Impact of vertical integration on the readmission of individuals with chronic...Óscar Brito Fernandes
INTRODUCTION: Ageing populations and the increasing prevalence of multimorbidity are a challenge for healthcare delivery and health system design. Integrated care has been discussed as a solution to address these challenges. In Portugal, Local Health Units (LHU) promote vertical integration of healthcare, with one of the expected effects being a decrease of readmission rates in individuals with chronic conditions. Readmissions are frequently studied for its negative impacts on individuals, carers, and providers, with excessive unplanned readmission rates among hospitals being a sign of frail integrated care. Thus, we assume as the main aim of this study to assess the impact of vertical integration on the readmission of individuals with chronic conditions.
METHODS: A database including administrative data from 1 679 634 inpatient episodes from years 2002-14 was considered. We identified readmissions with the hospital-wide all-cause unplanned readmission measure methodology of Centers for Medicare and Medicaid Services. The considered outcome was 30-day hospital-wide all-cause unplanned readmissions (1: readmitted), and risk-standardized readmission ratio. Chronic conditions were identified from all diagnoses coded with International Classification of Diseases – 9th version – Clinical Modification codes (1: chronic). In order to assess the impact of LHU on the readmission of individuals with chronic conditions, we compared 30-day readmissions before and after the creation of each LHU. We used difference-in- differences technique to address our main aim. In addition, to understand the associations between individuals’ risk factors and time to readmission, we developed a Cox regression model for LHU and control group.
RESULTS: Difference-in-differences results suggest that vertical integration promoted a decrease on risk-standardized readmission ratio in four LHU, but significant only in LHU 1. In addition, when analysed the individual risk of readmission we observed that it was reduced for four LHU, but only significantly for LHU 3 and LHU 5. A sensitivity analysis was performed for annual evolution of odds ratio of risk of readmission, and initial results were considered stable for most years. Cox regression results suggest that for LHU and control hospitals, female individuals were less at risk of readmission than men, the risk increased with increasing age and number of comorbidities. At LHU, we observed a decreased risk of readmission with increasing number of chronic conditions.
This document summarizes a study that assessed the quality of life of 100 glaucoma patients using the WHOQOL-Bref questionnaire. The study found that glaucoma patients had significantly lower quality of life scores than healthy controls in the physical, mental, social, and environmental domains. Among socio-demographic factors, quality of life was lower in older patients and those with lower socioeconomic status. Several clinical factors, such as severity of glaucoma, were also associated with lower quality of life. The study concludes that glaucoma significantly impacts patients' quality of life and that socio-demographic and clinical factors should be considered in glaucoma management.
This meta-analysis reviewed 15 randomized controlled trials involving over 188,000 participants to determine the effect of antioxidant vitamin supplementation on cardiovascular outcomes. The trials assessed supplements containing vitamin E, beta-carotene, and/or vitamin C compared to placebo. The analysis found that antioxidant vitamin supplementation had no significant effect on major cardiovascular events, myocardial infarction, stroke, total death, cardiac death, or other outcomes. There was no evidence that antioxidant vitamin supplements provide cardiovascular benefits.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
The International Journal of Engineering & Science is aimed at providing a platform for researchers, engineers, scientists, or educators to publish their original research results, to exchange new ideas, to disseminate information in innovative designs, engineering experiences and technological skills. It is also the Journal's objective to promote engineering and technology education. All papers submitted to the Journal will be blind peer-reviewed. Only original articles will be published.
This document summarizes a systematic review of randomized controlled trials evaluating natural products for the treatment of chronic plaque psoriasis. Three studies with a total of 127 participants were included that evaluated Mahonia aquifolium, topical Aloe vera, and Chinese herbal medicines. Results were mixed, with one study finding improvement in psoriasis severity with Aloe vera compared to conventional treatment at 2 months, but another found Chinese herbal medicines were less effective than conventional treatment at 6 months. Adverse events were similar between natural products and conventional treatments in one study. Quality of life measures did not differ. Due to variability in natural products studied and limited evidence, applicability and safety of natural products for psor
The job satisfaction of physicians is an important factor that influences their motivation for work and the quality of the provided health services. The aim of the study is to evaluate the job satisfaction of General Practitioners in Bulgaria and to explore some of the factors which influence this satisfaction.
This document summarizes current recommendations and gaps regarding extrapolation of time-to-event outcomes from clinical trials. It reviewed 11 methodological papers and 5 guidelines on extrapolating survival data. The guidelines, particularly from NICE, provide a detailed process for extrapolation including testing different survival models, validating the best fitting model, and using external data for validation. However, the guidelines need updating to apply to more disease areas beyond oncology and different time-to-event outcomes.
Impact of vertical integration on the readmission of individuals with chronic...Óscar Brito Fernandes
INTRODUCTION: Ageing populations and the increasing prevalence of multimorbidity are a challenge for healthcare delivery and health system design. Integrated care has been discussed as a solution to address these challenges. In Portugal, Local Health Units (LHU) promote vertical integration of healthcare, with one of the expected effects being a decrease of readmission rates in individuals with chronic conditions. Readmissions are frequently studied for its negative impacts on individuals, carers, and providers, with excessive unplanned readmission rates among hospitals being a sign of frail integrated care. Thus, we assume as the main aim of this study to assess the impact of vertical integration on the readmission of individuals with chronic conditions.
METHODS: A database including administrative data from 1 679 634 inpatient episodes from years 2002-14 was considered. We identified readmissions with the hospital-wide all-cause unplanned readmission measure methodology of Centers for Medicare and Medicaid Services. The considered outcome was 30-day hospital-wide all-cause unplanned readmissions (1: readmitted), and risk-standardized readmission ratio. Chronic conditions were identified from all diagnoses coded with International Classification of Diseases – 9th version – Clinical Modification codes (1: chronic). In order to assess the impact of LHU on the readmission of individuals with chronic conditions, we compared 30-day readmissions before and after the creation of each LHU. We used difference-in- differences technique to address our main aim. In addition, to understand the associations between individuals’ risk factors and time to readmission, we developed a Cox regression model for LHU and control group.
