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Background: Postpartum Length of hospital stay (PLOHS) is an essential indicator of the quality of maternal and perinatal healthcare services. Identifying the factors associated with PLOHS will inform targeted interventions to reduce unnecessary hospitalisations and improve patient outcomes after childbirth. Therefore, we assessed the length of hospital stay after birth and the associated factors in Ibadan, Nigeria. Methods: We used the Ibadan Pregnancy Cohort Study (IbPCS) data, and examined the 1057 women who had information on PLOHS the mode of delivery [spontaneous vagina delivery (SVD) or caesarean section (C/S)]. The outcome variable was PLOHS, which was described as the time interval between the delivery of the infant and discharge from the health facility. PLOHS was prolonged if > 24 h for SVD and > 96 h for C/S, but normal if otherwise. Data were analysed using descriptive statistics, a chi-square test, and modified Poisson regression. The prevalence-risk ratio (PR) and 95% confidence interval (CI) are presented at the 5% significance level. Results: The mean maternal age was (30.0 ± 5.2) years. Overall, the mean PLOHS for the study population was 2.6 (95% CI: 2.4–2.7) days. The average PLOHS for women who had vaginal deliveries was 1.7 (95%CI: 1.5–1.9) days, whereas those who had caesarean deliveries had an average LOHS of 4.4 (95%CI: 4.1–4.6) days. About a third had prolonged PLOHS: SVD 229 (32.1%) and C/S 108 (31.5%). Factors associated with prolonged PLOHS with SVD, were high income (aPR = 1.77; CI: 1.13, 2.79), frequent ANC visits (> 4) (aPR = 2.26; CI: 1.32, 3.87), and antenatal admission: (aPR = 1.88; CI: 1.15, 3.07). For C/S: maternal age > 35 years (aPR = 1.59; CI: 1.02, 2.47) and hypertensive disease in pregnancy (aPR = 0.61 ; CI: 0.38, 0.99) were associated with prolonged PLOHS. Conclusion: The prolonged postpartum length of hospital stay was common among our study participants occurring in about a third of the women irrespective of the mode of delivery. Maternal income, advanced maternal age, ANC related issues were predisposing factors for prolonged LOHS. Further research is required to examine providers' perspectives on PLOHS among obstetric patients in our setting. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to identify factors associated with the cessation of human milk prior to neonatal intensive care unit (NICU) discharge for infants diagnosed with bronchopulmonary dysplasia (BPD). Study Design Participants were recruited from the Johns Hopkins BPD Clinic between January 2016 and October 2018. Clinical and demographic characteristics were analyzed based on whether participants stopped human milk before or after NICU discharge. Results Of the 224 infants included, 109 (48.7%) infants stopped human milk prior to discharge. The median duration of human milk intake was less for infants who stopped human milk prior to discharge compared with those who continued after discharge (2 vs. 8 months, p < 0.001). In multivariate regression analysis, pulmonary hypertension (odds ratio [OR]: 2.90; p = 0.016), public insurance (OR: 2.86; p < 0.001), and length of NICU admission (OR: 1.26 per additional month; p = 0.002) were associated with human milk cessation prior to NICU discharge. Conclusion Infants with BPD who have severe medical comorbidities and markers of lower socioeconomic status may be at higher risk for earlier human milk discontinuation. Key Points Half of infants in our study with BPD who received human milk stopped human milk prior to NICU discharge. For infants on human milk after discharge, the duration of human milk intake was 8.6 months. Infants with pulmonary hypertension, tracheostomies, and ventilation stopped human milk earlier. Non-White race, lower income, and public insurance were predictors of early human milk cessation. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis (AA) is one of the most common surgical emergencies worldwide. It's classified into simple or complicated disease. Due to the high prevalence of the disease, AA has been studied as a marker to assess the quality of care afforded to minority groups. The purpose of this study was to compare AA outcomes in foreign workers (FW) to the general population in northern Israel. Methods: This is a retrospective cohort study. We identified all patients aged 18–50 who were admitted to our institution between January 1st, 2013 and October 31st, 2018, with the diagnosis of acute appendicitis. The study group included all FW and the control group included citizens of Israel. Study patients were matched based on age, sex, and co-morbidities. We compared time to presentation, admission parameters and disease outcomes. Our study outcomes were disease severity and length of hospital stay. Results: We identified 20 FW and 97 matched local patients. FW presented with significantly higher heart rate, temperature, and white blood cell count (WBC). Duration of symptoms was comparable between the two groups. The rates of complicated disease were significantly higher among FW (45 vs 17.5%, p < 0.0001). Length of hospitalization was significantly longer in the FW group (4.8 vs. 3.9 days, p = 0.01). The odds ratio of FWs for having a complicated disease was OR = 3.85 [95% CI: 1.38, 10.72], p = 0.01. Multivariate analysis identified FW and duration of symptoms as significantly contributing to a complicated disease outcome. Conclusions: Although duration of symptoms was comparable to the local population, FW in northern Israel are at increased risk for a complicated disease which resulted in longer hospital stay. Further studies may enlighten the reason for this disparity. [ABSTRACT FROM AUTHOR]

