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Background Many individuals with chronic obstructive pulmonary disease (COPD) experience frequent hospitalization and readmissions, which is burdensome on the health system. This study aims to investigate factors associated with unplanned readmissions and mortality following a COPD-related hospitalization over a 12-month period in Australia, focusing on mental disorders and accounting for the acute phase of the COVID-19 pandemic. Methods A retrospective cohort study using linked hospitalization and mortality records identified individuals aged ≥40 years who had at least one hospital admission with a principal diagnosis of COPD between 2014 and 2020 in New South Wales, Australia. A semi-competing risk analysis was conducted to examine factors associated with unplanned readmission and mortality. Results Adults with a mental disorder diagnosis, specifically anxiety, had a higher risk of 12-month unplanned readmission. Individuals with anxiety and dementia also had a higher risk of mortality pre- and post-unplanned readmission. Individuals who were admitted during the acute phase of the COVID-19 pandemic period had lower risk of unplanned readmission, but higher risk of mortality without unplanned readmission. Conclusion Interventions aimed at reducing admissions should consider adults living with mental disorders such as anxiety or dementia to improve healthcare delivery and health outcomes for individuals living with COPD. [ABSTRACT FROM AUTHOR]

Aims: Reducing preventable hospitalization for congestive heart failure (CHF) patients is a challenge for health systems worldwide. CHF patients who also have a recent or ongoing mental disorder may have worse health outcomes compared with CHF patients with no mental disorders. This study examined the impact of mental disorders on 28 day unplanned readmissions of CHF patients. Methods and results: This retrospective cohort study used population‐level linked public and private hospitalization and death data of adults aged ≥18 years who had a CHF admission in New South Wales, Australia, between 1 January 2014 and 31 December 2020. Individuals' mental disorder diagnosis and Charlson comorbidity and hospital frailty index scores were derived from admission records. Competing risk and cause‐specific risk analyses were conducted to examine the impact of having a mental disorder diagnosis on all‐cause hospital readmission. Of the 65 861 adults with index CHF admission discharged alive (mean age: 78.6 ± 12.1; 48% female), 19.2% (12 675) had at least one unplanned readmission within 28 days following discharge. Adults with CHF with a mental disorder diagnosis within 12 months had a higher risk of 28 day all‐cause unplanned readmission [hazard ratio (HR): 1.21, 95% confidence interval (CI): 1.15–1.27, P‐value < 0.001], particularly those with anxiety disorder (HR: 1.49, 95% CI: 1.35–1.65, P‐value < 0.001). CHF patients aged ≥85 years (HR: 1.19, 95% CI: 1.11–1.28), having ≥3 other comorbidities (HR: 1.35, 95% CI: 1.25–1.46), and having an intermediate (HR: 1.34, 95% CI: 1.28–1.40) or high (HR: 1.37, 95% CI: 1.27–1.47) frailty score on admission had a higher risk of unplanned readmission. CHF patients with a mental disorder who have ≥3 other comorbidities and an intermediate frailty score had the highest probability of unplanned readmission (29.84%, 95% CI: 24.68–35.73%) after considering other patient‐level factors and competing events. Conclusions: CHF patients who had a mental disorder diagnosis in the past 12 months are more likely to be readmitted compared with those without a mental disorder diagnosis. CHF patients with frailty and a mental disorder have the highest probability of readmission. Addressing mental health care services in CHF patient's discharge plan could potentially assist reduce unplanned readmissions. [ABSTRACT FROM AUTHOR]