RESULTS: Difference-in-differences results suggest that vertical integration promoted a decrease on risk-standardized readmission ratio in four LHU, but significant only in LHU 1. In addition, when analysed the individual risk of readmission we observed that it was reduced for four LHU, but only significantly for LHU 3 and LHU 5. A sensitivity analysis was performed for annual evolution of odds ratio of risk of readmission, and initial results were considered stable for most years. Cox regression results suggest that for LHU and control hospitals, female individuals were less at risk of readmission than men, the risk increased with increasing age and number of comorbidities. At LHU, we observed a decreased risk of readmission with increasing number of chronic conditions.
This document summarizes a study that assessed the quality of life of 100 glaucoma patients using the WHOQOL-Bref questionnaire. The study found that glaucoma patients had significantly lower quality of life scores than healthy controls in the physical, mental, social, and environmental domains. Among socio-demographic factors, quality of life was lower in older patients and those with lower socioeconomic status. Several clinical factors, such as severity of glaucoma, were also associated with lower quality of life. The study concludes that glaucoma significantly impacts patients' quality of life and that socio-demographic and clinical factors should be considered in glaucoma management.
This meta-analysis reviewed 15 randomized controlled trials involving over 188,000 participants to determine the effect of antioxidant vitamin supplementation on cardiovascular outcomes. The trials assessed supplements containing vitamin E, beta-carotene, and/or vitamin C compared to placebo. The analysis found that antioxidant vitamin supplementation had no significant effect on major cardiovascular events, myocardial infarction, stroke, total death, cardiac death, or other outcomes. There was no evidence that antioxidant vitamin supplements provide cardiovascular benefits.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
The International Journal of Engineering & Science is aimed at providing a platform for researchers, engineers, scientists, or educators to publish their original research results, to exchange new ideas, to disseminate information in innovative designs, engineering experiences and technological skills. It is also the Journal's objective to promote engineering and technology education. All papers submitted to the Journal will be blind peer-reviewed. Only original articles will be published.
This document summarizes a systematic review of randomized controlled trials evaluating natural products for the treatment of chronic plaque psoriasis. Three studies with a total of 127 participants were included that evaluated Mahonia aquifolium, topical Aloe vera, and Chinese herbal medicines. Results were mixed, with one study finding improvement in psoriasis severity with Aloe vera compared to conventional treatment at 2 months, but another found Chinese herbal medicines were less effective than conventional treatment at 6 months. Adverse events were similar between natural products and conventional treatments in one study. Quality of life measures did not differ. Due to variability in natural products studied and limited evidence, applicability and safety of natural products for psor
The job satisfaction of physicians is an important factor that influences their motivation for work and the quality of the provided health services. The aim of the study is to evaluate the job satisfaction of General Practitioners in Bulgaria and to explore some of the factors which influence this satisfaction.
This document summarizes current recommendations and gaps regarding extrapolation of time-to-event outcomes from clinical trials. It reviewed 11 methodological papers and 5 guidelines on extrapolating survival data. The guidelines, particularly from NICE, provide a detailed process for extrapolation including testing different survival models, validating the best fitting model, and using external data for validation. However, the guidelines need updating to apply to more disease areas beyond oncology and different time-to-event outcomes.
Value of Medication Adherence in Chronic Vascular Disease: Fixed Effects Mode...M. Christopher Roebuck
This document summarizes a study that examined the impact of medication adherence on health services utilization and costs for patients with chronic vascular conditions. The study used claims data from over 135,000 patients to measure adherence rates and model the relationship between adherence and outcomes. The results showed that optimal adherence was associated with higher pharmacy costs but lower medical costs, leading to overall savings. Adherence had a greater impact on reducing utilization and costs for elderly patients compared to non-seniors.
Machine learning and operations research to find diabetics at risk for readmisison.
A team of researchers was able to apply machine learning to reduce readmissions for diabetics, see "Identifying diabetic patients with high risk of readmission" (Bhuvan,Kumar, Zafar, Aand Kishore, 2016).
This document analyzes trends in surgical faculty attrition rates at a large academic medical center over a 15-year period from 1996 to 2011. It finds that:
1) Attrition trends were significantly different for faculty cohorts from 2001-2006 and 2006-2011 compared to overall trends, with the 2006-2011 cohort having much higher attrition.
2) Minorities, associate professors, and full professors contributed most to higher attrition in the 2006-2011 period.
3) Faculty leaving in 2006-2011 were more likely to transition to non-academic practice compared to previous periods.
4) The results suggest a need for academic medical centers to implement continuous retention strategies to compete for surgical talent given economic and demographic
I. INTRODUCTION
DEFINITION
HISTORY
NEED TO STUDY BIOSTATISTICS
SAMPLING
METHODS OF PRESENTATION OF DATA
METHODS OF SUMMARIZING THE DATA
: Measures of Central Tendency
: Mean
: Median
: Mode
: Measures of Dispersion
: range
: Mean deviation
: Standard deviation
: Coefficient of variation
CORRELATION & REGRESSION
NORMAL DISTRIBUTION AND NORMAL CURVE.
METHODS OF ANALYZING THE DATA
SUMMARY & CONCLUSION
Overall patient satisfaction was significantly higher in homeopathic than in ...home
The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in
relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS
due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias
in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
The CHAMP-Path study conducted a pilot study to measure patient centeredness using a validated questionnaire and focus group discussions. 35 patients completed the questionnaire which assessed satisfaction with various healthcare services. Focus groups were also conducted with 7 additional patients. The questionnaire showed high satisfaction with physician and nursing care but identified opportunities to improve communication about length of stay, hospital comfort, and food quality. Focus groups highlighted long emergency wait times and some gender differences in nursing experiences. The study provided insights into patient values to help improve quality of care.
This study examined musculoskeletal disorders (MSDs) among 100 medical care professionals working in two hospitals in Lorestan, Iran. The most common areas of pain reported were back pain (26% of participants at the first hospital and 20% at the second) and neck pain (20% at both hospitals). The majority (87-88%) of participants stated they did not receive treatment or pain management for their MSDs. While most (64%) felt stress was not associated with their pain, 36% reported their pain worsened with increased stress. The high rates of MSDs among these medical professionals suggests preventative measures are needed to address causes like improper posture and mechanics.
