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30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

https://arctichealth.org/en/permalink/ahliterature273361
Source
PLoS One. 2015;10(9):e0136547
Publication Type
Article
Date
2015
Author
Sahar Hassani
Anja Schou Lindman
Doris Tove Kristoffersen
Oliver Tomic
Jon Helgeland
Source
PLoS One. 2015;10(9):e0136547
Date
2015
Language
English
Publication Type
Article
Keywords
Comorbidity
Diagnosis-Related Groups
Episode of Care
Hospital Mortality
Hospital records
Hospitals - standards - statistics & numerical data
Humans
Length of Stay
Norway - epidemiology
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Patient transfer
Probability
Quality Improvement
Quality Indicators, Health Care
Survival Analysis
Abstract
The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.
Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013.
Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.
Notes
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PubMed ID
26352600 View in PubMed
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[Adherence of patients with stable angina to treatment with trimetazidine MR and frequency of emergency medical care: results of the EFFECT study].

https://arctichealth.org/en/permalink/ahliterature118141
Source
Kardiologiia. 2012;52(11):4-11
Publication Type
Article
Date
2012
Author
M G Glezer
R T Saigitov
Source
Kardiologiia. 2012;52(11):4-11
Date
2012
Language
Russian
Publication Type
Article
Keywords
Aged
Angina, Stable - drug therapy - epidemiology - physiopathology - psychology
Drug Monitoring - methods
Drug Substitution - statistics & numerical data
Electrocardiography
Emergencies - epidemiology
Emergency Medical Services - statistics & numerical data
Episode of Care
Female
Hospitalization - statistics & numerical data
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
Outcome and Process Assessment (Health Care)
Prospective Studies
Risk assessment
Risk factors
Russia - epidemiology
Therapeutic Equivalency
Treatment Outcome
Trimetazidine - administration & dosage - pharmacokinetics
Vasodilator Agents - administration & dosage - pharmacokinetics
Abstract
The adherence of patients with stable angina to antianginal therapy is the key factor of controlling the disease. The purpose of the study was to evaluate the relationship of adherence of patients with stable angina to treatment with trimetazidine modified release (MR) with frequency (risk) of emergency medical care. We consistently included in the study patients with stable angina in primary health care. The results of treatment for 16 weeks were monitored at patients with angina attacks three times per week or more, use of short nitrate and treatment with generic trimetazidine. To strengthen the antianginal therapy generic was replaced with original trimetazidine MR. Adherence is considered relatively high while taking 80-120% of the recommended dose of the drug (70 mg/day). The effectiveness of treatment evaluated by the frequency of emergency hospitalizations and/or ambulance calls because of the pain, discomfort, tightness in the chest or ischemic changes on the electrocardiogram. 870 patients were included in the study, the results of treatment in 185 were assessed. Patients with a relatively high adherence to trimetazidine MR (n=151) were used (median) 99% (98, 104), with low (<80%, n=34) adherence - 67% (49, 76) of the recommended dose of the drug. During the study period, the primary end point is fixed in 7 (21%) patients with low and in 18 (12%) - with relatively high adherence (p=0.182). The number of angina attacks, having necessitated taking short-nitrate, decreased in the groups, respectively, with 5 (3; 10) and 6 (4; 10) to 2 (1; 3) per week (p=0.791). Thus, replacing generic trimetazidine with original trimetazidine MR in patients with a high frequency of angina attacks can achieve significant antianginal effect. Adherence of patients to the reception of the drug by an average 1/3 below the recommended amount does not affect the risk of emergency hospitalizations and/or ambulance calls for 16 weeks.
PubMed ID
23237390 View in PubMed
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[Amalie, 14 years - The first Danish etherization]

