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Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region.

https://arctichealth.org/en/permalink/ahliterature123167
Source
BMC Health Serv Res. 2012;12:172
Publication Type
Article
Date
2012
Author
Andrew P Costa
Jeffrey W Poss
Thomas Peirce
John P Hirdes
Author Affiliation
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. acosta@uwaterloo.ca
Source
BMC Health Serv Res. 2012;12:172
Date
2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Acute Disease - epidemiology - therapy
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data
Catchment Area (Health) - statistics & numerical data
Evidence-Based Medicine
Female
Health Services for the Aged - standards
Home Care Services - standards
Hospitalization - statistics & numerical data - trends
Humans
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data - trends
Long-Term Care - methods
Male
Middle Aged
Nursing Homes - standards
Ontario - epidemiology
Patient Discharge - standards - statistics & numerical data - trends
Retrospective Studies
Time Factors
Waiting Lists
Abstract
Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.
Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.
ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27?day mean deviation, 99% CI?=?±14.6), psychiatric diagnosis (13?day mean deviation, 99% CI?=?±6.2), abusive behaviours (12?day mean deviation, 99% CI?=?±10.7), and stroke (7?day mean deviation, 99% CI?=?±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.
A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
Notes
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PubMed ID
22726609 View in PubMed
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Acute infections and venous thromboembolism.

https://arctichealth.org/en/permalink/ahliterature130192
Source
J Intern Med. 2012 Jun;271(6):608-18
Publication Type
Article
Date
Jun-2012
Author
M. Schmidt
E. Horvath-Puho
R W Thomsen
L. Smeeth
H T Sørensen
Author Affiliation
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. morten.schmidt@dce.au.dk
Source
J Intern Med. 2012 Jun;271(6):608-18
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Algorithms
Anti-Bacterial Agents - therapeutic use
Bacteremia - complications
Bacterial Infections - complications - drug therapy - epidemiology - microbiology
Case-Control Studies
Community-Acquired Infections - complications
Cross Infection - complications - drug therapy
Denmark - epidemiology
Female
Humans
Incidence
Inpatients - statistics & numerical data
Intraabdominal Infections - complications
Logistic Models
Male
Medical Records
Middle Aged
Odds Ratio
Outpatients - statistics & numerical data
Prevalence
Pulmonary Embolism - diagnosis - drug therapy - epidemiology - microbiology
Respiratory Tract Infections - complications
Risk assessment
Risk factors
Skin Diseases, Bacterial - complications
Urinary Tract Infections - complications
Venous Thromboembolism - diagnosis - drug therapy - epidemiology - microbiology
Abstract
Data on the association between acute infections and venous thromboembolism (VTE) are sparse. We examined whether various hospital-diagnosed infections or infections treated in the community increase the risk of VTE.
We conducted this population-based case-control study in Northern Denmark (population 1.8 million) using medical databases. We identified all patients with a first hospital-diagnosed VTE during the period 1999-2009 (n = 15 009). For each case, we selected 10 controls from the general population matched for age, gender and county of residence (n = 150 074). We identified all hospital-diagnosed infections and community prescriptions for antibiotics 1 year predating VTE. We used odds ratios from a conditional logistic regression model to estimate incidence rate ratios (IRRs) of VTE within different time intervals of the first year after infection, controlling for confounding.
Respiratory tract, urinary tract, skin, intra-abdominal and bacteraemic infections diagnosed in hospital or treated in the community were associated with a greater than equal to twofold increased VTE risk. The association was strongest within the first 2 weeks after infection onset, gradually declining thereafter. Compared with individuals without infection during the year before VTE, the IRR for VTE within the first 3 months after infection was 12.5 (95% confidence interval (CI): 11.3-13.9) for patients with hospital-diagnosed infection and 4.0 (95% CI: 3.8-4.1) for patients treated with antibiotics in the community. Adjustment for VTE risk factors reduced these IRRs to 3.3 (95% CI: 2.9-3.8) and 2.6 (95% CI: 2.5-2.8), respectively. Similar associations were found for unprovoked VTE and for deep venous thrombosis and pulmonary embolism individually.
Infections are a risk factor for VTE.
Notes
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PubMed ID
22026462 View in PubMed
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Adolescent psychiatric in-patients. A high-risk group for premature death.