This cross-sectional study analyzed data from nursing homes in Austria and the Czech Republic to compare the prevalence of dementia, behavioral symptoms, mobility, pain, and other health factors. Over 800 residents were assessed between 2016-2017. The main findings showed higher rates of cognitive impairment in Austria (85.2%) than the Czech Republic (53.0%), but higher rates of behavioral problems, pain, and malnutrition in the Czech Republic. While some results were similar, differences indicate a need for improved diagnostic services, dementia-specific care, and support. Overall, the high prevalence of issues found calls for further research and practice development to better address residents' needs.
Ezz eazy biostatistics for crash courseBasalama Ali
This document discusses the importance of statistical significance and p-values in hypothesis testing. It explains that the p-value is the probability of observing results as extreme or more extreme than what was actually observed, assuming the null hypothesis is true. A lower p-value provides stronger evidence against the null hypothesis. The decision to reject the null hypothesis depends on comparing the p-value to the pre-determined significance level (alpha), typically 0.05. If the p-value is less than the significance level, then the result is considered statistically significant and the null hypothesis can be rejected.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
The Preventable Burden of Productivity Loss Due to Suboptimal Asthma ControlIntan Agoes
This study examined the relationship between asthma control and productivity loss among 300 employed adults with asthma in British Columbia, Canada.
The key findings were:
1. Presenteeism (reduced productivity at work) but not absenteeism was associated with asthma control after adjusting for potential confounding factors.
2. Individuals with uncontrolled asthma could avoid $184.80 per week in productivity loss on average by achieving clinical control, 90.6% of which would be from reduced presenteeism.
3. Individuals with partially controlled asthma could avoid $34.20 per week in productivity loss on average, but this was not statistically significant.
4. Presenteeism was a more important source of
Comparative Studies of Diabetes in Adult Nigerians Lipid Profile and Antioxid...YogeshIJTSRD
The study sought to determine the extent to which the usage of social media in the marketing of agricultural products in South West Nigeria can enhance farmers turnover. It employed the survey research design to collect data with the help of a structured questionnaire to elicit information from respondents selected from six 6 south western states. Research data were analysed using structural equation modelling. The results showed that the use of social media WhatsApp and Facebook in marketing of agricultural products significantly enhances farmers turnover. The managerial implication is that use of Whatsapp and Facebook in the marketing of agricultural products for the enhancement of farmers’ turnover was found to have significant influence on the enhancement in farmers’ turnover from agricultural products. Policy makers in government should provide the enabling environment for the telecommunication companies to enhance their reach by installing their facilities across the length and breadth of the country so that the network coverage will be strong at all times so that the benefits of social media usage will not be constrained. Egejuru, Leonard O | Akubugwo, Emmanuel I | Ugorji, Beatrice N "Comparative Studies of Diabetes in Adult Nigerians: Lipid Profile and Antioxidants Vitamins (A and C)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45021.pdf Paper URL: https://www.ijtsrd.com/biological-science/biochemistry/45021/comparative-studies-of-diabetes-in-adult-nigerians-lipid-profile-and-antioxidants-vitamins-a-and-c/egejuru-leonard-o
Kabboord comobidity 2016 THE FINAL versionAnouk Kabboord
This systematic review and meta-analysis examined the association between comorbidity burden and functional rehabilitation outcomes after stroke or hip fracture. Twenty studies were included. The pooled correlation from seven studies showed a moderate negative association between comorbidity and functional status at discharge (r = -0.43). Assessments that included severity weighting of comorbidities revealed stronger associations. The Cumulative Illness Rating Scale severity index and Liu comorbidity index showed moderate negative correlations (r ranging from -0.25 to -0.50) with functional outcomes, explaining 12-16% and 4-7% of variance respectively. Assessments that only counted comorbid conditions showed weaker or no associations. The results indicate that comorbidity burden is modestly
This document provides an introduction to biostatistics. It defines biostatistics as the branch of statistics concerned with biological data and events. It discusses how biostatistics is applied in various fields including public health, medicine, dentistry, and more. Specifically, it outlines how biostatistics is used as a science and with figures to evaluate health programs, compare treatment efficacy, identify disease patterns, and more. The document also covers key biostatistics concepts like data collection, classification of data as qualitative or quantitative, and primary versus secondary sources.
Effect of Emergency Department and ICU Occupancy on Admission Decisions and O...Ching-wen Lu
1) Critically ill patients requesting admission to a busy medical ICU (MICU) had lower odds of acceptance when the MICU was at full capacity, despite availability in other ICUs.
2) For patients both accepted and denied MICU admission, longer boarding times in the emergency department post-consult were associated with higher risk of in-hospital mortality or persistent organ dysfunction.
3) The study highlights the impact of ICU bed availability and emergency department crowding on decisions to admit critically ill patients, and shows that increased boarding time is an independent risk factor for worse patient outcomes.
This study evaluated the use of sirolimus, an mTOR inhibitor, in 4 patients with diffuse hyperinsulinemic hypoglycemia that was unresponsive to standard treatments with diazoxide and octreotide. Patients received sirolimus with dose adjustments to achieve target serum levels. Glycemic control improved in all patients after starting sirolimus. The study suggests mTOR inhibitors may provide an alternative treatment option for severe hyperinsulinemic hypoglycemia unresponsive to other therapies, but larger and longer-term studies are still needed to fully evaluate efficacy and safety.
The document summarizes a study that evaluated the effects of probiotic treatment on depression-related behaviors in rats fed either a control or high-fat diet. Key findings include:
1. Probiotic treatment significantly lowered depressive-like behavior in rats and improved performance in memory tests, regardless of diet.
2. Probiotics modulated cytokine production and expression of genes related to the hypothalamic-pituitary-adrenal axis and neuroplasticity.