Background and Objective: The impact of type 1 diabetes mellitus (T1D) on academic performance is inconclusive. This study aims to compare scholastic performance and high‐school completion in young people hospitalized with T1D compared to matched peers not hospitalized with diabetes. Research Design: Retrospective case‐comparison cohort study. Method: A population‐level matched case‐comparison study of people aged ≤18 hospitalized with T1D during 2005–2018 in New South Wales, Australia using linked health‐related and education records. The comparison cohort was matched on age, gender, and residential postcode. Generalized linear mixed modeling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with T1D compared to peers. Adjusted relative risks (ARR) were calculated. Results: Young females and males hospitalized with T1D did not have a higher risk of not achieving the NMS compared to peers for numeracy (ARR: 1.19; 95%CI 0.77–1.84 and ARR: 0.74; 95%CI 0.46–1.19) or reading (ARR: 0.98; 95%CI 0.63–1.50 and ARR: 0.85; 95%CI 0.58–1.24), respectively. Young T1D hospitalized females had a higher risk of not completing year 11 (ARR: 1.73; 95%CI 1.19–2.53) or 12 (ARR: 1.65; 95%CI 1.17–2.33) compared to peers, while hospitalized T1D males did not. Conclusions: There was no difference in academic performance in youth hospitalized with T1D compared to peers. Improved glucose control and T1D management may explain the absence of school performance decrements in students with T1D. However, females hospitalized with T1D had a higher risk of not completing high school. Potential associations of this increased risk, with attention to T1D and psycho‐social management, should be investigated. [ABSTRACT FROM AUTHOR]

Background: There is inconclusive evidence of the effect of asthma on the academic performance of young people. This study aims to compare scholastic performance and high school completion of young people hospitalized with asthma compared to matched peers not hospitalized with asthma. Method: A population‐based matched case‐comparison cohort study of young people aged ≤18 years hospitalized for asthma during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalized linear mixed‐modelling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with asthma compared to matched peers. Results: Young males hospitalized with asthma had a 13% and 15% higher risk of not achieving the NMS for numeracy (95%CI 1.04–1.22) and reading (95%CI 1.07–1.23), respectively, compared to peers. Young males hospitalized with asthma had a 51% (95%CI 1.22–1.86) higher risk of not completing year 10, and around a 20% higher risk of not completing year 11 (ARR: 1.25; 95%CI 1.15–1.36) or year 12 (ARR: 1.27; 95%CI 1.17–1.39) compared to peers. Young females hospitalized with asthma showed no difference in achieving numeracy or reading NMSs, but did have a 21% higher risk of not completing year 11 (95%CI 1.09–1.36) and a 33% higher risk of not completing year 12 (95%CI 1.19–1.49) compared to peers. Conclusions: Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students. [ABSTRACT FROM AUTHOR]

Background: Exploring the impact of injury and injury severity on academic outcomes could assist to identify characteristics of young people likely to require learning support services. This study aims to compare scholastic performance and high school completion of young people hospitalised for an injury compared to young people not hospitalised for an injury by injury severity; and to examine factors influencing scholastic performance and school completion.Method: A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for an injury during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy (NAPLAN) and generalised linear regression examined risk of not completing high school for injured young people compared to matched peers.Results: Injured young people had a higher risk of not achieving the NMS compared to their matched peers for numeracy (ARR: 1.12; 95%CI 1.06-1.17), reading (ARR: 1.09; 95%CI 1.04-1.13), spelling (ARR: 1.13; 95%CI 1.09-1.18), grammar (ARR: 1.11; 95%CI 1.06-1.15), and writing (ARR: 1.07; 95%CI 1.04-1.11). As injury severity increased from minor to serious, the risk of not achieving the NMS generally increased for injured young people compared to matched peers. Injured young people had almost twice the risk of not completing high school at year 10 (ARR: 2.17; 95%CI 1.73-2.72), year 11 (ARR: 1.95; 95%CI 1.78-2.14) or year 12 (ARR: 1.93; 95%CI 1.78-2.08) compared to matched peers.Conclusions: The identification of characteristics of young people most likely to encounter problems in the academic environment after sustaining an injury is important to facilitate the potential need for learning support. Assessing learning needs and monitoring return-to-school progress post-injury may aid identification of any ongoing learning support requirements. [ABSTRACT FROM AUTHOR]

