Sills MR. Inpatient capacity margin at children's hospitals during the fall 2009 H1N1 influenza pandemic. Presentation to the Colorado Emergency Medicine Research Center. 14 June 2010.
Understanding zoonotic impacts: the added value from One Health approachesNaomi Marks
This document discusses the benefits of mass vaccination programs for animal diseases that can infect humans (zoonoses).
It first presents data showing that mass vaccinating 25 million livestock animals in Mongolia against brucellosis would provide over $30 million in total societal benefits, including public health benefits, private health benefits, reduced household income loss, and agricultural benefits.
It then uses a mathematical model to show that mass dog vaccination is less costly than human post-exposure prophylaxis for controlling rabies transmission between dogs and humans.
Finally, it references a study that found an approach combining dog and human vaccination for rabies control in N'Djaména to be more cost-effective than human
Lorenzo Damia - Anomalie dentarie e problematiche ortognatodonticheDr. Lorenzo Damia
Pubblicazione "Anomalie dentarie e problematiche ortognatodontiche" a cura di G.L. Caccianica e Lorenzo Damia.
Le anomalie dentarie possono costituire un elemento condizionante lo svolgimento della terapia ortognatodontica.
This document analyzes the performance of major ports in India. It finds that while India has experienced rapid economic growth in recent years, the average turnaround time of cargo ships at major Indian ports is much higher than other countries like Hong Kong, undermining India's competitiveness. Major issues include inadequate road and rail links between ports and their hinterlands, leading to cargo congestion. The government has taken steps to improve connectivity and encourage private sector participation in port operations and services. Overall cargo traffic at Indian ports has grown in recent years, correlated with GDP growth. Changing trade patterns are also influencing cargo volumes and mixes.
Louis did a series called "When Louis Met..." from 2000-2002 for BBC Two and also directed specials including "Louis and the Brothel" and "Transgender Kids". His most famous work is the documentary "Fahrenheit 9/11" which he directed and produced and is the highest grossing documentary of all time.
Urodził się 23 marca 1910 w Omori jako ostatnie
z siedmiorga dzieci rodziny o tradycjach
samurajskich. Zainteresował się kinem dzięki
starszemu bratu. Heigo Kurosawa był aktorem i
podkładał głos postaci niemych filmów. Gdy
zaczęto nagrywać udźwiękowione filmy, stracił
pracę i z tego powodu popełnił samobójstwo.
Drugim traumatyczyn doświadczeniem Akiry
było trzęsienie ziemi, które nawiedziło Tokio w
1923 roku. Był świadkiem przemiany Japonii ze
słabo rozwiniętego kraju w potęgę ekonomiczną.
1) Studies by Harvard Medical School and Brigham and Women's Hospital found that male pattern baldness is linked to an increased risk of heart disease, with the risk increasing based on the extent of hair loss.
2) Men with hair loss on the top of their head had a 23% increased risk of heart conditions, while men who had lost hair from most of the crown had a 36% increased risk.
3) Male pattern baldness is linked to higher levels of testosterone, which can increase heart disease risks by raising blood pressure and cholesterol levels.
Understanding zoonotic impacts: the added value from One Health approachesNaomi Marks
This document discusses the benefits of mass vaccination programs for animal diseases that can infect humans (zoonoses).
It first presents data showing that mass vaccinating 25 million livestock animals in Mongolia against brucellosis would provide over $30 million in total societal benefits, including public health benefits, private health benefits, reduced household income loss, and agricultural benefits.
It then uses a mathematical model to show that mass dog vaccination is less costly than human post-exposure prophylaxis for controlling rabies transmission between dogs and humans.
Finally, it references a study that found an approach combining dog and human vaccination for rabies control in N'Djaména to be more cost-effective than human
Lorenzo Damia - Anomalie dentarie e problematiche ortognatodonticheDr. Lorenzo Damia
Pubblicazione "Anomalie dentarie e problematiche ortognatodontiche" a cura di G.L. Caccianica e Lorenzo Damia.
Le anomalie dentarie possono costituire un elemento condizionante lo svolgimento della terapia ortognatodontica.