3. Metabolomic analysis found probiotics significantly affected 13 plasma metabolites involved in immune function, glucose regulation, and neurotransmission.
Pay-for-Performance and Distributional Effects in Tanzania: A Supply-side Ass...resyst
This document analyzes the distributional effects of a pay-for-performance (P4P) program in Tanzania. Initial results showed higher payouts going to higher socioeconomic status (SES) facilities, but this inequality decreased over time. The main contributors to initial unequal payouts were facility SES, level of care, baseline performance, and ownership. While there were no significant differences found, utilization effects like facility deliveries and antimalarial treatment during pregnancy seemed to increase more for lower SES facilities and dispensaries. The strongest utilization effects were seen for deliveries in lower SES facilities and dispensaries, and for antimalarial treatment in better resourced facilities.
Comparative hospital performance: new data, borrowed methods, more targeted a...cheweb1
Comparative hospital performance data can be used for two main purposes: 1) to identify general poor performance among hospitals, and 2) to inform quality improvement initiatives for specific conditions. This document analyzes data on chest pain presentations across four hospitals. It finds variations in costs, outcomes, and processes of care across the hospitals. Specifically, one hospital had higher costs, readmission rates, and length of stay compared to the benchmark hospital. Analyzing the data by patient subgroups found some of the variations were driven by differences in patients seen after hours with existing conditions. The document discusses potential strategies for using this type of comparative data to incentivize hospitals to reduce unwarranted variations in performance.
Value of Medication Adherence in Chronic Vascular Disease: Fixed Effects Mode...M. Christopher Roebuck
This document summarizes a study that examined the impact of medication adherence on health services utilization and costs for patients with chronic vascular conditions. The study used claims data from over 135,000 patients to measure adherence rates and model the relationship between adherence and outcomes. The results showed that optimal adherence was associated with higher pharmacy costs but lower medical costs, leading to overall savings. Adherence had a greater impact on reducing utilization and costs for elderly patients compared to non-seniors.
Machine learning and operations research to find diabetics at risk for readmisison.
A team of researchers was able to apply machine learning to reduce readmissions for diabetics, see "Identifying diabetic patients with high risk of readmission" (Bhuvan,Kumar, Zafar, Aand Kishore, 2016).
This document analyzes trends in surgical faculty attrition rates at a large academic medical center over a 15-year period from 1996 to 2011. It finds that:
1) Attrition trends were significantly different for faculty cohorts from 2001-2006 and 2006-2011 compared to overall trends, with the 2006-2011 cohort having much higher attrition.
2) Minorities, associate professors, and full professors contributed most to higher attrition in the 2006-2011 period.
3) Faculty leaving in 2006-2011 were more likely to transition to non-academic practice compared to previous periods.
4) The results suggest a need for academic medical centers to implement continuous retention strategies to compete for surgical talent given economic and demographic
I. INTRODUCTION
DEFINITION
HISTORY
NEED TO STUDY BIOSTATISTICS
SAMPLING
METHODS OF PRESENTATION OF DATA
METHODS OF SUMMARIZING THE DATA
: Measures of Central Tendency
: Mean
: Median
: Mode
: Measures of Dispersion
: range
: Mean deviation
: Standard deviation
: Coefficient of variation
CORRELATION & REGRESSION
NORMAL DISTRIBUTION AND NORMAL CURVE.
METHODS OF ANALYZING THE DATA
SUMMARY & CONCLUSION
Overall patient satisfaction was significantly higher in homeopathic than in ...home
The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in
relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS
due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias
in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
The CHAMP-Path study conducted a pilot study to measure patient centeredness using a validated questionnaire and focus group discussions. 35 patients completed the questionnaire which assessed satisfaction with various healthcare services. Focus groups were also conducted with 7 additional patients. The questionnaire showed high satisfaction with physician and nursing care but identified opportunities to improve communication about length of stay, hospital comfort, and food quality. Focus groups highlighted long emergency wait times and some gender differences in nursing experiences. The study provided insights into patient values to help improve quality of care.
This study examined musculoskeletal disorders (MSDs) among 100 medical care professionals working in two hospitals in Lorestan, Iran. The most common areas of pain reported were back pain (26% of participants at the first hospital and 20% at the second) and neck pain (20% at both hospitals). The majority (87-88%) of participants stated they did not receive treatment or pain management for their MSDs. While most (64%) felt stress was not associated with their pain, 36% reported their pain worsened with increased stress. The high rates of MSDs among these medical professionals suggests preventative measures are needed to address causes like improper posture and mechanics.
This cross-sectional study analyzed data from nursing homes in Austria and the Czech Republic to compare the prevalence of dementia, behavioral symptoms, mobility, pain, and other health factors. Over 800 residents were assessed between 2016-2017. The main findings showed higher rates of cognitive impairment in Austria (85.2%) than the Czech Republic (53.0%), but higher rates of behavioral problems, pain, and malnutrition in the Czech Republic. While some results were similar, differences indicate a need for improved diagnostic services, dementia-specific care, and support. Overall, the high prevalence of issues found calls for further research and practice development to better address residents' needs.
Ezz eazy biostatistics for crash courseBasalama Ali
This document discusses the importance of statistical significance and p-values in hypothesis testing. It explains that the p-value is the probability of observing results as extreme or more extreme than what was actually observed, assuming the null hypothesis is true. A lower p-value provides stronger evidence against the null hypothesis. The decision to reject the null hypothesis depends on comparing the p-value to the pre-determined significance level (alpha), typically 0.05. If the p-value is less than the significance level, then the result is considered statistically significant and the null hypothesis can be rejected.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
The Preventable Burden of Productivity Loss Due to Suboptimal Asthma ControlIntan Agoes
This study examined the relationship between asthma control and productivity loss among 300 employed adults with asthma in British Columbia, Canada.
The key findings were:
1. Presenteeism (reduced productivity at work) but not absenteeism was associated with asthma control after adjusting for potential confounding factors.
2. Individuals with uncontrolled asthma could avoid $184.80 per week in productivity loss on average by achieving clinical control, 90.6% of which would be from reduced presenteeism.