https://arctichealth.org/en/permalink/ahliterature34950
Source
Dan Medicinhist Arbog. 1996;:227-34
Publication Type
Article
Date
1996
Author
B. Haarmark
Source
Dan Medicinhist Arbog. 1996;:227-34
Date
1996
Language
Danish
Publication Type
Article
Keywords
Anesthesiology - history
Child
Child, Hospitalized - history
Denmark
English Abstract
Episode of Care
Ethers - history
History, 19th Century
Hospitals - history
Humans
Abstract
Etherizations were developed in USA and was applied for the first time of the dentist Thomas Greene Morton (1819-1868) in 1846. Professor Dr. Ole Secher (1918-1996) studied the first Danish anaesthesias and discovered that the first etherization was carried out in February 1847 at the surgical department, Almindelig Hospital in Copenhagen. The patient was a young girl, with an albus tumore in the knee. She was etherized during an appliqué of ferrum candens. Dr. Secher was not able to find the case record, but she was identified in the hospital records dated 1846 and 1847. The hospital was separated in an alms department and a hospital. Patients were not allowed to stay at the hospital for more than 6 months, then they were placed in the alms department. The etherization was carried out in the alms department, to which the girl was transferred from the hospital. Reviewing the hospital records for the previous 6 months the girl was identified at the surgical department. Her name was Amalie, and she was 14 years old. She died two months after the etherization in April 1847.
PubMed ID
11625143 View in PubMed
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Analysing duration of episodes of pharmacological care: an example of antidepressant use in Danish general practice.

https://arctichealth.org/en/permalink/ahliterature83059
Source
Pharmacoepidemiol Drug Saf. 2006 Mar;15(3):167-77
Publication Type
Article
Date
Mar-2006
Author
Gichangi Anthony
Andersen Morten
Kragstrup Jakob
Vach Werner
Author Affiliation
Department of Statistics, University of Southern Denmark, DK-5000 Odense C, Denmark. anthony@stat.sdu.dk
Source
Pharmacoepidemiol Drug Saf. 2006 Mar;15(3):167-77
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antidepressive Agents - administration & dosage - adverse effects
Databases, Factual
Denmark - epidemiology
Drug Utilization - statistics & numerical data - trends
Episode of Care
Family Practice
Female
Humans
Incidence
Male
Middle Aged
Mortality
Patient Compliance - statistics & numerical data
Pharmacoepidemiology - methods
Proportional Hazards Models
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
Analysing duration of treatment episodes has become a standard task in many pharmacoepidemiological studies. However, such analyses are often carried out in a rather simplistic manner and more subtle issues are often ignored. In this paper, methods of analysing duration treatment episodes beyond simple analyses allowing investigation of the risk for certain events over time are demonstrated. In particular, the use of cumulative incidence functions, cause-specific hazard functions, hazard rate models and expected mortality in analysing duration of episodes is presented. We used these statistical techniques in analysing the early treatment history of patients who started a regular treatment with antidepressant drugs in the primary health care sector in Denmark. We have extracted some important features: The risk of discontinuing and switching treatment was very high around 10 weeks after starting treatment. After discontinuing the first treatment period, many patients soon started a second treatment period depending on the duration of the first treatment period with highest risk around 10 weeks. The mortality rate among the patients in treatment was about three times higher than the expected mortality. The risk of dying immediately after stopping treatment was about twice the expected mortality. The analysis suggests that: (1) there is a critical period for a first discontinuing, switching and restarting treatment around 10 weeks, (2) the GPs prescribing habits have more influence on the patterns than patient or drug characteristics, (3) over time Danish GPs tend to prolong the duration of first treatment period and avoid longer treatment breaks.
PubMed ID
16315340 View in PubMed
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Analysing the length of care episode after hip fracture: a nonparametric and a parametric Bayesian approach.

