Search

Specialize? Diversify? Do patients care? The authors investigate the demand-side effects of a hospital's portfolio strategy, which entails decisions about the depth and breadth of its service offerings. Positing that both depth (focus) and breadth (related focus) signal expertise, the authors use both archival and experimental evidence to examine these effects. The archival study is based on Florida's State Inpatient Databases for 2006–2015 and spans all major departments in health care delivery. The empirical analysis exploits plausible exogenous variation from other health care markets and reveals that patient choice is positively influenced by a hospital's depth (focus) and breadth (related focus) of expertise in a department. Complementing the archival evidence, the authors also conducted online experiments to examine the signaling effects of hospital portfolio strategy on patient choice behavior. The results provide support for the idea that hospital portfolio strategy influences patients' perceptions of hospital expertise in focal and related areas and, subsequently, their choice behavior. The authors also highlight potential synergistic effects between focus and related focus and heterogeneity in the effects across departments, payer types, and hospital profit status. These findings underscore the need for managers to adopt a targeted approach to portfolio decisions in health care. [ABSTRACT FROM AUTHOR]

BackgroundEach year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC).MethodsHealth systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.ResultsEight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.ConclusionThis HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

Introduction  Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patients perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover.  Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (Im on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.

Purpose: Informal caregivers (ICs) in Africa perform a long list of tasks to support hospitalization care. However, available studies are weak in accounting for the experiences of everyday role-routines of hospital-based informal caregiving (HIC) in under-resourced settings. This article explored the experiences of role-routines among informal caregivers in a Nigerian tertiary health facility. Methods: The ethnographic exploratory study relied on primary data collected from 75 participants, including 21 ICs, 15 inpatients, 36 hospital staff, and 3 ad-hoc/paid carers in a tertiary health facility in Southwestern Nigeria. Results: ICs perform several essential roles for hospitalized relatives, with each role characterized by a range of tasks. An integrative narrative of everyday routines of HIC as experienced by ICs showed critical complexities and complications involved in seemingly simple tasks of assisting hospitalized relatives with hygiene maintenance, medical investigations, blood donation, resource mobilization, errand-running, patient- and self-care and others. The role-routines are burdensome and ICs' experiences of them revealed the undercurrents of how health systems dysfunctions condition family members to support hospitalization care in Nigeria. Conclusion: The intensity and repetitive nature of role-routines is suggestive of "routinization of suffering". We recommend the closing of gaps driving hospital-based informal caregiving in Africa's under-resourced settings. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia approximately 3,200,000 babies are born annually and 41.09 per 10,000 live births are affected by spina bifida. Hydrocephalus (HCP) is another common pediatric neurosurgical condition with studies in Ethiopia showing the most common etiology is post spina bifida closure. The out-of-pocket expense (OOPE) and indirect expense of patients treated surgically for spina bifida and hydrocephalus during the first year of life were assessed. Methods: A prospective hospital-based study was done on patients treated surgically for spina bifida and HCP in two university-affiliated hospitals, between April 1st, 2022, and April 1st, 2023. Data on direct and indirect expenses were collected during inpatient care and follow-up. Catastrophic health expenditure (CHE) was assessed, defined as total expenditure exceeding 10% of the total annual household expenditure. Result: A total of 245 patients were eligible for analysis. The median annual total expenditure of households for treatment was ETB 11,510.00 with ETB 5700.00 being indirect expenditure. Forty-nine percent of the households suffered CHE. In multivariate analysis, the factors which were found to have a statistically significant association with CHE were the hospital where the patient received the treatment, the household's wealth quintile, the place of residency, and pre-admission duration of stay. Conclusion: Our study revealed a high CHE in households with spina bifida and HCP. We recommend working on primary prevention of spina bifida, expanding surgical services regionally to minimize costs associated with travel for surgical care, and reducing pre-admission duration of stay by improving evaluation and investigations at outpatient clinics. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. Methods: This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. Results: We observed significant decreases in the number of inpatient hospital admissions by 24–28% compared to the reference period. Day clinic admissions were even further reduced by 44–61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Conclusion: Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions. [ABSTRACT FROM AUTHOR]