https://arctichealth.org/en/permalink/ahliterature196074
Source
Br J Psychiatry. 2000 Feb;176:121-5
Publication Type
Article
Date
Feb-2000
Author
E. Kjelsberg
Author Affiliation
Centre for Child and Adolescent Psychiatry, Oslo, Norway.
Source
Br J Psychiatry. 2000 Feb;176:121-5
Date
Feb-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Cause of Death
Cohort Studies
Diagnosis-Related Groups - statistics & numerical data
Female
Humans
Inpatients - statistics & numerical data
Male
Mental Disorders - mortality
Norway - epidemiology
Risk factors
Abstract
Research has demonstrated increased mortality rates in adolescent psychiatric in-patients.
To investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age.
A nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15-33 years after first hospitalisation by record linkage to the National Death Cause Registry.
The SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated.
A broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.
PubMed ID
10755047 View in PubMed
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Adverse drug events in the elderly population admitted to a tertiary care hospital.

https://arctichealth.org/en/permalink/ahliterature188411
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Publication Type
Article
Author
Nahid Azad
Michael Tierney
Gary Victor
Parul Kumar
Author Affiliation
Faculty of Medicine, Geriatric Assessment Unit, Ottawa Hospital Civic Campus, Canada. nazad@ottawahospital.on.ca
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Cohort Studies
Drug Prescriptions
Drug Therapy - utilization
Drug Utilization Review
Drug-Related Side Effects and Adverse Reactions
Female
Health Services Research
Hospital Bed Capacity, 500 and over
Hospitals, Teaching - standards - utilization
Humans
Incidence
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Ontario - epidemiology
Polypharmacy
Prospective Studies
Abstract
Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, adverse drug events are poorly described, and analytical methods are questionable. This leads to problems with imprecise estimates and generalizability of results.
PubMed ID
12325252 View in PubMed
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Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden.

https://arctichealth.org/en/permalink/ahliterature193757
Source
Int Psychogeriatr. 2001 Jun;13(2):183-97
Publication Type
Article
Date
Jun-2001
Author
R. Sourial
J. McCusker
M. Cole
M. Abrahamowicz
Author Affiliation
Department of Nursing and Quality Management, St Mary's Hospital, Montreal, PQ, Canada.
Source
Int Psychogeriatr. 2001 Jun;13(2):183-97
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aggression - psychology
Canada - epidemiology
Cost of Illness
Dementia - complications - psychology
Female
Hospitals, University
Humans
Incidence
Inpatients - statistics & numerical data
Long-Term Care
Male
Middle Aged
Nursing Staff, Hospital - psychology
Prevalence
Psychomotor Agitation - epidemiology - psychology
Abstract
BACKGROUND/LITERATURE REVIEW: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff.
The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints.
Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden.
The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.
PubMed ID
11495393 View in PubMed
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Antipsychotic dosing patterns for schizophrenia in three treatment settings.