This document analyzes the performance of major ports in India. It finds that while India has experienced rapid economic growth in recent years, the average turnaround time of cargo ships at major Indian ports is much higher than other countries like Hong Kong, undermining India's competitiveness. Major issues include inadequate road and rail links between ports and their hinterlands, leading to cargo congestion. The government has taken steps to improve connectivity and encourage private sector participation in port operations and services. Overall cargo traffic at Indian ports has grown in recent years, correlated with GDP growth. Changing trade patterns are also influencing cargo volumes and mixes.
Louis did a series called "When Louis Met..." from 2000-2002 for BBC Two and also directed specials including "Louis and the Brothel" and "Transgender Kids". His most famous work is the documentary "Fahrenheit 9/11" which he directed and produced and is the highest grossing documentary of all time.
Urodził się 23 marca 1910 w Omori jako ostatnie
z siedmiorga dzieci rodziny o tradycjach
samurajskich. Zainteresował się kinem dzięki
starszemu bratu. Heigo Kurosawa był aktorem i
podkładał głos postaci niemych filmów. Gdy
zaczęto nagrywać udźwiękowione filmy, stracił
pracę i z tego powodu popełnił samobójstwo.
Drugim traumatyczyn doświadczeniem Akiry
było trzęsienie ziemi, które nawiedziło Tokio w
1923 roku. Był świadkiem przemiany Japonii ze
słabo rozwiniętego kraju w potęgę ekonomiczną.
1) Studies by Harvard Medical School and Brigham and Women's Hospital found that male pattern baldness is linked to an increased risk of heart disease, with the risk increasing based on the extent of hair loss.
2) Men with hair loss on the top of their head had a 23% increased risk of heart conditions, while men who had lost hair from most of the crown had a 36% increased risk.
3) Male pattern baldness is linked to higher levels of testosterone, which can increase heart disease risks by raising blood pressure and cholesterol levels.
This document summarizes alternative energy sources as a replacement for fossil fuels, with a special focus on solar energy. It notes that fossil fuels are finite and their combustion contributes to global warming. Renewable sources like solar, wind, hydro and biomass could meet increasing energy demand in a more sustainable way. Solar energy in particular is highlighted as a promising alternative that can be harnessed through solar panels or collectors and has many environmental benefits compared to fossil fuels.
LTE is an advanced technology that improves upon 3G networks by offering faster speeds and new services through optimized internet protocol. It employs OFDMA for downlink transmission and SC-FDMA for uplink, along with MIMO antenna technology. LTE can deliver peak download speeds of 100 Mbps and upload speeds of 50 Mbps with latency under 15 ms, using scalable bandwidth from 1.25-20 MHz.
The document discusses possible occurrences of transition zones and residual oil zones below oil-water contacts in mature oil fields in southeast Saskatchewan. It identifies four oil pools with potential transition/residual oil zones, and provides evidence from well logs, cores, and fluorescence tests. Estimates indicate the oil initially in place within identified transition/residual zones could be around half the amount stored in the pools' moveable oil zones. The document considers potential origins of the zones but does not draw conclusions, noting post-entrapment changes and water flows in the basin could have led to residual oil formation.
1. Tire manufacturing involves preparing rubber components, assembling them into raw tires, and vulcanizing the tires through heating and curing them in molds.
2. A major energy user is rubber compounding where ingredients are intensively mixed. Electric motors used account for 35-55% of total factory energy.
3. In curing, green tires are placed in molds and heated to around 200°C for 10 minutes using steam or hot water, chemically transforming the rubber through vulcanization. This process accounts for significant energy use.
Dr. Ebba Ossiannilsson has extensive experience in online learning, open education, open educational resources (OER), MOOCs, and quality assurance. She holds positions at multiple universities and organizations related to these areas. The document outlines her qualifications and roles promoting openness in education through digital technologies and OER.
H1N1 Influenza: a descriptive study of the response of an influenza assessmen...Jamie Ranse
The document summarizes a study of an Influenza Assessment Clinic (IAC) that collaborated with an emergency department in Australia during the 2009 H1N1 influenza pandemic. Over 1,100 patients presented to the IAC and ED with influenza-like symptoms between June 3 and July 3, 2009. Most patients presented in the morning. Those presenting to the ED were younger on average than those presenting to the IAC. The IAC had a higher proportion of discharges compared to admissions, with a ratio of admissions to discharges of 1:16 across both facilities. The caseload was shared between the IAC and ED as expected based on the streaming of patients.