https://arctichealth.org/en/permalink/ahliterature142186
Source
Health Care Manag Sci. 2010 Jun;13(2):170-81
Publication Type
Article
Date
Jun-2010
Author
Jaakko Riihimäki
Reijo Sund
Aki Vehtari
Author Affiliation
Department of Biomedical Engineering and Computational Science, Helsinki University of Technology-TKK, P.O. Box 2200, 02015 Helsinki, Finland. jaakko.riihimaki@tkk.fi
Source
Health Care Manag Sci. 2010 Jun;13(2):170-81
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Bayes Theorem
Episode of Care
Finland
Hip Fractures
Humans
Length of Stay
Models, Statistical
Registries
Abstract
Effective utilisation of limited resources is a challenge for health care providers. Accurate and relevant information extracted from the length of stay distributions is useful for management purposes. Patient care episodes can be reconstructed from the comprehensive health registers, and in this paper we develop a Bayesian approach to analyse the length of care episode after a fractured hip. We model the large scale data with a flexible nonparametric multilayer perceptron network and with a parametric Weibull mixture model. To assess the performances of the models, we estimate expected utilities using predictive density as a utility measure. Since the model parameters cannot be directly compared, we focus on observables, and estimate the relevances of patient explanatory variables in predicting the length of stay. To demonstrate how the use of the nonparametric flexible model is advantageous for this complex health care data, we also study joint effects of variables in predictions, and visualise nonlinearities and interactions found in the data.
PubMed ID
20629418 View in PubMed
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Assessment of physical etiologies for mood and anxiety disorders in structured diagnostic interviews.

https://arctichealth.org/en/permalink/ahliterature164012
Source
Soc Psychiatry Psychiatr Epidemiol. 2007 Jun;42(6):462-6
Publication Type
Article
Date
Jun-2007
Author
Scott B Patten
Jeanne V A Williams
Author Affiliation
Dept. of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary (AB) Canada T2N 4N1. patten@ucalgary.ca
Source
Soc Psychiatry Psychiatr Epidemiol. 2007 Jun;42(6):462-6
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anxiety Disorders - epidemiology - etiology
Canada - epidemiology
Cross-Sectional Studies
Depressive Disorder, Major - epidemiology
Diagnostic and Statistical Manual of Mental Disorders
Episode of Care
Female
Humans
Interview, Psychological - methods
Male
Medical History Taking - methods
Middle Aged
Mood Disorders - epidemiology - etiology
Panic Disorder - epidemiology
Precipitating Factors
Prevalence
Reproducibility of Results
Self-Assessment
Syndrome
Abstract
Structured diagnostic inter- views include items that evaluate physical etiologies for mood and anxiety disorders. The objective of this article was to assess the impact of such items.
A mental health survey in Canada collected data from n = 36,984 household residents. The lifetime prevalence of mood and anxiety disorders was calculated with and without exclusions due to physical causes.
Approximately 10% of subjects with a lifetime depressive disorder reported that all of their episodes were due to one or more physical cause. Many of the reported etiologies were implausible given the DSM-IV requirement that the disturbance be a "direct physiological consequence" of the physical cause. The results were similar for manic episodes and anxiety disorders.
Structured diagnostic interviews assess physical etiologies in ways that are subject to inconsistency and inaccuracy. Physical etiology items may bias estimates by introducing etiological opinions into the assessment of disorder frequency.
PubMed ID
17450450 View in PubMed
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[Banking on the systematic follow-up of patients for better management of treatment periods].

https://arctichealth.org/en/permalink/ahliterature205038
Source
Infirm Que. 1998 May-Jun;5(5):12
Publication Type
Article

'Bed-blockers': delayed discharge of hospital patients in a nationwide perspective in Sweden.

https://arctichealth.org/en/permalink/ahliterature73275
Source
Health Policy. 1993 Dec;26(2):155-70
Publication Type
Article
Date
Dec-1993
Author
K. Styrborn
M. Thorslund
Author Affiliation
University Hospital, Uppsala, Sweden.
Source
Health Policy. 1993 Dec;26(2):155-70
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Aftercare
Aged
Bed Occupancy - legislation & jurisprudence - statistics & numerical data - trends
Comparative Study
Data Collection
Episode of Care
Female
Health Services Misuse - statistics & numerical data
Health Services for the Aged - legislation & jurisprudence - utilization
Hospitals - utilization
Humans
Length of Stay - statistics & numerical data - trends
Patient Discharge - economics - standards - statistics & numerical data
Sweden
Abstract
Between 1989 and 1992 the number of 'bed-blocking' patients in Sweden decreased from 15 to 7% according to national registers containing approx. 4000 patients. Part of this reduction can be explained by the 1992 Elderly Reform, which placed economic responsibility for bed-blockers on municipalities. However, the decrease began before the economic reform, implying that other factors are also involved, such as access to alternative institutional beds and other forms of care. An in-depth study of one district has provided a description of these often elderly patients, their heavy hospital utilization both before and after the bed-blocking period and their mortality. Nearly half the patients were dead within a year. Bed-blocking is a poorly defined concept requiring urgent discussion. Other related topics to which attention should be drawn are the administrative costs of economic control systems and efficient utilization of public resources as a whole.
PubMed ID
10131281 View in PubMed
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Beyond demographic change in human resources planning: an extended framework and application to nursing.