Background: Neonatal seizures are diagnostically challenging and predominantly electrographic-only. Multichannel video continuous electroencephalography (cEEG) is the gold standard investigation, however, out-of-hours access to neurophysiology support can be limited. Automated seizure detection algorithms (SDAs) are designed to detect changes in EEG data, translated into user-friendly seizure probability trends. The aim of this study was to evaluate the diagnostic accuracy of the Persyst neonatal SDA in an intensive care setting. Methods: Single-centre retrospective service evaluation study in neonates undergoing cEEG during intensive care admission to Great Ormond Street Hospital (GOSH) between May 2019 and December 2022. Neonates with <44 weeks corrected gestational age, who had a cEEG recording duration >60 minutes, whilst inpatient in intensive care, were included in the study. One-hour cEEG clips were created for all cases (seizures detected) and controls (seizure-free) and analysed by the Persyst neonatal SDA. Expert neurophysiology reports of the cEEG recordings were used as the gold standard for diagnostic comparison. A receiver operating characteristic (ROC) curve was created using the highest seizure probability in each recording. Optimal seizure probability thresholds for sensitivity and specificity were identified. Results: Eligibility screening produced 49 cases, and 49 seizure-free controls. Seizure prevalence within those patients eligible for the study, was approximately 19% with 35% mortality. The most common case seizure aetiology was hypoxic ischaemic injury (35%) followed by inborn errors of metabolism (18%). The ROC area under the curve was 0.94 with optimal probability thresholds 0.4 and 0.6. Applying a threshold of 0.6, produced 80% sensitivity and 98% specificity. Conclusions: The Persyst neonatal SDA demonstrates high diagnostic accuracy in identifying neonatal seizures; comparable to the accuracy of the standard Persyst SDA in adult populations, other neonatal SDAs, and amplitude integrated EEG (aEEG). Overdiagnosis of seizures is a risk, particularly from cEEG recording artefact. To fully examine its clinical utility, further investigation of the Persyst neonatal SDA's accuracy is required, as well as confirming the optimal seizure probability thresholds in a larger patient cohort. [ABSTRACT FROM AUTHOR]

Within a multistate viral genomic surveillance program, we evaluated whether proportions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections attributed to the JN.1 variant and to XBB-lineage variants (including HV.1 and EG.5) differed between inpatient and outpatient care settings during periods of cocirculation. Both JN.1 and HV.1 were less likely than EG.5 to account for infections among inpatients versus outpatients (adjusted odds ratio [aOR], 0.60 [95% confidence interval (CI),.43–.84; P =.003] and 0.35 [.21–.58; P <.001], respectively). JN.1 and HV.1 variants may be associated with a lower risk of severe illness. The severity of coronavirus disease 2019 may have attenuated as predominant circulating SARS-CoV-2 lineages shifted from EG.5 to HV.1 to JN.1. [ABSTRACT FROM AUTHOR]