https://arctichealth.org/en/permalink/ahliterature196219
Source
Psychiatr Serv. 2001 Jan;52(1):96-8
Publication Type
Article
Date
Jan-2001
Author
G. Remington
C M Shammi
R. Sethna
R. Lawrence
Author Affiliation
Department of Psychiatry, University of Toronto, Ontario, Canada. gary_remington@camh.net
Source
Psychiatr Serv. 2001 Jan;52(1):96-8
Date
Jan-2001
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - administration & dosage
Canada
Chlorpromazine - administration & dosage
Dosage Forms
Drug Utilization - statistics & numerical data
Drug Utilization Review
Female
Guideline Adherence
Hospitals, Community - statistics & numerical data
Hospitals, County - statistics & numerical data
Hospitals, Teaching - statistics & numerical data
Humans
Inpatients - statistics & numerical data
Male
Outpatients - statistics & numerical data
Practice Guidelines as Topic
Retrospective Studies
Schizophrenia - drug therapy
Therapeutic Equivalency
Abstract
Daily dosages of antipsychotic medications were evaluated to determine whether current guidelines advocating lower dosing are being followed. A chart review of 163 outpatients with schizophrenia was undertaken in three outpatient hospital settings-a general community hospital, a provincial hospital, and an academic teaching hospital. The daily dosage in chlorpromazine equivalents was significantly higher in the provincial hospital (773.8 mg) than in the community hospital (355 mg) or the academic hospital (424.8 mg). A greater proportion of patients at the provincial hospital received conventional antipsychotics than novel antipsychotics or depot antipsychotics, and a greater proportion received more than one antipsychotic.
PubMed ID
11141536 View in PubMed
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Appendectomy in Sweden 1989-1993 assessed by the Inpatient Registry.

https://arctichealth.org/en/permalink/ahliterature33696
Source
J Clin Epidemiol. 1998 Oct;51(10):859-65
Publication Type
Article
Date
Oct-1998
Author
P. Blomqvist
H. Ljung
O. Nyrén
A. Ekbom
Author Affiliation
Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Source
J Clin Epidemiol. 1998 Oct;51(10):859-65
Date
Oct-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Analysis of Variance
Appendectomy - adverse effects - statistics & numerical data - utilization
Appendicitis - diagnosis - epidemiology - surgery
Child
Child, Preschool
Female
Humans
Incidence
Infant
Infant, Newborn
Inpatients - statistics & numerical data
Length of Stay - trends
Linear Models
Male
Middle Aged
Patient Admission - statistics & numerical data - trends
Population Surveillance
Registries
Seasons
Sweden - epidemiology
Abstract
We analyzed all appendectomies in Sweden 1989-1993 (n = 60,306) recorded in the national Inpatient Registry. Our focus was on diagnostic accuracy, incidence rate of appendicitis, perforative appendicitis, and length of stay by day of admission and hospital category. The incidence rate of appendectomy decreased by 9.8% in women compared to 4.1% in men. Since the number of patients with an end diagnosis of appendicitis remained almost constant, diagnostic accuracy increased each year. This was more pronounced in women than men, seen in all hospital categories, and was higher for those admitted during periods of low capacity (weekends/ holidays). Perforated appendicitis did not increase. Duration of hospital stay decreased continuously, especially among the oldest. We found no indications of an increased frequency of complications, such as increases in the incidence rate of perforations or in the length of stay.
PubMed ID
9762879 View in PubMed
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Appropriateness of diagnostic strategies for evaluating suspected venous thromboembolism.