https://arctichealth.org/en/permalink/ahliterature183009
Source
J Health Serv Res Policy. 2003 Oct;8(4):225-9
Publication Type
Article
Date
Oct-2003
Author
Stephen Birch
Linda O'Brien-Pallas
Chris Alksnis
Gail Tomblin Murphy
Donna Thomson
Author Affiliation
Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
Source
J Health Serv Res Policy. 2003 Oct;8(4):225-9
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Demography
Efficiency, Organizational
Episode of Care
Health Manpower
Health Services Needs and Demand - trends
Hospital Bed Capacity
Hospital Planning
Hospitals - utilization
Humans
Needs Assessment
Nursing Staff, Hospital - supply & distribution
Ontario - epidemiology
Outpatient Clinics, Hospital - utilization
Patient Admission - statistics & numerical data - trends
Regional Health Planning
Severity of Illness Index
Abstract
To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity.
Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs.
Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode.
The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.
PubMed ID
14596757 View in PubMed
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Burden of acute otitis media on Canadian families.

https://arctichealth.org/en/permalink/ahliterature137743
Source
Can Fam Physician. 2011 Jan;57(1):60-5
Publication Type
Article
Date
Jan-2011
Author
Eve Dubé
Philippe De Wals
Vladimir Gilca
Nicole Boulianne
Manale Ouakki
France Lavoie
Richard Bradet
Author Affiliation
Quebec National Institute of Public Health, Quebec, QC. eve.dube@ssss.gouv.qc.ca
Source
Can Fam Physician. 2011 Jan;57(1):60-5
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Absenteeism
Acute Disease
Adult
Age Distribution
Canada - epidemiology
Caregivers - statistics & numerical data
Child, Preschool
Cost of Illness
Episode of Care
Health Knowledge, Attitudes, Practice
Health Services Accessibility - economics - statistics & numerical data - trends
Humans
Infant
Nonprescription Drugs - therapeutic use
Otitis Media - complications - drug therapy - economics - epidemiology
Physicians, Family - utilization
Prescription Drugs - therapeutic use
Quality of Life - psychology
Questionnaires
Severity of Illness Index
Time Factors
Waiting Lists
Abstract
To estimate the burden of acute otitis media (AOM) on Canadian families.
Telephone survey using random-digit dialing.
All Canadian provinces between May and June 2008.
Caregivers of 1 or more children aged 6 months to 5 years.
Caregivers' reports on the number of AOM episodes experienced by the child in the past 12 months, as well as disease characteristics, health services and medication use, time spent on medical consultations (including travel), and time taken off from work to care for the sick children.
A total of 502 eligible caregivers were recruited, 161 (32%) of whom reported at least 1 AOM episode for their children and 42 (8%) of whom reported 3 or more episodes during the past 12 months. Most children (94%, 151 of 161) visited with health professionals during their most recent AOM episodes. The average time required for medical examination was 3.1 hours in an emergency department and 1.8 hours in an outpatient clinic. Overall, 93% of episodes resulted in antibiotics use. A substantial proportion of caregivers (38%) missed work during this time; the average time taken off work was 15.9 hours.
In Canada, episodes of AOM are still associated with substantial use of health services and indirect costs to the caregivers.
Notes
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Comment In: Can Fam Physician. 2011 Apr;57(4):41221490351
PubMed ID
21252135 View in PubMed
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100 records – page 1 of 10.