3. Individuals with partially controlled asthma could avoid $34.20 per week in productivity loss on average, but this was not statistically significant.
4. Presenteeism was a more important source of
Comparative Studies of Diabetes in Adult Nigerians Lipid Profile and Antioxid...YogeshIJTSRD
The study sought to determine the extent to which the usage of social media in the marketing of agricultural products in South West Nigeria can enhance farmers turnover. It employed the survey research design to collect data with the help of a structured questionnaire to elicit information from respondents selected from six 6 south western states. Research data were analysed using structural equation modelling. The results showed that the use of social media WhatsApp and Facebook in marketing of agricultural products significantly enhances farmers turnover. The managerial implication is that use of Whatsapp and Facebook in the marketing of agricultural products for the enhancement of farmers’ turnover was found to have significant influence on the enhancement in farmers’ turnover from agricultural products. Policy makers in government should provide the enabling environment for the telecommunication companies to enhance their reach by installing their facilities across the length and breadth of the country so that the network coverage will be strong at all times so that the benefits of social media usage will not be constrained. Egejuru, Leonard O | Akubugwo, Emmanuel I | Ugorji, Beatrice N "Comparative Studies of Diabetes in Adult Nigerians: Lipid Profile and Antioxidants Vitamins (A and C)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45021.pdf Paper URL: https://www.ijtsrd.com/biological-science/biochemistry/45021/comparative-studies-of-diabetes-in-adult-nigerians-lipid-profile-and-antioxidants-vitamins-a-and-c/egejuru-leonard-o
Kabboord comobidity 2016 THE FINAL versionAnouk Kabboord
This systematic review and meta-analysis examined the association between comorbidity burden and functional rehabilitation outcomes after stroke or hip fracture. Twenty studies were included. The pooled correlation from seven studies showed a moderate negative association between comorbidity and functional status at discharge (r = -0.43). Assessments that included severity weighting of comorbidities revealed stronger associations. The Cumulative Illness Rating Scale severity index and Liu comorbidity index showed moderate negative correlations (r ranging from -0.25 to -0.50) with functional outcomes, explaining 12-16% and 4-7% of variance respectively. Assessments that only counted comorbid conditions showed weaker or no associations. The results indicate that comorbidity burden is modestly
This document provides an introduction to biostatistics. It defines biostatistics as the branch of statistics concerned with biological data and events. It discusses how biostatistics is applied in various fields including public health, medicine, dentistry, and more. Specifically, it outlines how biostatistics is used as a science and with figures to evaluate health programs, compare treatment efficacy, identify disease patterns, and more. The document also covers key biostatistics concepts like data collection, classification of data as qualitative or quantitative, and primary versus secondary sources.
Effect of Emergency Department and ICU Occupancy on Admission Decisions and O...Ching-wen Lu
1) Critically ill patients requesting admission to a busy medical ICU (MICU) had lower odds of acceptance when the MICU was at full capacity, despite availability in other ICUs.
2) For patients both accepted and denied MICU admission, longer boarding times in the emergency department post-consult were associated with higher risk of in-hospital mortality or persistent organ dysfunction.
3) The study highlights the impact of ICU bed availability and emergency department crowding on decisions to admit critically ill patients, and shows that increased boarding time is an independent risk factor for worse patient outcomes.
This study evaluated the use of sirolimus, an mTOR inhibitor, in 4 patients with diffuse hyperinsulinemic hypoglycemia that was unresponsive to standard treatments with diazoxide and octreotide. Patients received sirolimus with dose adjustments to achieve target serum levels. Glycemic control improved in all patients after starting sirolimus. The study suggests mTOR inhibitors may provide an alternative treatment option for severe hyperinsulinemic hypoglycemia unresponsive to other therapies, but larger and longer-term studies are still needed to fully evaluate efficacy and safety.
The document summarizes a study that evaluated the effects of probiotic treatment on depression-related behaviors in rats fed either a control or high-fat diet. Key findings include:
1. Probiotic treatment significantly lowered depressive-like behavior in rats and improved performance in memory tests, regardless of diet.
2. Probiotics modulated cytokine production and expression of genes related to the hypothalamic-pituitary-adrenal axis and neuroplasticity.
3. Metabolomic analysis found probiotics significantly affected 13 plasma metabolites involved in immune function, glucose regulation, and neurotransmission.
Pay-for-Performance and Distributional Effects in Tanzania: A Supply-side Ass...resyst
This document analyzes the distributional effects of a pay-for-performance (P4P) program in Tanzania. Initial results showed higher payouts going to higher socioeconomic status (SES) facilities, but this inequality decreased over time. The main contributors to initial unequal payouts were facility SES, level of care, baseline performance, and ownership. While there were no significant differences found, utilization effects like facility deliveries and antimalarial treatment during pregnancy seemed to increase more for lower SES facilities and dispensaries. The strongest utilization effects were seen for deliveries in lower SES facilities and dispensaries, and for antimalarial treatment in better resourced facilities.
Comparative hospital performance: new data, borrowed methods, more targeted a...cheweb1
Comparative hospital performance data can be used for two main purposes: 1) to identify general poor performance among hospitals, and 2) to inform quality improvement initiatives for specific conditions. This document analyzes data on chest pain presentations across four hospitals. It finds variations in costs, outcomes, and processes of care across the hospitals. Specifically, one hospital had higher costs, readmission rates, and length of stay compared to the benchmark hospital. Analyzing the data by patient subgroups found some of the variations were driven by differences in patients seen after hours with existing conditions. The document discusses potential strategies for using this type of comparative data to incentivize hospitals to reduce unwarranted variations in performance.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
The document discusses WHO and working for WHO. It begins by outlining that the views expressed are those of the individual presenter and not necessarily WHO's official views. It then provides an overview of WHO as an organization, including that it is a UN agency established in 1948 with 194 member states and headquarters in Geneva. The rest of the document discusses Universal Health Coverage (UHC), what it means to achieve UHC, and advice for those interested in global health careers.