Introduction: Decisions to prescribe opioids to patients depend on many factors, including illness severity, pain assessment, and patient age, race, ethnicity, and gender. Gender and sex disparities have been documented in many healthcare settings, but are understudied in inpatient general medicine hospital settings. Objective: We assessed for differences in opioid administration and prescription patterns by legal sex in adult patient hospitalizations from the general medicine service at a large urban academic center. Designs, Setting, and Participants: This study included all adult patient hospitalizations discharged from the acute care inpatient general medicine services at the University of California, San Francisco (UCSF) Helen Diller Medical Center at Parnassus Heights from 1/1/2013 to 9/30/2021. Main Outcome and Measures: The primary outcomes were (1) average daily inpatient opioids received and (2) days of opioids prescribed on discharge. For both outcomes, we first performed logistic regression to assess differences in whether or not any opioids were administered or prescribed. Then, we performed negative binomial regression to assess differences in the amount of opioids given. We also performed all analyses on a subgroup of hospitalizations with pain-related diagnoses. Results: Our study cohort included 48,745 hospitalizations involving 27,777 patients. Of these, 24,398 (50.1%) hospitalizations were female patients and 24,347 (49.9%) were male. Controlling for demographic, clinical, and hospitalization-level variables, female patients were less likely to receive inpatient opioids compared to male patents (adjusted OR 0.87; 95% CI 0.82, 0.92) and received 27.5 fewer morphine milligram equivalents per day on average (95% CI - 39.0, - 16.0). When considering discharge opioids, no significant differences were found between sexes. In the subgroup analysis of pain-related diagnoses, female patients received fewer inpatient opioids. Conclusions: Female patients were less likely to receive inpatient opioids and received fewer opioids when prescribed. Future work to promote equity should identify strategies to ensure all patients receive adequate pain management. [ABSTRACT FROM AUTHOR]

AbstractThis study explores staff balancing parental involvement when performing recovery-oriented work via Patient-Initiated Brief Admission (PIBA) for adolescents. Data from focus group interviews with employees in Swedish Child and Adolescent Psychiatry (CAP) is discussed and analyzed using ecological systems theory. Findings suggest dualistic views on participation and parental involvement, where safety and security have to be considered supporting adolescents’ participation in psychiatric inpatient care. Staff has the potential to involve parents during PIBA without automatically diminishing adolescents’ participation, and this has to be legitimized if PIBA is to become an integrated tool to promote recovery-oriented care in CAP. [ABSTRACT FROM AUTHOR]

Background: Measuring and assessing the relationship between inpatient nurse staffing and workload across a national health system is difficult because of challenges in systematically observing inpatient workload at the unit level. Objective: The objective of this study was to apply a novelmeasure of inpatient nurse workload to estimate the relationship between inpatient nurse staffing and nurse workload at the unit level during a key nursing activity: the peak-time medication pass. Methods: A retrospective observational study was conducted in the Veterans Health Administration, the largest employer of nurses in the United States. The sample included all patients (n = 1,578,399 patient days) admitted to 311 non-intensive care unit inpatient acute care units in 112 hospitals in 2019 (104,588 unit days). Staffingwas measured as the unit-level, nurse-to-patient ratio, and workload was measured using average time (duration) for RNs to complete the peak-time medication pass. Results: We found a negative relationship between the RN-to-patient ratio and average peak-timemedication pass duration after adjusting for unit-level patient volume and average patient severity of illness and other unit-level factors. This relationship was nonlinear: The marginal effect of staffing on workload decreased as staffing increased. Discussion: As unit-level nurse staffing increased, average RN workload decreased. This result suggests that interventions to improve nurse staffing may have larger nonlinear effects for units with lower staffing levels. Understanding the effect of differing staffing decisions on variations in nursing workload is critical for adopting models of care that effectively use scarce staffing resources and contribute to retaining nurses in the inpatient workforce. This work provides evidence that peak-time medication pass duration is a valid process-based measure of workload and highlights the potential diminishing returns to increasing staffing. [ABSTRACT FROM AUTHOR]