The addition of a vaccine patrol team at Fairview Hospital led to an increased pneumococcal vaccination rate among adult inpatients. During a four week trial period, the vaccine patrol team, consisting of a nurse practitioner and intern, was able to administer pneumococcal vaccines to 75% of eligible adult inpatients. Common barriers to vaccination identified were inability to communicate with patients, nurses forgetting to order the vaccine, and patients being discharged before vaccination. The patrol team recommends modifications to the electronic medical record to help address these barriers and further increase vaccination rates.
Here are the calculations for the surveillance rates:
1. Nosocomial sepsis rate (Prevalence rate)
Number of at-risk patients in one month: 242
Number of sepsis cases: 15
Prevalence Rate = Number of sepsis cases / Number of at-risk patients x 100%
= 15 / 242 x 100% = 6.2%
2. Procedure-specific SSI rate (Incidence rate)
Number of cesarean section operations in one month: 50
Total Number of New Skin/Soft tissue infections: 5
Incidence Rate = Number of new SSI / Number of cesarean sections performed x 100%
= 5 / 50 x 100% = 10%
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Chapter 3Measures of Morbidity and Mortality Used in .docxketurahhazelhurst
Chapter 3
Measures of Morbidity and
Mortality Used in
Epidemiology
Learning Objectives
• Define and distinguish among ratios,
proportions, and rates
• Explain the term population at risk
• Identify and calculate commonly used
rates for morbidity, mortality, and natality
• State the meanings and applications of
incidence rates and prevalence
Learning Objectives (cont’d)
• Discuss limitations of crude rates and
alternative measures for crude rates
• Apply direct and indirect methods to
adjust rates
• List situations where direct and indirect
adjustment should be used
Overview of Epidemiologic
Measures
Count
• The simplest and most frequently
performed quantitative measure in
epidemiology.
• Refers to the number of cases of a
disease or other health phenomenon
being studied.
Examples of Counts
• Cases of influenza reported in
Westchester County, New York,
during January of a particular year.
• Traffic fatalities in Manhattan in a 24-
hour time period
• College dorm students who had mono
• Foreign-born stomach cancer patients
Ratio
• The value obtained by dividing one
quantity by another.
• Consists of a numerator and a
denominator.
• The most general form has no specified
relationship between numerator and
denominator.
• Rates, proportions, and percentages are
also ratios.
Example of a
Simple Sex Ratio Calculation
• A ratio may be expressed at = X/Y
• Simple sex ratio (data from textbook)
• Of 1,000 motorcycle fatalities, 950 victims
are men and 50 are women.
Number of male cases 950
Number of female cases 50
19:1 male to female= =
Example of a
Demographic Sex Ratio Calculation
• This ratio refers to the number of
males per 100 females. In the U.S.,
the sex ratio in 2010 for the entire
population was 96.7, indicating more
females than males.
Number of male cases 151,781,326
Number of female cases 156,964,212
96.7X 100 = =X 100
Example of a
Sex Ratio at Birth Calculation
• The sex ratio at birth is defined as:
(the number of male births divided by
the number of female births)
multiplied by 1,000.
Number of male births
Number of female births
X 1,000
Definition of Proportion
• A measure that states a count relative
to the size of the group.
• A ratio in which the numerator is part
of the denominator.
• May be expressed as a percentage.
Uses of Proportions
• Can demonstrate the magnitude of a
problem.
• Example: 10 dormitory students
develop hepatitis. How important is
this problem?
– If only 20 students live in the dorm, 50%
are ill.
– If 500 students live in the dorm, 2% are
ill.
Example of a Proportion
• Calculate the proportion of African-
American male deaths among African-
American and white boys aged 5 to 14
years.
Rate
• Definition: a ratio that consists of a
numerator and a denominator and in
which time forms part of the denominat ...