Introduction: In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person‐centered care during pregnancy and birth among Black birthing people in California. Methods: We used data from 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person‐Centered Prenatal Care (PCPC) and the Person‐Centered Maternity Care (PCMC‐US) scales. Bivariate and multivariate analyses were conducted to examine the associations between PCPC and PCMC‐US scores and sociodemographic, health‐related, and care‐related factors. Results: The factors associated with lower PCPC scores were having foreign‐born parents, having public or no insurance, part‐time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self‐rated health (less than very good), and lack of continuity of care with prenatal providers. Factors associated with lower PCMC‐US scores were having public insurance, late start of prenatal care, longer length of stay in facility following birth, poorer self‐rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with birth provider. Conclusions: Our analysis highlights the contributions of intersecting identities as well as health‐related and care‐related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance, in particular, were shown to improve pregnancy and birth experiences. [ABSTRACT FROM AUTHOR]

Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14–0.33; β 0.37, 95% CI 0.27–0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50–0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13–0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system. [ABSTRACT FROM AUTHOR]

Background: Potentially preventable complications are monitored as part of the Maryland Hospital Acquired Conditions Program and are used to adjust hospital reimbursement. Few studies have evaluated racial-ethnic disparities in potentially preventable complications. Our study objective was to explore whether racial-ethnic disparities in potentially preventable complications after Cesarean delivery exist in Maryland.Methods: We performed a retrospective observational cohort study using data from the Maryland Health Services Cost Review Commission database. All patients having Cesarean delivery, who had race-ethnicity data between fiscal years 2016 and 2020 were included. Multivariable logistic regression modeling was performed to estimate risk-adjusted odds of having a potentially preventable complication in patients of different race-ethnicity.Results: There were 101,608 patients who had Cesarean delivery in 33 hospitals during the study period and met study inclusion criteria. Among them, 1,772 patients (1.7%), experienced at least one potentially preventable complication. Patients who had a potentially preventable complication were older, had higher admission severity of illness, and had more government insurance. They also had more chronic hypertension and pre-eclampsia (both P<0.001). Median length of hospital stay was longer in patients who had a potentially preventable complications (4 days vs. 3 days, P<0.001) and median hospital charges were approximately $4,600 dollars higher, (P<0.001). The odds of having a potential preventable complication differed significantly by race-ethnicity group (P=0.05). Hispanic patients and Non-Hispanic Black patients had higher risk-adjusted odds of having a potentially preventable complication compared to Non-Hispanic White patients, OR=1.26 (95% CI=1.05 to 1.52) and OR=1.17 (95% CI=1.03 to 1.33) respectively.Conclusions: In Maryland a small percentage of patients undergoing Cesarean delivery experienced a potentially preventable complication with Hispanic and Non-Hispanic Black patients disproportionately impacted. Continued efforts are needed to reduce potentially preventable complications and obstetric disparities in Maryland. [ABSTRACT FROM AUTHOR]

Background: The role of socioeconomic status (SES) of patients in health care outcomes has been investigated in many health care systems. The health care literature suggests that there is a relationship between patients' socioeconomic status and their health care outcomes. Most research has investigated this relation using individual SES, rather than exploring the regional socioeconomic characteristics of a population on patients' outcomes. Purpose: This study explores the correlation between regional socioeconomic characteristics of a population and patients' hospital length of stay (LOS). Assuming the demographic characteristics of patients in a region are relatively consistent, this will enable more effective regional planning and a customized decision-making process considering characteristics of the population that a health care system serves. Methodology: We use a weighted clustering algorithm to exploit the relationship between regional socioeconomic characteristics and patients' LOS. To do so, the demographic attributes and regional socioeconomic factors of patients are obtained using their ZIP Codes. Results: The results suggest that regional characteristics have a direct impact on LOS, and patients of the same medical status may experience longer LOS if they live in a more disadvantaged community. Practice implications: Our findings indicate that regional demographic characteristics of the population a health care system serves can have an impact on surgical patient outcomes, specifically length of stay, and therefore can be considered by hospital administrators to enable more efficient and effective resource and operational planning. In optimizing care delivery, to achieve the best possible value for individual patients and populations, it is important to understand all factors that contribute to the outcomes in order to focus resources to mitigate those that reduce value. [ABSTRACT FROM AUTHOR]