Objective Indicators based on hospital administrative data have potential for misclassification error, especially if they rely on clinical detail that may not be well recorded in the data. We applied an approach using modified logistic regression models to assess the misclassification (false-positive and false-negative) rates of low-value care indicators. Design and setting We applied indicators involving 19 procedures to an extract from the New South Wales Admitted Patient Data Collection (1 January 2012 to 30 June 2015) to label episodes as low value. We fit four models (no misclassification, false-positive only, false-negative only, both false-positive and false-negative) for each indicator to estimate misclassification rates and used the posterior probabilities of the models to assess which model fit best. Results False-positive rates were low for most indicators--if the indicator labels care as low value, the care is most likely truly low value according to the relevant recommendation. False-negative rates were much higher but were poorly estimated (wide credible intervals). For most indicators, the models allowing no misclassification or allowing false-negatives but no false-positives had the highest posterior probability. The overall low-value care rate from the indicators was 12%. After adjusting for the estimated misclassification rates from the highest probability models, this increased to 35%. Conclusion Binary performance indicators have a potential for misclassification error, especially if they depend on clinical information extracted from administrative data. Indicators should be validated by chart review, but this is resource- intensive and costly. The modelling approach presented here can be used as an initial validation step to identify and revise indicators that may have issues before continuing to a full chart review validation. [ABSTRACT FROM AUTHOR]

Background: Rates of low-value care vary between hospitals in New South Wales, Australia. Understanding factors associated with this variation will help in understanding the drivers of low-value care and in planning initiatives to reduce low-value care.Methods: For eight low-value procedures, we used Poisson regression of the number of low-value episodes at each hospital to assess the association between low-value care and hospital characteristics. We also used hierarchical clustering on the low-value procedures used and their rates at each hospital to try to identify groups of hospitals with higher or lower rates of low-value care across multiple procedures.Results: Some hospital characteristics, such as hospital peer group and proportion of total episodes that involve the specific procedure, showed associations for some procedures, but none were consistent across all eight procedures. We clustered hospitals into five groups, but low-value care rates did not differ much between these groups.Conclusion: Available hospital variables show little association with rates of low-value care and no patterns across different low-value procedures. We need to investigate factors within hospitals, such as clinician knowledge and beliefs about low-value care. [ABSTRACT FROM AUTHOR]

Background: Whether patients receive low-value hospital care (care that is not expected to provide a net benefit) may be influenced by unmeasured factors at the hospital they attend or the hospital's Local Health District (LHD), or the patients' areas of residence. Multilevel modelling presents a method to examine the effects of these different levels simultaneously and assess their relative importance to the outcome. Knowing which of these levels has the greatest contextual effects can help target further investigation or initiatives to reduce low-value care.Methods: We conducted multilevel logistic regression modelling for nine low-value hospital procedures. We fit a series of six models for each procedure. The baseline model included only episode-level variables with no multilevel structure. We then added each level (hospital, LHD, Statistical Local Area [SLA] of residence) separately and used the change in the c statistic from the baseline model as a measure of the contribution of the level to the outcome. We then examined the variance partition coefficients (VPCs) and median odds ratios for a model including all three levels. Finally, we added level-specific covariates to examine if they were associated with the outcome.Results: Analysis of the c statistics showed that hospital was more important than LHD or SLA in explaining whether patients receive low-value care. The greatest increases were 0.16 for endoscopy for dyspepsia, 0.13 for colonoscopy for constipation, and 0.14 for sentinel lymph node biopsy for early melanoma. SLA gave a small increase in c compared with the baseline model, but no increase over the model with hospital. The VPCs indicated that hospital accounted for most of the variation not explained by the episode-level variables, reaching 36.8% (95% CI, 31.9-39.0) for knee arthroscopy. ERCP (8.5%; 95% CI, 3.9-14.7) and EVAR (7.8%; 95% CI, 2.9-15.8) had the lowest residual variation at the hospital level. The variables at the hospital, LHD and SLA levels that were available for this study generally showed no significant effect.Conclusions: Investigations into the causes of low-value care and initiatives to reduce low-value care might best be targeted at the hospital level, as the high variation at this level suggests the greatest potential to reduce low-value care. [ABSTRACT FROM AUTHOR]