This study analyzed data from the National Inpatient Sample from 2012-2013 to examine the impact of postpartum hemorrhage (PPH) on hospital length of stay and inpatient mortality in the United States. The results showed that PPH was associated with a small but statistically significant longer hospital length of stay compared to non-PPH deliveries. PPH, especially non-atonic PPH, was also associated with higher rates of inpatient mortality. However, the overall mortality rates were low, reflecting recent improvements in managing PPH. This large study provided novel insights into how PPH affects both length of hospitalization and mortality in the United States.
This document summarizes the work of Dr. Elizabeth Alpern and the Pediatric Emergency Care Applied Research Network (PECARN) to develop an emergency care visit registry using data from electronic health records. The registry collects over 60 quality performance measures across multiple pediatric emergency departments. It provides timely reports to individual clinicians and sites on their performance benchmarks compared to peers. The registry data has been used to study topics like antibiotic prescribing patterns and identify opportunities to improve sepsis screening and management. The goal is to continuously evaluate and improve pediatric emergency care through data-driven quality improvement efforts.
This document summarizes research on predicting COVID-19 recovery rates. It first analyzes the relationship between medical resources (physician and hospital bed densities) and recovery rates, finding no significant impact. A second analysis examines country development level (GDP and life expectancy) and finds a significant association, with higher development linked to higher recovery. A multiple regression model is developed to predict recovery rates based on these development variables and medical resources. In conclusion, country development level but not solely medical resources appears to impact COVID-19 recovery rates.
Medical Surveillance and Outbreaks of Disease.pdfLuckyBoyCount
This document discusses key concepts in medical surveillance and epidemiology including:
- Medical surveillance involves the continuous collection of health data from a target population to identify disease patterns and outbreaks for prevention and control.
- Rates, proportions, and percentages are numerical metrics used to represent epidemiological findings. A rate is a ratio comparing two health measures over time.
- Morbidity refers to disease burden while mortality refers to deaths. Incidence measures new cases over time while prevalence measures all current cases.
- Correct classification of disease, symptoms, and exposures is important for epidemiological studies, as misclassification can bias results.
This document discusses preparations for COVID-19 vaccination at community health centers. It recommends forming a central task force to plan vaccination efforts, leverage existing infrastructure for flu shots and testing, and communicate with partners. The task force should plan for various scenarios around vaccine availability and prioritization. Advanced preparation is needed for vaccine storage, supplies, staffing, and high-volume clinics. Partnerships with government will be important to advocate for community health center patients and capabilities to administer vaccines at large scale.
This document summarizes alternative energy sources as a replacement for fossil fuels, with a special focus on solar energy. It notes that fossil fuels are finite and their combustion contributes to global warming. Renewable sources like solar, wind, hydro and biomass could meet increasing energy demand in a more sustainable way. Solar energy in particular is highlighted as a promising alternative that can be harnessed through solar panels or collectors and has many environmental benefits compared to fossil fuels.
LTE is an advanced technology that improves upon 3G networks by offering faster speeds and new services through optimized internet protocol. It employs OFDMA for downlink transmission and SC-FDMA for uplink, along with MIMO antenna technology. LTE can deliver peak download speeds of 100 Mbps and upload speeds of 50 Mbps with latency under 15 ms, using scalable bandwidth from 1.25-20 MHz.
The document discusses possible occurrences of transition zones and residual oil zones below oil-water contacts in mature oil fields in southeast Saskatchewan. It identifies four oil pools with potential transition/residual oil zones, and provides evidence from well logs, cores, and fluorescence tests. Estimates indicate the oil initially in place within identified transition/residual zones could be around half the amount stored in the pools' moveable oil zones. The document considers potential origins of the zones but does not draw conclusions, noting post-entrapment changes and water flows in the basin could have led to residual oil formation.
1. Tire manufacturing involves preparing rubber components, assembling them into raw tires, and vulcanizing the tires through heating and curing them in molds.
2. A major energy user is rubber compounding where ingredients are intensively mixed. Electric motors used account for 35-55% of total factory energy.
3. In curing, green tires are placed in molds and heated to around 200°C for 10 minutes using steam or hot water, chemically transforming the rubber through vulcanization. This process accounts for significant energy use.
Dr. Ebba Ossiannilsson has extensive experience in online learning, open education, open educational resources (OER), MOOCs, and quality assurance. She holds positions at multiple universities and organizations related to these areas. The document outlines her qualifications and roles promoting openness in education through digital technologies and OER.