Background: Acute care of patients in the emergency department (ED) can be very challenging when patients attend EDs without their important medical information. This is especially problematic for multimorbid patients under polypharmacy. The aim of this study was to assess systematically the frequency and clinical relevance of incomplete medical data upon ED admission. Methods: The study was conducted in the neurological ED of a German tertiary hospital. The availability and accuracy of medical data of all neurological patients in the ED were assessed upon arrival. Treating ED physicians were asked about the acute care of the patients to clarify whether missing data resulted in delays or complications in the emergency treatment. Additionally, doctors responsible for the inpatient care of patients who were admitted to a ward via the ED were questioned about the course of the inpatient stay to monitor how initially missing data might have influenced the hospital stay. Results: Medical data of 27% of the 272 included patients were missing or incomplete upon admission in the ED. The ED physicians had to make additional phone calls to gather information in 57% of these cases (vs. 22% in patients with complete data, p < 0.0001). Delays between 5 and 240 min were documented due to initially missing data. Unnecessary diagnostic procedures (e.g., lumbar puncture) were performed in 5% of these patients, thus compromising patient safety. Even the inpatient stay was complicated by initially missing data, as doctors still had to spend time (between 10 and 180 min) to gain relevant information. Retrospectively, 5% of hospitalizations could have been avoided if all medical information had been available upon ED admission. Conclusions: Missing medical data caused complications and delays in acute as well as inpatient care of patients admitted to the neurological ED. This compromised patient safety and led to a waste of medical resources and valuable time of the responsible medical team. Therefore, a comprehensive, digital data management system is urgently needed to improve patient safety and facilitate efficient patient care in the ED and beyond. [ABSTRACT FROM AUTHOR]

Introduction Aeromedical evacuations from the past few decades have yielded massive amounts of data that may inform the Military Health System (MHS) on patient needs, specifically for understanding the inpatient and outpatient needs of evacuees. In this study, we evaluate inpatient and outpatient trends based on aeromedical evacuation data from recent conflicts. We anticipate that evacuations requiring MHS inpatient beds are primarily trauma-related and necessitate an increased need for inpatient trauma care. Materials and Methods We conducted a descriptive analysis of aeromedical evacuations using the U.S. Transportation Command Regulating and Command & Control Evacuation System database. We queried the database for aeromedical evacuations originating from the U.S. EUCOM and ending in the CONUS, from January 1, 2008 to June 4, 2020. With the resultant data, evacuee demographics were characterized by gender, age, active duty (AD) versus non-AD, and branch of service. Following this, the proportion of battle injury to disease and non-battle injury was categorized by both patient age ranges and year. Additionally, evacuations were stratified by their ICD codes, as well as the primary specialty responsible for care. Lastly, evacuations were categorized by inpatient and outpatient care status. Results The final dataset yielded 32,485 unique patients. The majority of evacuees were male (86.9%) with a mean age of 29.0 ± 9.6 years. Evacuees were primarily AD Military (96.7%), with the majority of those personnel being in the Army (70.2%). The total number of evacuations steadily increased from 2008 (n  = 3,703) until a peak in 2010 (n  = 4,929), which was also the peak year for battle injury (n  = 1,472). Battle injury was also most prevalent in the 21 to 24 age group (24.7%) and declined in older age groups. Regarding diagnoses, the leading categories were injury/poisoning (33.1%), psychiatric (28.1%), and musculoskeletal (12.1%). As for specialty care of evacuees, psychiatry received the largest share of total evacuations (28.1%), followed by orthopedic surgery (22.7%) and general surgery (8.6%). Looking at proportions of inpatient and outpatient care, the majority of evacuees required outpatient care (65.6%) with a sizable minority requiring inpatient care (34.4%). Inpatient evacuations peaked in 2010 (n  = 2,013), accounting for 40.8% of all evacuations that year. Orthopedic surgery had the largest share of inpatient evacuations (27.3%), followed by psychiatry (21.5%) and general surgery (18.2%). As for outpatient care, the specialties with the largest proportion of outpatient evacuations were psychiatry (33.6%), orthopedic surgery (20.3%), and neurology (9.8%). Conclusions The results of this study reveal what the MHS can expect in future conflicts. Most evacuations are for psychiatric-/injury-/musculoskeletal-related diagnoses, typically requiring care by psychiatrists, orthopedic surgeons, or general surgeons. Outpatient care is important, though it is critical to bolster inpatient care requirements as future conflicts may bring extensive numbers of inpatient casualties. The MHS should program and plan resources accordingly, planning for the care of surgical/injured and psychiatric patients. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATION FOR REHABILITATIONThis study aimed to describe the nature of interactions between health care professionals and a young adult with autism spectrum disorder with limited speech during an inpatient stay. An observational study was conducted to describe the interactions between a young adult on the autism spectrum and 14 of his inpatient health care providers. Naturalistic video-recordings were taken, and behavioral coding was completed to measure the frequency and type of communication turns taken. The providers took 93% of conversational turns. Most provider turns (76%) were non-obligatory in nature and did not invite the young adult to engage in turn-taking. The young adult only had access to his communication system during one of the 27 interactions (4%); however, when he had access to his system, he demonstrated higher levels of turn-taking. Health care providers should offer patients with limited speech more communicative turns, provide adequate wait time, and ensure communication systems are available during all inpatient interactions.Inpatient health care providers dominated interactions with a young adult with autism and limited speech.Most inpatient health care provider turns did not present an opportunity for the patient to respond.The young adultcould not access his communication system for most interactions.Inpatient health care providers dominated interactions with a young adult with autism and limited speech.Most inpatient health care provider turns did not present an opportunity for the patient to respond.The young adultcould not access his communication system for most interactions. [ABSTRACT FROM AUTHOR]