Objective. To describe the rates of antenatal hospital admission during twin or higher order multifetal pregnancies, and the admission outcomes as discharge undelivered, transfer to higher care, or spontaneous or elective delivery. Methods. Cohort study using linked birth and hospital data. The cohort comprised women who gave birth to twins or higher order multiple infants of ≥ 24 weeks gestation in 2001--2008 and who were admitted to hospital in weeks 20--36 of the pregnancy. Results. In 63.4% of 10 779 twin pregnancies and 99.5% of 197 triplet and quadruplet pregnancies, the woman was admitted to hospital at least once in weeks 20--36 of the pregnancy, for a total 10 985 admissions. Almost half the admissions (46.3%) ended in discharge without delivery, 10.7% in transfer to higher care, 21.1% in spontaneous labour and birth, and 21.8% in elective delivery (induction or prelabour Caesarean section). The reason for admission was preterm labour in 34.2% of admissions. Conclusions. Hospital admission during pregnancy is common for women with multifetal pregnancies, with many of these admissions resulting in preterm birth. This is the first study to report the rate of pregnancy admissions for women with multifetal pregnancies, and provides a baseline for future studies of hospital use in this population. [ABSTRACT FROM AUTHOR]

Importance: Studies of low-value care have focused on the prevalence of low-value care interventions but have rarely quantified downstream consequences of these interventions for patients or the health care system., Objective: To measure immediate in-hospital harm associated with 7 low-value procedures., Design, Setting, and Participants: A cohort study with a descriptive analysis using hospital admission data from 225 public hospitals in New South Wales, Australia, was conducted from July 1, 2014, to June 30, 2017. All 9330 episodes involving 1 of 7 low-value procedures were evaluated, including endoscopy for dyspepsia in people younger than 55 years (3689 episodes); knee arthroscopy for osteoarthritis or meniscal tears (3963 episodes); colonoscopy for constipation in people younger than 50 years (665 episodes); endovascular repair of abdominal aortic aneurysm in asymptomatic, high-risk patients (508 episodes); carotid endarterectomy in asymptomatic, high-risk patients (273 episodes); renal artery angioplasty (176 episodes); and spinal fusion for uncomplicated low back pain (56 episodes). Sixteen hospital-acquired complications (HACs) were used as a measure of harm associated with low-value care., Main Outcomes and Measures: For each low-value procedure, the percentage associated with any HAC and the difference in mean length of stay for patients receiving low-value care with and without HACs were calculated., Results: Across the 225 hospitals and 9330 episodes of low-value care, rates of HACs were low for low-value endoscopy (4 [0.1%] episodes; 95% CI, 0.02%-0.2%), knee arthroscopy (18 [0.5%] episodes; 95% CI, 0.2%-0.7%), and colonoscopy (2 [0.3%] episodes; 95% CI, 0.0%-0.9%) but higher for low-value spinal fusion (4 [7.1%] episodes; 95% CI, 2.2%-11.5%), endovascular repair of abdominal aortic aneurysm (76 [15.0%] episodes; 95% CI, 11.1%-19.7%), carotid endarterectomy (21 [7.7%] episodes; 95% CI, 5.2%-10.1%), and renal artery angioplasty (15 [8.5%] episodes; 95% CI, 5.8%-11.5%). For most procedures, the most common HAC was health care-associated infection, which accounted for 83 (26.3%) (95% CI, 21.8%-31.5%) of all HACs observed. The highest rate of health care-associated infection was 8.4% (95% CI, 5.2%-11.4%) for renal artery angioplasty. For all 7 low-value procedures, median length of stay for patients with an HAC was 2 times or more the median length of stay for patients without a complication. For example, median length of stay was 1 (interquartile range [IQR], 1-1) day for knee arthroscopy with no HACs but increased to 10.5 (IQR, 1.0-21.3) days for patients with an HAC., Conclusions and Relevance: These findings suggest that use of these 7 procedures in patients who probably should not receive them is harming some of those patients, consuming additional hospital resources, and potentially delaying care for other patients for whom the services would be appropriate. Although only some immediate consequences of just 7 low-value services were examined, harm related to all low-value procedures was noted, including high rates of harm for certain higher-risk procedures. The full burden of low-value care for patients and the health system is yet to be quantified.