Relationship between Health Care System Setup and Adherence To Tuberculosis T...QUESTJOURNAL
ABSTRACT : Despite the concerted effort to detect and treat TB, there are still poor treatment outcomes in a significant number of the patients. These poor treatment outcomes have been significantly linked to poor adherence to TB treatment. Therefore, a cross sectional descriptive study was conducted in Kisumu East District to establish the relationship between health care system factors and TB treatment adherence among patients aged above 18 years attending TB clinics in Kisumu East District, in Western Kenya. A total sample of 250 respondents was surveyed. An interviewer administered structured questionnaire was used to collect data from the respondents on the social, demographic aspects of the patients and structural aspects of TB care. The data was analyzed using descriptive statistics for socio-demographic variables and bivariate analysis to determine the health care system factors that significantly predicted treatment adherence. P values, Odds Ratios with 95% confidence interval (CI) were used to demonstrate significance of association between the health system related predictors and adherence. Significance was assumed at P value ≤0.05. Behaviour of the health care workers (OR: 3.6; 95% CI1.1-12.1; P=0.031) and waiting time (OR: 7; 95%CI: 3-18; P<0.001) were the significant determinants of adherence related to health care set up. Health care system setup has a number of immediate modifiable predictors of adherence like waiting time and staff behaviour. It is important to establish the key predictors of adherence that are linked to health care system for quality TB treatment and care services in every TB care setting.
The drivers of public health spending: integrating policies and institutionsOECD Governance
This presentation was made by Joaquim Oliveira Martins at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems, held on 4-5 February 2016 at the OECD Conference Centre in Paris.
Comorbidity and the cost implications for long term conditions webinar hosted by Dr Umesh Kadam, Senior Lecturer, Clinical Epidemiologist & GP.
Learning outcomes:
• Understand the importance of transition for people with multi morbidity
• Know how to use local data for targeted improvement interventions for people with multiple long term conditions
• Consider how to use pairing of complex diseases to drive pathway development and potential contracting arrangements.
More at http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care.aspx
26: Nurse practitioners focus on health care in terms of cure and care: Analy...ICF Education
oster presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town).
THEME: ICF-related data: the new frontier of individualised, predictive healthcare
http://www.icfeducation.org
The document discusses the value of analytics in healthcare and provides examples of analytics projects at the Institute for Healthcare Business Intelligence (IHBI) at Central Michigan University. It summarizes an admissions forecasting model developed for a hospital that helped predict weekly admission rates by specialty and unit occupancy. It also discusses IHBI's contextual dataset and rules-based approach to linking patient encounters over time based on their specialty and procedures. Finally, it briefly introduces the Michigan Health Information Network and its role in managing the legal and technical framework for health information exchange statewide.
The document provides an overview of the Analytics Opportunity in Healthcare. It discusses the value of analytics in healthcare, shares examples of best and worst analytics projects, and introduces the Michigan Health Information Network (MiHIN) and how it is adding intelligence to its network. The document contains information on the Institute for Healthcare Business Intelligence (IHBI) at Carnegie Mellon University, including its customers and partners, contextual datasets, and research focus areas like data science and predictive modeling.
The document provides an overview of the Analytics Opportunity in Healthcare. It discusses the value of analytics in healthcare, shares examples of best and worst analytics projects, and introduces the Michigan Health Information Network (MiHIN) and how it is adding intelligence to its network. The document contains details about the Institute for Healthcare Business Intelligence (IHBI) at Carnegie Mellon University, including its customers, partners, datasets, and research focus areas like data science and predictive modeling.
1) The document evaluates integrating HIV care (ART clinics) with regular outpatient care (OPD) in a clinic in Zambia. Data was collected before and after integration on waiting times.
2) Preliminary results found ART patient processing times were longer, and waiting times increased for both patient types after integration. However, more analysis was needed to account for other changing factors.
3) Simulation results also initially found ART waiting times increased after integration, even when controlling for staffing levels. Further simulation informed how and when best to integrate clinics based on patient mix and other factors.
1. The document provides guidelines for the management of sepsis and septic shock in adult patients in a hospital setting. It includes 23 recommendations on screening, initial resuscitation, infection management, and other treatment approaches.
2. Several recommendations were changed from the previous 2016 guidelines, including downgrading the strength of some recommendations and adding new recommendations on topics like screening tools, fluid resuscitation targets, and antifungal therapy.
3. Implementation of performance improvement programs that include sepsis screening and standard operating procedures is recommended to help identify sepsis early and ensure appropriate management.
A study on patients care quality in public district hospitals in tamilnaduIAEME Publication
This document summarizes a study on patient care quality in public district hospitals in Tamil Nadu, India. The study examined 34 variables related to patient care quality as perceived by patients. It found that patients' expectations generally exceeded their perceptions of quality. Some key findings:
- Rural patients gave higher ratings than urban patients for doctors' knowledge, analytical nature, and test performance ability.
- There were significant perception differences between urban and rural patients for 14 of the 34 variables.
- Factor analysis identified five important factors of patient care quality: empathy, patients' needs, relationship, professionalism, and responsiveness.
The study suggests that while Tamil Nadu has invested in healthcare, public hospitals need more autonomy
This document discusses performance indicators for assessing hospital services and other health care services in Australia. It provides context on frameworks that have been used previously and introduces the National Health Performance Framework, which is now being used. The framework has three tiers - health status and outcomes, determinants of health, and health system performance. The document describes the various dimensions within the health system performance tier and provides examples of performance indicators presented in the report that relate to each dimension. These include indicators related to costs, lengths of stay, separation rates, accreditation and more. It also notes some limitations of the available data.
Presented by John Buckell on 4th July 2014 at the 8th North American Productivity Workshop in Ottawa, Canada. The work is coauthored with Dr Andrew Smith and Phill Wheat at ITS, Roberta Longo from the Academic Unit of Health Economics and David Holland from Keele Universwww.its.leeds.ac.uk/people/j.buckell
Sex, Drugs & Scotland's Health- Population- level estimates of Hepatitis C re...HIVScotland
Delivered at Sex, Drugs & Scotland's Health Virtual Conference, this presentation was delivered by Dr Alan Yeung.