In Japan, little is known about the approaches to medical care for older patients with multimorbidity used by physicians either at patients' homes or in hospitals. A questionnaire survey was conducted to understand the current approaches to older patients with multimorbidity. The questionnaire was sent to 3300 people, including 1650 geriatric specialists and 1650 primary care specialists, were enrolled. A four-point Likert-type scale was used to score the following items: diseases that cause difficulties in treatment (diseases), patient backgrounds that cause difficulties in treatment (backgrounds), important clinical factors, and important clinical strategies. We used the Tukey–Kramer test to examine the differences between scores across 3 groups: physicians providing only home care (the "home" group), physicians providing only inpatient care (the "hospital" group), and physicians providing both home care and inpatient care (the "home and hospital" group). Out of 836 valid responses, those from 587 physicians were included in the analysis. The overall score for diseases was significantly higher in the "hospital" group than in either the "home" or "home and hospital" groups. The overall score for important clinical strategies was significantly higher in the "home and hospital" group than in the "hospital" group. In conclusion, physicians' approaches to treating older people with multimorbidity may vary by practice setting, and particularly whether they provide care only to patients at home or in hospital or to both. To improve the quality of transition of care between hospital and home, a support system that considers differences in physician practice should be developed. [ABSTRACT FROM AUTHOR]

Aim(s): To evaluate the literature to inform and propose a conceptual definition for dementia friendly in the context of hospitalization. Methods: The Walker & Avant method for concept analysis was utilized for this review. Data Sources (Include Search Dates): Initial search conducted June 2022. Repeated search conducted in February 2023. Databases for the literature search include Scopus, PubMed, CINAHL, PsycINFO, and AGELINE. Results: Five attributes of the concept of dementia friendly in the context of hospitalization were identified including: staff knowledge/education, environmental modification, person‐centred care, nursing care delivery and inclusion of family caregivers. Based on these attributes a conceptual definition is proposed. Conclusion: A clarified definition for dementia friendly in the context of hospitalization will aid in understanding the concept, provide guidance for hospitals seeking to implement dementia‐friendly interventions and benefit researchers aiming to study the impact of such programs. Reporting Method: n/a. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has strained the resources of the world's healthcare systems. Most individuals with neurodevelopmental disabilities (NDDs) experience significant mental health issues and face substantial barriers in accessing appropriate supports which have been exacerbated during the pandemic. It is unknown the extent to which COVID-19 impacted the demand for and effectiveness of inpatient care for those with NDDs. The impact of COVID-19 on the number of admissions of youth with NDDs to pediatric inpatient psychiatry units, as well as their functioning and length of stay during the first two years of the pandemic was analyzed using Bayesian structural time series models. Admission data of youth with NDDs from four pediatric inpatient units in Alberta, Canada (n = 2144) was examined. Inpatient admissions of youth with NDDs significantly increased following the onset of the pandemic. Compared to the period prior to the pandemic, patients with NDDs had significantly worse overall functioning and received fewer days of treatment. These findings highlight the need for increased resources to support the mental health needs of this vulnerable population and are consistent with other studies in the general population examining the utilization of inpatient psychiatric units during the pandemic. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate outpatient and inpatient dental care for patients with disabilities from 2014 to 2023. Material and methods: A time series analysis was carried out with data from Brazil's public healthcare system, considering the outpatient productivity of Special Needs Dentistry specialists and hospitalizations (inpatient admissions) of patients with disabilities for dental procedures, both normalized to every 100,000 inhabitants (incidence). The significance level was set at 5%. Results: In the last 10 years, 22,420,859 procedures were carried out and 89,380 hospitalizations were approved. Trend analysis showed no significant temporal variation in the incidence of both variables. Regarding the procedures, the majority were low‐complexity (82.1%, p <.001) and clinical (71.2%, p <.001). Periodontal (19.9%) and restorative (19.5%) procedures were the most frequent. Considering the hospitalizations, almost (R$) 40 million was allocated, and the majority were classified as elective (71.9%, p =.002) and of short duration (less than a day). Conclusion: Dental care for patients with disabilities presented patterns related to the types of procedures, complexity and circumstance, in addition to not showing significant temporal variation over the last 10 years. [ABSTRACT FROM AUTHOR]