Background: To determine whether increasing distance to the nearest accessible specialist hospital (NASH, a public hospital with a thoracic surgical service) increases a patient's likelihood of missing out on curative surgery for localized non-small cell lung cancer (NSCLC)., Method: Population-based study of cancer registry records for 27 033 people with lung cancer diagnosed in New South Wales, Australia, between 2000 and 2008 linked to hospital admission records. This analysis includes 3240 patients with localized NSCLC admitted to hospital within 12 months of diagnosis., Results: Patients who lived 100+ km from the NASH were more likely to have no surgery (50.6%) than those living 0-39 km away (37.6%) and more likely to attend general hospitals for their care (52.2% at 100+ km, 14.8% at 0-39 km). Relative to patients living 0-39 km from the NASH and attending a specialist hospital for their care, the odds ratio (OR) of not having surgery was high if patients attended a general hospital (adjusted OR 5.99, 95% confidence interval (CI) 3.87-9.26, for those 0-39 km distant) and even higher as distance from the NASH increased (24.68, 95% CI 12.37-49.13 for 40-49 km and 30.10, 95% CI 18.2-49.40 for 100+ km). For patients treated in specialist hospitals (public or private), the trend with distance was opposite: relative to 0-39 km, the OR was 0.29 (95% CI 0.15-0.50) at 40-99 km and 0.14 (95% CI 0.08-0.26) at 100+ km., Conclusions: Patients with localized NSCLC are most likely to have no potentially curative surgery if they live distant from a specialist hospital and attend a general hospital for their care., (© 2014 Royal Australasian College of Surgeons.)

Background: Lung cancer patients have better survival when treated in thoracic surgical (specialist) centres., Aims: To determine whether outcome of non-small cell lung cancer (NSCLC) patients is poorer with increasing distance to the nearest accessible specialist hospital (NASH)., Methods: We linked cancer registry, hospital and death records of 23,871 NSCLC patients; 3240 localised, 2435 regional and 3540 distant stage patients hospitalised within 12 months of diagnosis were analysed. Distance from patients' residences to the NASH was measured using geographical coordinates. Cox proportional hazards models examined predictors of NSCLC death., Results: Having a resection of the cancer, which admission to a specialist hospital made more likely, substantially reduced hazard of NSCLC death. Distance influenced hazard of death through both these variables; a patient was less likely to be admitted to a specialist hospital than a general hospital and less likely to have a resection the further they lived from the NASH. However, patients who lived distant from the NASH and were admitted to a specialist hospital were more likely to have a resection and less likely to die from NSCLC than patients admitted to a specialist hospital and living closer to the NASH. These patterns varied little with lung cancer stage., Conclusions: NSCLC outcome is best when patients are treated in a specialist hospital. Greater distance to the NASH can affect its outcome by reducing the likelihood of being treated in a specialist hospital. Research is needed into patient and health service barriers to referral of NSCLC patients for specialist care., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To assess the frequency and outcomes of preterm hospital admissions during pregnancy, with a focus on transfers to higher levels of care., Design: Population-based cohort study using linked population data., Setting and Subjects: Women who were admitted to hospital in weeks 20-36 of pregnancy (preterm) and gave birth to a liveborn singleton infant in New South Wales during 2001-2008., Main Outcome Measure: Numbers of preterm admissions of pregnant women who were discharged without giving birth, were transferred to higher care, or who gave birth., Results: 110,439 pregnancies (16.0%) involved at least one preterm admission. After their initial preterm admission, 71.9% of women were discharged, 6.3% were transferred and 21.8% gave birth. Median gestational age at admission was 33 weeks and median time to discharge, transfer or giving birth was 1 day. Most women who were transferred or who gave birth had been admitted for preterm rupture of membranes or preterm labour. Of the women who were admitted or were transferred with suspected preterm labour, only 29% and 38%, respectively, gave birth. Compared with other admitted women, women having a first birth, public patients and those living in areas of low socioeconomic status were more likely to be transferred or to give birth. As gestational age increased, the proportion of women transferred decreased and the proportion giving birth increased. Infants born after maternal transfer had lower gestational age and more adverse outcomes than those born without maternal transfer., Conclusions: Preterm hospital admission affects one in six women with singleton pregnancies. Methods that could improve assessment of labour status have a large potential to reduce the burden on maternity services. The increased morbidity for infants born after maternal transfer suggests women with high-risk pregnancies are being appropriately identified.