More information about the virtual event is available here: http://ow.ly/YntW50GWhJ0
CHC15 - EHR adoption in a european environment and public management hospital...Carlos Sousa
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
Taiwan has achieved universal health coverage with a service coverage index of 85, on par with other high coverage countries like Canada, South Korea, and Japan. Key health indicators for Taiwan include a 97.7% antenatal care coverage rate, 70% tuberculosis treatment effectiveness, and 97.8% coverage for childhood immunizations. Taiwan also has strong programs for non-communicable diseases like diabetes, with quality targets met by over 90% of patients and extensive primary and secondary prevention programs for cancer.
Similar to Impact evaluation of the creation of Local Health Units on the readmission of patients with chronic conditions (20)
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Healthy Eating Habits:
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Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
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Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
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Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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2024 HIPAA Compliance Training Guide to the Compliance Officers
Impact evaluation of the creation of Local Health Units on the readmission of patients with chronic conditions
1. Impact evaluation of the creation of Local
Health Units on the readmission of patients with
chronic conditions
Óscar Brito Fernandes1, Rui Santana1,2, Sílvia Lopes1,2
1 Escola Nacional de Saúde Pública | 2 Centro de Investigação em Saúde Pública
Management and Efficiency of Healthcare Organizations
Workshop NOVAhealth
2016.04.27
4. Ageing populations(1,2), prevalence of multiple chronic conditions(2) and
the increasing pressure of burden of disease challenge nowadays
healthcare systems(3,4) and the way healthcare delivery is designed(5).
Integrated care is an organizational principle for care delivery(6) as a
managerial response to differentiation and fragmentation(7).
Integrated care is a way of assuming that there are modifiable factors
driving readmissions that could be targeted at a hospital-level to reduce
them(8).
Readmission is a subsequent inpatient admission to any acute care facility
which occurs within 30 days of the discharge date of an eligible index
admission(9).
Excessive unplanned readmission rates among hospitals could be a sign of
frail integrated care(8).
OVERVIEW 4
5. Chronic conditions(10) includes health conditions that persist across time
and require healthcare, including non-communicable diseases, mental
disorders, some communicable conditions and on-going physical
impairments.
Individuals with chronic conditions are more likely to experience hospital
readmission since they are more vulnerable to non-effective home
transitions after hospital discharge(11).
The focus of many integrated care approached seems to have in common
the support to individuals with chronic conditions to live more
independently(12,13), with improvements to the patients’ care experience
and health outcomes.
OVERVIEW 5
7. Compare 30-day readmission rates in patients with chronic conditions in
Local Health Units and other hospitals.
Assess the relationship of gender, age group, chronic conditions,
Elixhauser comorbidity index and institution type to time to readmission.
AIMS 7
9. Outcome research
Observational, analytical, longitudinal, and retrospective cohort study
Datasets were provided by ACSS, Portuguese Central Administration for
Health Care System.
Data refers to Portugal mainland hospital morbidity from 2002 to 2014,
including the period before and after creation of seven LHU.
Statistic analysis:
Generalized linear mixed models at the speciality cohort (AHRQ)
(covariates age, discharge condition, comorbidities)
Cox regression
(covariates gender, age group, chronic conditions, comorbidities and hospital of treatment)
Difference in differences
RESEARCH DESIGN 9
10. RESEARCH DESIGN 10
9 523 432 1 679 634
Treatment
n=845 275
Selected index admissions Treatment – Control sample
Control
n=834 359
Treatment group Control group
Included 7 LHU 6 hospitals
Selection criteria
Data available from pre- and post-
integration periods
(observation period: 8 years, 5 years
pre-integration, 3 post-integration)
- Be part of the same ACSS hospital
benchmark group as LHU
- Excluded hospitals with different
contexts (e.g., public-private
ventures)
18. Age increase risk of readmission (85+ 74% more at risk than 0-19)
Chronic conditions increase risk of readmission (from 28% to 37%)
Increased comorbidites present higher risk of readmission
LHU episodes present 12% less of a risk of readmission than control group
Adjusted-readmission rates: LHU have lower rates for patients with
chronic conditions
Decreased risk of readmission for 4 LHU ( 2 of them significant)
Most LHU showed a decreasing risk of readmission after integration
RESULTS 18
MAIN FINDINGS
20. DISCUSSION 20
Despite efforts for a better integrated care, LHU risk of
readmission do not follow a clear pattern for all. Other
studies found similar results over health outcomes(14,15).
Evidence of different barriers for integrated care for each organization (e.g.,
higher number of primary care physicians associated with increase of
readmissions(16,17))
There are vary interventions addressed to reduce hospital readmission with
different potential of effectiveness(18): e.g., case management(19), referral
networks(20), or follow-up after discharge(21-23)
21. DISCUSSION 21
Chronic condition 5+ group is the one with decreased risk of
readmission compared to the reference group, in the
multivariate Cox regression .
Univariate model shows increased risk of readmission along chronic condition
groups, similar to other studies(24).
Possible evidence of better coordinated care for these patients?
Adjusting readmission rates by chronic conditions, LHU
present lower readmission rates for chronic patients.
Readmission rates reflect not only the quality of hospital care(25-27) but also
factors in patient’s homes and communities(28-30).
23. CONCLUSIONS 23
There’s a research gap over integrated care and integration in Portugal.
People with multiple chronic conditions are a growing sector of the
population(31) and attention should be given to younger age groups(13).
Vertical integration in Portugal presents some evidence of reducing 30-day
readmissions for patients with chronic conditions, but it’s not consistent.
Portugal needs to evolve towards a more integrated approach of
healthcare, increasing and deepening relations among levels of care(32).
24. REFERENCES
24
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Care. 2015;15(October):1–10.
[2] Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: A comprehensive conceptual framework based on the integrative
functions of primary care. Int J Integr Care. 2013;13(4):1-10.