H1N1 Influenza: a descriptive study of the response of an influenza assessmen...Jamie Ranse
The document summarizes a study of an Influenza Assessment Clinic (IAC) that collaborated with an emergency department in Australia during the 2009 H1N1 influenza pandemic. Over 1,100 patients presented to the IAC and ED with influenza-like symptoms between June 3 and July 3, 2009. Most patients presented in the morning. Those presenting to the ED were younger on average than those presenting to the IAC. The IAC had a higher proportion of discharges compared to admissions, with a ratio of admissions to discharges of 1:16 across both facilities. The caseload was shared between the IAC and ED as expected based on the streaming of patients.
The addition of a vaccine patrol team at Fairview Hospital led to an increased pneumococcal vaccination rate among adult inpatients. During a four week trial period, the vaccine patrol team, consisting of a nurse practitioner and intern, was able to administer pneumococcal vaccines to 75% of eligible adult inpatients. Common barriers to vaccination identified were inability to communicate with patients, nurses forgetting to order the vaccine, and patients being discharged before vaccination. The patrol team recommends modifications to the electronic medical record to help address these barriers and further increase vaccination rates.
Here are the calculations for the surveillance rates:
1. Nosocomial sepsis rate (Prevalence rate)
Number of at-risk patients in one month: 242
Number of sepsis cases: 15
Prevalence Rate = Number of sepsis cases / Number of at-risk patients x 100%
= 15 / 242 x 100% = 6.2%
2. Procedure-specific SSI rate (Incidence rate)
Number of cesarean section operations in one month: 50
Total Number of New Skin/Soft tissue infections: 5
Incidence Rate = Number of new SSI / Number of cesarean sections performed x 100%
= 5 / 50 x 100% = 10%
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Chapter 3Measures of Morbidity and Mortality Used in .docxketurahhazelhurst
Chapter 3
Measures of Morbidity and
Mortality Used in
Epidemiology
Learning Objectives
• Define and distinguish among ratios,
proportions, and rates
• Explain the term population at risk
• Identify and calculate commonly used
rates for morbidity, mortality, and natality
• State the meanings and applications of
incidence rates and prevalence
Learning Objectives (cont’d)
• Discuss limitations of crude rates and
alternative measures for crude rates
• Apply direct and indirect methods to
adjust rates
• List situations where direct and indirect
adjustment should be used
Overview of Epidemiologic
Measures
Count
• The simplest and most frequently
performed quantitative measure in
epidemiology.
• Refers to the number of cases of a
disease or other health phenomenon
being studied.
Examples of Counts
• Cases of influenza reported in
Westchester County, New York,
during January of a particular year.
• Traffic fatalities in Manhattan in a 24-
hour time period
• College dorm students who had mono
• Foreign-born stomach cancer patients
Ratio
• The value obtained by dividing one
quantity by another.
• Consists of a numerator and a
denominator.
• The most general form has no specified
relationship between numerator and
denominator.
• Rates, proportions, and percentages are
also ratios.
Example of a
Simple Sex Ratio Calculation
• A ratio may be expressed at = X/Y
• Simple sex ratio (data from textbook)
• Of 1,000 motorcycle fatalities, 950 victims
are men and 50 are women.
Number of male cases 950
Number of female cases 50
19:1 male to female= =
Example of a
Demographic Sex Ratio Calculation
• This ratio refers to the number of
males per 100 females. In the U.S.,
the sex ratio in 2010 for the entire
population was 96.7, indicating more
females than males.
Number of male cases 151,781,326
Number of female cases 156,964,212
96.7X 100 = =X 100
Example of a
Sex Ratio at Birth Calculation
• The sex ratio at birth is defined as:
(the number of male births divided by
the number of female births)
multiplied by 1,000.
Number of male births
Number of female births
X 1,000
Definition of Proportion
• A measure that states a count relative
to the size of the group.
• A ratio in which the numerator is part
of the denominator.
• May be expressed as a percentage.
Uses of Proportions
• Can demonstrate the magnitude of a
problem.
• Example: 10 dormitory students
develop hepatitis. How important is
this problem?