Off-service placement is a common capacity-pooling strategy that hospitals utilize to address mismatches in supply and demand that arise from the day-to-day variation in patient demand. This strategy involves placing patients in a bed in a unit that is designated for another specialty service. Building on prior work that documents the negative first order effects of off-service placement on patients who are placed off service themselves, we quantify the spillover effects of this practice on patients who are actually placed on service. Using an estimation strategy that combines the Heckman correction procedure and a heteroskedasticity-based identification approach, we find that off-service placement has substantial negative spillover effects on the efficiency of care delivered to on-service patients. In particular, we find that a 10 percentage point increase in the level of off-service placement during a patient's hospitalization is associated with a 10.9% increase in length of stay. Through a series of counterfactual analyses, we propose alternate routing and capacity-planning policies that could meaningfully improve the efficiency of care in the inpatient setting. This paper was accepted by Stefan Scholtes, healthcare management. Funding: This work was supported by Claude Marion Endowed Faculty Scholar Award; Fishman-Davidson Center for Service and Operations Management. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.02202. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThe aim of this study was to explore spirituality in inpatient rehabilitation care from the patient’s perspective.Participants were recruited from three inpatient rehabilitation services in Sydney, Australia. A qualitative research design was adopted. Demographic data collected included religious affiliation, age and gender. Participants completed a short survey, where they indicated the level of acceptability for 14 items which could be used in a spiritual history. This was followed by a semi-structured interview where participants discussed how they would like to be asked about spirituality, and by whom.Eighteen participants were recruited (10 females, 8 males; mean age 68.8 years) and were undertaking either general rehabilitation (n = 9) or neurorehabilitation (spinal cord injury n = 6, traumatic brain injury n = 3). The impact of loss and existential struggle was evident for participants with long-lasting injuries. These participants could identify sources of spiritual strength which helped them engage with hardship and described how staff could facilitate access to these sources of strength.Rehabilitation inpatients are willing to explore issues around spirituality. Staff can support inpatients to access sources of spiritual strength by creating a safe and trusting environment and finding out what is most meaningful to the patient.Rehabilitation inpatients can experience losses which lead to a reconsideration of life’s meaning and a greater drawing upon sources of spiritual strength.Spirituality may often be understood to refer to religion only yet can encompass a broader range of connection and experience that relate to the source of a person’s ultimate meaning and purpose.By creating a safe and trusting environment for rehabilitation inpatients, staff can find out what is most meaningful for a person.Rehabilitation inpatients can experience losses which lead to a reconsideration of life’s meaning and a greater drawing upon sources of spiritual strength.Spirituality may often be understood to refer to religion only yet can encompass a broader range of connection and experience that relate to the source of a person’s ultimate meaning and purpose.By creating a safe and trusting environment for rehabilitation inpatients, staff can find out what is most meaningful for a person. [ABSTRACT FROM AUTHOR]