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[5] Mohrman SA, Kanter MH. Chapter 3 Designing for Health: Learning from Kaiser Permanente [Internet]. Organizing for Sustainable Health Care. Emerald
Group Publishing Ltd.; 2012. 77-111 p. Available from: http://dx.doi.org/10.1108/S2045-0605(2012)0000002007
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[7] Lillrank P. Integration and coordination in healthcare: an operations management view. J Integr Care [Internet]. Emerald Group Publishing Limited; 2012
Feb 10 [cited 2016 Apr 18];20(1):6–12. Available from: http://www.emeraldinsight.com/doi/abs/10.1108/14769011211202247
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[9] Horwitz L, Grady J, Zhang W, DeBuhr J, Deacon S, Krumholz H, et al. 2015 Measure Updates and Specifications Report: Hospital-Wide All-Cause
Unplanned Readmission Measure - Version 4.0. 2015.
[10] WHO. Innovative care for chronic conditions: building blocks for action: global report. Noncommunicable Diseases and Mental Health. 2002. p. 1–99.
[11] Jackson CT, Trygstad TK, DeWalt DA, DuBard CA. Transitional care cut hospital readmissions for North Carolina medicaid patients with complex chronic
conditions. Health Aff. 2013;32(8):1407–15.
[12] Dorling G, Fountaine T, McKenna S, Suresh B. The Evidence for Integrated Care [Internet]. 2015. Available from:
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[13] OECD. Health Reform: Meeting the Challenge of Ageing and Multiple Morbidities [Internet]. Meeting the Challenge of Ageing and Multiple Morbidities.
2011. Available from: http://www.oecd-ilibrary.org/social-issues-migration-health/health-reform_9789264122314-en
[14] Nolte E, Pitchforth E. What is the evidence on the economic impacts of integrated care? 2014;1–55.
[15] Walston SL, Kimberly JR, Burns LR. Owned vertical integration and health care: Promise and performance. Health Care Manage Rev [Internet]. 1996 Jan
[cited 2016 Apr 20];21(1):83–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8647695
[16] Hernandez AF, Greiner M a, Fonarow GC, Hammill BG, Heidenreich P a, Yancy CW, et al. Relationship between early physician follow-up and 30-day
readmission among Medicare beneficiaries hospitalized for heart failure. JAMA [Internet]. 2010 May 5;303(17):1716–22. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/20442387
[17] Sharma G, Kuo Y-F, Freeman JL, Zhang DD, Goodwin JS. Outpatient follow-up visit and 30-day emergency department visit and readmission in patients
hospitalized for chronic obstructive pulmonary disease. Arch Intern Med [Internet]. 2010 Oct 11;170(18):1664–70. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/20937926
[18] Bradley EH, Curry L, Horwitz LI, Sipsma H, Thompson JW, Elma M, et al. Contemporary evidence about hospital strategies for reducing 30-day
readmissions: A national study. J Am Coll Cardiol [Internet]. Elsevier Inc.; 2012;60(7):607–14. Available from: http://dx.doi.org/10.1016/j.jacc.2012.03.067
25. REFERENCES
25
[19] White B, Carney PA, Flynn J, Marino M, Fields S. Reducing hospital readmissions through primary care practice transformation. J Fam Pract.
2014;63(2):67–74.
[20] Mascia D, Angeli F, Di Vincenzo F. Effect of hospital referral networks on patient readmissions. Soc Sci Med [Internet]. Elsevier Ltd; 2015;132:113–21.
Available from: http://dx.doi.org/10.1016/j.socscimed.2015.03.029
[21] Boccuti C, Casillas G. Aiming for Fewer Hospital U-turns : The Medicare Hospital Readmission Reduction Program. Policy Brief. 2015;1–10. Available
from: http://bit.ly/1KWsOkd
[22] Conroy SP, Dowsing T, Reid J, Hsu R. Understanding readmissions: An in-depth review of 50 patients readmitted back to an acute hospital within 30
days. Eur Geriatr Med [Internet]. Elsevier Masson SAS; 2013;4(1):25–7. Available from: http://dx.doi.org/10.1016/j.eurger.2012.02.007
[23] Hansen LO, Young RS, Hinami K, Leung A, Williams M V. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med
[Internet]. 2011 Oct 18 [cited 2016 Apr 16];155(8):520–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22007045
[24] Friedman B, Jiang HJ, Elixhauser A. Costly hospital readmissions and complex chronic illness. Inquiry [Internet]. 2008;45(4):408–21. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/19209836
[25] Bianco A, Molè A, Nobile CGA, Di Giuseppe G, Pileggi C, Angelillo IF. Hospital Readmission Prevalence and Analysis of Those Potentially Avoidable in
Southern Italy. PLoS One. 2012;7(11).
[26] Fischer C, Lingsma HF, Marang-van De Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator? A review of
the evidence. PLoS One. 2014;9(11):1–10.
[27] Horwitz LI, Partovian C, Lin Z, Grady JN, Herrin J, Conover M, et al. Development and use of an administrative claims measure for profiling hospital-wide
performance on 30-day unplanned readmission. Ann Intern Med. 2014;161:S66–75.
[28] Kangovi S, Grande D, Meehan P, Mitra N, Shannon R, Long JA. Perceptions of readmitted patients on the transition from hospital to home. J Hosp Med.
2012;7(9):709–12.
[29] Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff (Millwood) [Internet].
2014 May;33(5):778–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24799574
[30] Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med [Internet]. 2013 Mar 28;368(13):1175–7. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/23465069
[31] Navickas R, Visockienė Ž, Puronaitė R, Rukšėnienė M, Kasiulevičius V, Jurevičienė E. Prevalence and structure of multiple chronic conditions in
Lithuanian population and the distribution of the associated healthcare resources. Eur J Intern Med. 2015;26(3):160–8.
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26. Impact evaluation of the creation of Local Health Units on the readmission of
patients with chronic conditions
Óscar Brito Fernandes1, Rui Santana1,2, Sílvia Lopes1,2
1 Escola Nacional de Saúde Pública | 2 Centro de Investigação em Saúde Pública
o.fernandes@ensp.unl.pt
Management and Efficiency of Healthcare Organizations
Workshop NOVAhealth
2016.04.27
Thank you!