Payment by Results (PbR) national tariff severely penalises efficiency and early hospital discharge

2009 ◽  
Vol 8 (3) ◽  
pp. 123-126
Author(s):  
Syed Munawer Alam ◽  
◽  
Alex Brown ◽  
Sulleman Moreea ◽  
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Secondary Care ◽  
Healthcare Resource ◽  
Teaching Hospitals ◽  
Short Stay ◽  
Acute Medicine ◽  
Healthcare Resource Groups ◽  
One Year ◽  
Additional Income

The system of Payment by Results (PbR) was instituted in 2005 to reimburse secondary care for its activity. One of the features of PbR is the short stay tariff (SST), in which only 20-50% of the national tariff is paid if patients have a length of stay (LoS) of less than 2 days in hospital for certain Healthcare Resource Groups (HRGs) – or conditions. We analysed the admissions under Acute Medicine at Bradford Teaching Hospitals over a period of one year and identified the HRGs to which the SST applied. We used the 2007 PbR national tariff to calculate the additional income that would have been generated if these patients were kept in hospital for at least 2 days in order to avoid SST. We calculated an extra theoretical income of approximately £5 million if all these patients had a length of stay (LoS) more than 2 days to avoid the SST. Sixteen additional beds (assuming 85% occupancy) would have been required at a cost of around £1million per year to accommodate these patients. We show that the current PbR system is flawed and penalises hospitals with a higher turnover of patients.

Length of Stay, Short Stay Units and Psychiatric Emergency Admissions

1989 ◽  
Vol 34 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Brian Baker ◽  
James Rochon
Keyword(s):  
Length Of Stay ◽  
Metropolitan Area ◽  
Psychiatric Emergency ◽  
Short Stay ◽  
General Hospitals ◽  
Emergency Admissions ◽  
Total Length ◽  
Major Metropolitan Area ◽  
One Year

Length of stay information was collected from 1,364 individuals over a one year period for five general hospitals in a major metropolitan area. The current set of data represents homogeneity in the nature of admissions and the type of facilities examined. Three of the hospitals operated short stay units. Significant differences in the total length of stay were observed according to age, sex and presence of psychosis but there were no unequivocal distinctions between short stay and conventional hospitals.

Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study

2020 ◽  
Author(s):  
Miranda Yelvington ◽  
Matthew Godleski ◽  
Austin F Lee ◽  
Jeremy Goverman ◽  
Ingrid Parry ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Range Of Motion ◽  
Hospital Discharge ◽  
Injury Severity ◽  
Model System ◽  
Future Research ◽  
P Value ◽  
Local Practices ◽  
Improvement Measures ◽  
Joint Motions

Abstract Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

scholarly journals Epidemiology of Endometriosis in France: A Large, Nation-Wide Study Based on Hospital Discharge Data

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Peter von Theobald ◽  
Jonathan Cottenet ◽  
Silvia Iacobelli ◽  
Catherine Quantin
Keyword(s):  
Hospital Discharge ◽  
Temporal Trends ◽  
Hospital Discharge Data ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Discharge Data ◽  
Rehospitalization Rate ◽  
Number Of Patients ◽  
French Hospital ◽  
One Year

We aimed to assess the prevalence of hospitalization for endometriosis in the general population in France and in each French region and to describe temporal trends, rehospitalization rates, and prevalence of the different types of endometriosis. The analyses were carried out on French hospital discharge data and covered the period 2008–2012 and a population of 14,239,197 women of childbearing age. In this population, the prevalence of hospitalization for endometriosis was 0.9%, ranging from 0.4% to 1.6% between regions. Endometriosis affected 1.5% of hospitalized women of childbearing age, ranging from 1.0% to 2.4% between regions. The number of patients hospitalized for endometriosis significantly increased over the study period (p<0.01). Of these, 4.2% were rehospitalized at least once at one year: ranging from 2.7% to 6.3% between regions. The cumulative rehospitalization rate at 3 years was 6.9%. The types of endometriosis according to the procedures performed were as follows: ovarian (40–50%), peritoneal (20–30%), intestinal (10–20%), and ureteral or bladder (<10%), with significant differences between regions. This is the first detailed epidemiological study of endometriosis in France. Further studies are needed to assess the reasons for the increasing prevalence of endometriosis and for the significant differences in regional prevalence of this disease.

scholarly journals Mortality is not increased with Diabetes in Hospitalised Very Old Adults: A multi-site review.

2020 ◽  
Author(s):  
Peter Smerdely
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Negative Binomial ◽  
Negative Impact ◽  
Outcome Data ◽  
Teaching Hospitals ◽  
Very Old ◽  
Old Adults ◽  
Lengths Of Stay ◽  
Hospital Acquired

Abstract Background: Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient.Methods: A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over six years (2012-2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital's electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome. Results: A total of 139130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p<0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p<0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p<0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p=0.523).Conclusion: Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.

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