– If only 20 students live in the dorm, 50%
are ill.
– If 500 students live in the dorm, 2% are
ill.
Example of a Proportion
• Calculate the proportion of African-
American male deaths among African-
American and white boys aged 5 to 14
years.
Rate
• Definition: a ratio that consists of a
numerator and a denominator and in
which time forms part of the denominat ...
This study analyzed data from the National Inpatient Sample from 2012-2013 to examine the impact of postpartum hemorrhage (PPH) on hospital length of stay and inpatient mortality in the United States. The results showed that PPH was associated with a small but statistically significant longer hospital length of stay compared to non-PPH deliveries. PPH, especially non-atonic PPH, was also associated with higher rates of inpatient mortality. However, the overall mortality rates were low, reflecting recent improvements in managing PPH. This large study provided novel insights into how PPH affects both length of hospitalization and mortality in the United States.
This document summarizes the work of Dr. Elizabeth Alpern and the Pediatric Emergency Care Applied Research Network (PECARN) to develop an emergency care visit registry using data from electronic health records. The registry collects over 60 quality performance measures across multiple pediatric emergency departments. It provides timely reports to individual clinicians and sites on their performance benchmarks compared to peers. The registry data has been used to study topics like antibiotic prescribing patterns and identify opportunities to improve sepsis screening and management. The goal is to continuously evaluate and improve pediatric emergency care through data-driven quality improvement efforts.
This document summarizes research on predicting COVID-19 recovery rates. It first analyzes the relationship between medical resources (physician and hospital bed densities) and recovery rates, finding no significant impact. A second analysis examines country development level (GDP and life expectancy) and finds a significant association, with higher development linked to higher recovery. A multiple regression model is developed to predict recovery rates based on these development variables and medical resources. In conclusion, country development level but not solely medical resources appears to impact COVID-19 recovery rates.
Medical Surveillance and Outbreaks of Disease.pdfLuckyBoyCount
This document discusses key concepts in medical surveillance and epidemiology including:
- Medical surveillance involves the continuous collection of health data from a target population to identify disease patterns and outbreaks for prevention and control.
- Rates, proportions, and percentages are numerical metrics used to represent epidemiological findings. A rate is a ratio comparing two health measures over time.
- Morbidity refers to disease burden while mortality refers to deaths. Incidence measures new cases over time while prevalence measures all current cases.
- Correct classification of disease, symptoms, and exposures is important for epidemiological studies, as misclassification can bias results.
This document discusses preparations for COVID-19 vaccination at community health centers. It recommends forming a central task force to plan vaccination efforts, leverage existing infrastructure for flu shots and testing, and communicate with partners. The task force should plan for various scenarios around vaccine availability and prioritization. Advanced preparation is needed for vaccine storage, supplies, staffing, and high-volume clinics. Partnerships with government will be important to advocate for community health center patients and capabilities to administer vaccines at large scale.
2. Measurements of Morbidity and Mortality.pptxFerhanKadir
The most ambitious definition of health is that proposed by WHO in 1948: “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” but,
Practical definitions of health and disease are needed in epidemiology, which concentrates on aspects of health that are easily measurable and amenable to improvement.
Definitions of health states used by epidemiologists tend to be simple, for example, “disease present” or “disease absent”
1. Hospital statistics provide key information for health care decision-makers by analyzing clinical and financial data from hospitals. They summarize metrics like patient volumes, diagnoses, procedures, and revenue.
2. Core hospital statistics include administrative data on available beds, patient occupancy rates, and surgical volumes. Morbidity and mortality statistics track leading causes of illness and death by sex.
3. Calculating indicators such as average length of stay, bed turnover rate, and occupancy percentage helps monitor service delivery, plan facilities, and evaluate policies. However, hospital data only reflects patients seeking care and may not represent overall disease burdens.
1. Hospital statistics provide key information for health care decision-makers by analyzing clinical and financial data from hospitals. They summarize metrics like patient volumes, diagnoses, procedures, and revenue.
2. Core hospital statistics include administrative data on available beds, patient occupancy rates, and surgical volumes. Morbidity and mortality statistics track leading causes of illness and death by sex.