Purpose: There are scarce data describing the outcomes of hospitalized patients admitted with inflammatory bowel disease (IBD) stratified by race. In this retrospective cohort study, we evaluated the difference in outcomes between adult white and black patients hospitalized with a principal diagnosis of inflammatory bowel disease. Methods: Data were obtained from the 2016 and 2017 National Inpatient Sample (NIS) database. Our primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), total hospital charges (THC), red blood cell (RBC) transfusion, diagnosis of bowel perforation, and severe sepsis with septic shock. We conducted the analysis using STATA software. We used propensity-matched multivariate regression analysis to adjust for potential confounders. Results: Among 71 million hospital hospitalizations, we found 177,574 hospitalizations with a principal diagnosis of IBD, with 24,635 (13.9%) for black patients, 124,899 (70.3%) for white patients, and 28,040 (15.8%) were for others. There was no significant difference in inpatient mortality for black vs white patients. Among secondary outcomes, white compared to black patients had increased odds of having a diagnosis of bowel perforation when admitted with a diagnosis of IBD while there was no difference in the odds of developing septic shock. White patients admitted with a diagnosis of UC were also found to have increased total LOS and THC. Conclusion: White patients hospitalized with a principal diagnosis of IBD had no difference in inpatient mortality or septic shock but had worse outcomes such as increased odds of bowel perforation compared to black patients. [ABSTRACT FROM AUTHOR]

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INTRODUCTION This scoping review aims to identify the evidence and the factors influencing the outcomes of early discharge of both healthy first-time mothers and newborns. METHODS Systematic searches were conducted using four databases up to February 2021, and a search for grey literature was performed. A total of 2030 articles were identified and reduced to 13 articles, and one article was added through chain search in reference lists. The aims of the identified studies, the methodology, participants, inclusion and exclusion criteria, and the setting, context, and findings are summarized. RESULTS A total of 14 studies were included. A thematic analysis identified the following factors influencing the outcomes of discharge within 24 hours after birth: parental education in pregnancy, perinatal information before discharge, sources of support, and follow-up strategies after discharge. Also, the analysis identified outcomes such as breastfeeding, parents' experience and readmission of the newborn that may be influenced when first-time parents are discharged within 24 hours after birth. Findings in this review highlight the importance of identifying factors and outcomes related to early discharge. However, because of the heterogeneity in methodology, terminology and assessment procedures used in the retrieved articles, the generalization of study results is limited. CONCLUSIONS A gap in the literature about the outcomes of discharge within 24 hours after birth has been identified. Future studies with strong evidence are needed, defining criteria, context, and intervention. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of socioeconomic status (SES) as a key element of social determinants of health on intensive care unit (ICU) outcomes for adults. Objective: We assessed whether a validated individual SES index termed HOUSES (HOUsing-based SocioEconomic status index) derived from housing features was associated with short-term outcomes of critical illness including ICU mortality, ICU-free days, hospital-free days, and ICU readmission. Methods: We performed a populationbased cohort study of adult patients living in Olmsted County, Minnesota, admitted to 7 intensive care units at Mayo Clinic from 2011 to 2014. We compared outcomes between the lowest SES group (HOUSES quartile 1 [Q1]) and the higher SES group (HOUSES Q2-4). We stratified the cohort based on age (<50 years old and ≥50 years old). Results: Among 4134 eligible patients, 3378 (82%) patients had SES successfully measured by the HOUSES index. Baseline characteristics, severity of illness, and reason for ICU admission were similar among the different SES groups as measured by HOUSES except for larger number of intoxications and overdoses in younger patients from the lowest SES. In all adult patients, there were no overall differences in mortality, ICU-free days, hospital-free days, or ICU readmissions in patients with higher SES compared to lower SES. Among older patients (>50 years), those with higher SES (HOUSES Q2-4) compared to those with lower SES (HOUSES Q1) had lower mortality rates (hazard ratio = 0.72; 95% CI: 0.56-0.93; adjusted P = .01), increased ICU-free days (mean 1.08 days; 95% CI: 0.34-1.84; adjusted P = .004), and increased hospital-free days (mean 1.20 days; 95% CI: 0.45-1.96; adjusted P = .002). There were no differences in ICU readmission rates (OR = 0.74; 95% CI: 0.55-1.00; P = .051). Conclusion: Individual-level SES may be an important determinant or predictor of critical care outcomes in older adults. Housing-based socioeconomic status may be a useful tool for enhancing critical care research and practice. [ABSTRACT FROM AUTHOR]