https://arctichealth.org/en/permalink/ahliterature165399
Source
Thromb Haemost. 2007 Feb;97(2):195-201
Publication Type
Article
Date
Feb-2007
Author
Thomas Arnason
Philip S Wells
Alan J Forster
Author Affiliation
Ottawa Health Research Institute - Clinical Epidemiology Program, Ottawa, ON, Canada.
Source
Thromb Haemost. 2007 Feb;97(2):195-201
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Chemical Analysis - statistics & numerical data - utilization
Cohort Studies
Decision Trees
Diagnostic Imaging - statistics & numerical data - utilization
Emergency Service, Hospital - statistics & numerical data
Female
Fibrin Fibrinogen Degradation Products - metabolism
Guideline Adherence - statistics & numerical data
Humans
Inpatients - statistics & numerical data
Male
Middle Aged
Ontario
Practice Guidelines as Topic
Probability
Pulmonary Embolism - blood - diagnosis
Retrospective Studies
Thromboembolism - blood - diagnosis
Venous Thrombosis - blood - diagnosis
Abstract
It was the objective of this study to determine the proportion of patients who undergo an appropriate diagnostic work-up following a D-dimer test performed to evaluate suspected pulmonary embolism (PE) or deep vein thrombosis (DVT). We performed a retrospective cohort study at a tertiary care hospital. We included patients if they underwent D-dimer testing between 2002 and 2005, if the D-dimer was performed for evaluation of VTE, and if the D-dimer test was successful. We classified: the patients' clinical probability of DVT or PE according to the Wells models, the imaging results, and the appropriateness of the testing algorithm. Of 1,000 randomly selected patients, 863 met our study criteria. Seven hundred nineteen patients (83%) had testing during an emergency department visit, while 144 were tested as inpatients (17%). Physicians performed the D-dimer test to evaluate DVT and PE in 238 (28%) and 625 (72%) patients, respectively. Overall, the testing strategy was appropriate in 69% (95% confidence interval [CI]: 66%-72%) of cases. The testing strategy was more likely to be appropriate for emergency department versus inpatients (75% vs. 39%, p
PubMed ID
17264947 View in PubMed
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Are inpatients' needs better served by hospitalists than by their family doctors?: no.

https://arctichealth.org/en/permalink/ahliterature155704
Source
Can Fam Physician. 2008 Aug;54(8):1101-3, 1105-7
Publication Type
Article
Date
Aug-2008
Author
Galt Wilson
Author Affiliation
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. Galt.Wilson@northernhealth.ca
Source
Can Fam Physician. 2008 Aug;54(8):1101-3, 1105-7
Date
Aug-2008
Language
English
French
Publication Type
Article
Keywords
Attitude of Health Personnel
British Columbia
Delivery of Health Care - standards - trends
Female
Health Services Needs and Demand - statistics & numerical data
Hospitalists - standards - trends
Humans
Inpatients - statistics & numerical data
Male
Patient Care - standards - trends
Physician's Practice Patterns - standards - trends
Physicians, Family - standards - trends
Sensitivity and specificity
Notes
Cites: Can Fam Physician. 2007 Dec;53(12):213118077751
Comment In: Can Fam Physician. 2008 Nov;54(11):1525-619005116
Comment In: Can Fam Physician. 2008 Sep;54(9):1227, 122918791086
Comment On: Can Fam Physician. 2008 Aug;54(8):1100-1, 1104-618697962
PubMed ID
18697963 View in PubMed
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Are inpatients' needs better served by hospitalists than by their family doctors: yes.

https://arctichealth.org/en/permalink/ahliterature155705
Source
Can Fam Physician. 2008 Aug;54(8):1100-1, 1104-6
Publication Type
Article
Date
Aug-2008
Author
Darryl Samoil
Author Affiliation
Fraser Health Authority Hospitalist Program, Langley Memorial Hospital, Langley, BC, Canada. Darryl.Samoil@fraserhealth.ca
Source
Can Fam Physician. 2008 Aug;54(8):1100-1, 1104-6
Date
Aug-2008
Language
English
French
Publication Type
Article
Keywords
Attitude of Health Personnel
British Columbia
Delivery of Health Care - standards - trends
Female
Health Services Needs and Demand - statistics & numerical data
Hospitalists - methods - trends
Humans
Inpatients - statistics & numerical data
Male
Patient Care - methods
Physician's Practice Patterns - standards - trends
Physicians, Family - standards - trends
Sensitivity and specificity
Notes
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Comment In: Can Fam Physician. 2008 Nov;54(11):1525-619005116
Comment In: Can Fam Physician. 2008 Nov;54(11):152519005117
Comment In: Can Fam Physician. 2008 Sep;54(9):1227, 122918791085
Comment In: Can Fam Physician. 2008 Aug;54(8):1101-3, 1105-718697963
PubMed ID
18697962 View in PubMed
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128 records – page 1 of 13.