3. Calculating indicators such as average length of stay, bed turnover rate, and occupancy percentage helps monitor service delivery, plan facilities, and evaluate policies. However, hospital data only reflects patients seeking care and may not represent overall disease burdens.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Hospice can help reduce hospital readmissions and lengths of stay for patients with serious illnesses like heart failure. By providing comprehensive care, including nursing support 24 hours a day, palliative care physician support, medications, equipment, and targeted programs for conditions like CHF, hospice can help meet patient goals of comfort and avoiding inappropriate hospitalizations. For the patient with heart failure described in the case study, hospice could help prevent readmissions and allow the patient to focus on quality of life rather than further medical interventions by providing end-of-life care in their home.
The document outlines the steps for investigating an epidemic, including verifying diagnoses, confirming the existence of an epidemic, defining the population at risk, rapidly searching for all cases and their characteristics, analyzing data, formulating and testing hypotheses, evaluating ecological factors, further investigating the population at risk, and writing a report of the investigation. The goal of the investigation is to determine the cause, source, and mode of transmission of the epidemic in order to implement control measures and prevent future recurrence.
This document discusses analyzing categorical variables in healthcare data. It describes descriptive statistics like frequency distributions and charts that can be used to describe nominal and ordinal categorical variables. Contingency tables can be used to analyze relationships between two categorical variables. Inferential statistics like hypothesis testing can determine if relationships seen in sample data provide sufficient evidence of relationships in the overall population. Various types of rates used in healthcare like utilization rates and population health rates are also presented. Examples are provided to illustrate calculating different rates and performing hypothesis tests on proportions.
This document discusses analyzing categorical variables in healthcare data. It describes descriptive statistics like frequency distributions and charts that can be used to describe nominal and ordinal categorical variables. Contingency tables can be used to analyze relationships between two categorical variables. Inferential statistics like hypothesis testing can determine if relationships seen in sample data provide sufficient evidence of relationships in the overall population. Various types of rates used in healthcare like utilization rates and population health rates are also presented. Examples are provided to illustrate calculating different rates and performing hypothesis tests on proportions.
This document discusses the hospitalist model and debunks myths about it. It summarizes research showing that hospitalists can reduce length of stay and costs without harming quality of care. While primary care physicians initially had concerns about loss of continuity and poor communication, studies show patient, family, and physician satisfaction are preserved or improved with hospitalists. For hospitals, hospitalists can increase efficiency and market share. The model has grown significantly since being introduced.
Measuring and Enhancing Your Academic Medical ImpactMarion Sills
Overview of measuring and enhancing the impact of your scholarly work in academic medicine. The talk reviews how impact is defined and measured, how to improve your own impact metrics and how to describe the impact of your scholarly contributions to science.
Adding Social Determinant Data Changes Children’s Hospitals’ Readmissions Per...Marion Sills
Adding social determinant data to risk adjustment models for pediatric readmissions led to minimal changes in model performance at the discharge level, but resulted in changes to hospital performance rankings. Specifically:
- Adding social determinant variables from electronic health records and zip codes to existing clinical risk adjustment models did not meaningfully improve the accuracy or fit of models predicting individual readmissions.
- However, accounting for social determinants did change some hospitals' risk-adjusted readmission rates and performance deciles compared to peers. This suggests social determinants may influence hospital performance evaluations and penalties if unadjusted.
- Including social determinants in readmissions modeling more fully captures factors influencing readmissions and provides a more accurate assessment of hospital quality.
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
Practice Variability in and Correlates of Patient-Centered Medical Home Chara...Marion Sills
Schilling LM, Sills MR, Fairclough D, Kwan MB. Practice Variability in and Correlates of Patient-Centered Medical Home Characteristics. SAFTINet Convocation. Aurora, Colorado. 13 Feb 2013.
This document describes the design and methods of a prospective cohort study examining the association between practice-level medical home characteristics and asthma outcomes in children and adults. The study will use surveys of medical home characteristics and secondary data from 2011-2013. Asthma control and exacerbations will be measured repeatedly from July 2012 to December 2013. Hierarchical linear models will assess the relationship between medical home scores and asthma outcomes, adjusting for potential confounders. Sensitivity analyses will address issues like misclassification bias. Results will be presented separately for children and adults.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Patient-reported outcomes for asthma in children and adultsMarion Sills
Patient-reported outcomes for asthma in children and adults. Guided Discussion to Facilitate SAFTINet Stakeholders' Selection of an Asthma PROM. Teleconference. 1 April 2011
Sills MR. Cardiovascular Cohorts PROM Measures Updates and Action Items. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholder Community. 21 March 2012.
Sills MR. Evolution of PRO Measure for Cardiovascular Cohorts in SAFTINet. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 2 May 2012.
Sills MR. Medication Adherence PROM Measures Updates and Pilot Results. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection and Refinement by SAFTINet Stakeholders. 2 July 2012.
Sills MR. Medication Adherence PROM Measures and Self Efficacy. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 21 May 2012.
Cer safti net overview edrc 1 feb 2011Marion Sills
Sills MR. Overview of Comparative Effectiveness Research Using SAFTINet as an Example. Methods Talk presented to the Emergency Department Research Conference, Department of Pediatrics, 1 February 2011.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
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CEMRC H1N1 Presentation 20100614
1. Inpatient capacity margin at
children's hospitals during the
fall 2009 H1N1 influenza
pandemic
Marion R. Sills, MD, MPH,
2. Objectives
• Objectives:
Compare occupancy—non-ICU and ICU—during the fall
2009 pandemic to baseline numbers
Measure how close each hospital came to threshold
occupancy—non-ICU and ICU
Measure how much of an increase in ED admissions it
would have taken to fill each hospital (and each ICU)
3. Background
• March 2009: “swine flu” reported with 6% case fatality rate in
Mexico; Mexico City shut down
• April 2009: public health emergency declared in US
• April 2010: CDC estimate of
H1N1 case fatality rate in US: 0.02% (0.006% in children 0-17 years)
H1N1 case hospitalization rate: 0.45% (0.44% in children 0-17 years)
6. Methods
• Inpatient data from Pediatric Health Information System
(PHIS) database
• 41 children’s hospitals
7. Methods
Data
• All hospitalizations
Non-ICU bed-days
ICU bed-days
• Known # active beds
• Historic occupancy
data
• All ED visits for
influenza-like-illness
(23 hospitals)
Calculate
• Percent occupancy
by day (non-ICU,
ICU)
• ED ILI admission rate
8. Methods
• Objective 1: Compare occupancy—non-ICU and ICU—during
the fall 2009 pandemic to baseline numbers
• Same weeks (35-45) for 2008 (charted below)
• Seasonal flu (weeks 4-11 of 2009) for 2008-09
9. Methods
• Objective 2: Measure how close each hospital came to
threshold occupancy—non-ICU and ICU
• 2 definitions of threshold occupancy:
Normative: 100% of all active beds occupied
Relative: the own-hospital 95th percentile of occupancy (2008)
10. Methods
• Objective 2: Measure how close each hospital came to
threshold occupancy—non-ICU and ICU
How best to express this?
• Proportion of days over threshold occupancy during pandemic period?
• Some component of duration: X weeks of Y% of days over threshold?
• Number of bed-days that could have been filled daily before threshold
occupancy was reached?
• Number of additional patients that could have been accepted daily
before threshold occupancy was reached?
12. Methods
• Part of the story: many children’s hospitals are already
nearing or over threshold occupancy (2006 data)
13. Methods
Objective 3: Measure how much of an increase in ED
admissions it would have taken to fill each hospital (and each
ICU)
For each hospital, calculate actual ED-to-non-ICU and ED-to-
ICU admit rate among all patients with ILI
Calculate how much higher this rate would have had to be to
fill all beds
Select a bad flu year (pandemic flu year? recent seasonal flu
year?) and re-do the modeling for Objective 2 to show how
full hospitals would have been, and how many excess beds
we would have needed (i.e., how many would have boarded
in the ED)
14. Methods
Objective 3: Measure how much of an increase in ED
admissions it would have taken to fill each hospital (and each
ICU)
Assumptions:
• All ED-to-hospital admissions with discharge diagnosis of
ILI had H1N1 influenza
• All inpatients with influenza were admitted via that
hospital’s ED
• ED-to-hospital admissions were distributed evenly
throughout the study period