Background: Readmissions in psychiatric inpatient care may reflect problems in the provision of care, but the underlying factors are not well known. We examined the associations of patient characteristics (sociodemographic factors, diagnoses), treatment (duration, previous episodes, neuromodulation) and ward overload with psychiatric inpatient readmissions and multiple readmissions in Finland. Methods: We used a routinely collected data pool from one hospital district and followed all 2052 hospitalizations that started in 2018. The outcomes were readmission within 30 days and one year, and among those with readmission, the number of readmissions. Results: Of the patients, 11% had readmission within 30 days and 33% had readmission within one year. Women, those with previous hospitalizations, those with an ICD-10 diagnosis from the 'behavioural syndromes associated with physiological disturbances and physical factors / disorders of adult personality and behaviour' group, those with a diagnosis from the 'neurotic, stress-related and somatoform disorders' group, those with psychotic disorders, and those who received neuromodulation treatment were more likely to have readmissions. Having a diagnosis of 'disorders of psychological development' or 'behavioural and emotional disorders with onset usually occurring in childhood and adolescence' was associated with a lower likelihood of readmission. The duration of treatment and ward overload during the index period were not associated with readmission. Conclusions: The findings of this study suggest possible risk factors for readmission and can be used to plan psychiatric care. To some degree, the risk factors varied between different readmission types. It is important to examine whether there are unmet treatment needs in psychiatric inpatient care for children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-fold: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories. Methods: We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories. Results: The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group. Conclusion: The trajectory of the proportion of pPCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends. [ABSTRACT FROM AUTHOR]

This article summarises the Joint British Diabetes Societies for Inpatient Care (JBDS‐IP) Group guidelines on the use of technology to support diabetes care in hospital. The guideline incorporates two main areas: (i) use of wearable technology devices to improve diabetes management in hospital (including continuous glucose monitoring and insulin pump therapy) and (ii) information technology. Although it is reasonable to extrapolate from the evidence available, that devices developed to enhance diabetes care outside hospital will show similar benefits, there are challenges posed within the inpatient setting in hospital. This guidance provides a pragmatic approach to supporting self‐management in individuals using wearable technology admitted to hospital. Furthermore, it also aims to provide a best practice guide for using information technology to monitor diabetes care and communicate between health professionals. [ABSTRACT FROM AUTHOR]

Background: Understanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life. Methods: A retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life. Results: Three distinct classes were identified: "Few care contacts," with limited interaction with any services; "Social service contacts," comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and "Numerous care contacts," with extensive contacts with both healthcare and social services. The "few care contacts" class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support. Conclusions: Using a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusion We developed ECHOMANTRA, a digital guided intervention for patients with anorexia nervosa and their carers to provide support during transition from inpatient care to community settings. This study reports on participants' engagement with, and feedback of, ECHOMANTRA.Patients and carers (N = 184 dyads) were given access to ECHOMANTRA for 12 months. The intervention included online groups, a workbook and recovery‐oriented videoclips. Satisfactory engagement was defined as attendance of a minimum of four online groups by each dyad. Participants received an Intervention Feedback Form to measure frequency of use and provide feedback of the intervention. Those who did not meet the engagement criterion were asked to complete an Obstacles to Engagement Form.19% of the sample reached the engagement criterion. Seventy‐six patients and 60 carers completed the Intervention Feedback Form. Of those, approximately 60% reported using at least a quarter of the workbook and videoclips. Overall, participants found the materials useful and easy to access (median = 3 on a scale 1–5). Obstacles to engagement (35 patients and 14 carers) included lack of time due to caring responsibilities, treatment, work/school commitments.A more personalised form of support may be needed to enhance motivation and ability to change following inpatient care. [ABSTRACT FROM AUTHOR]

Background: Organizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients' health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers. Methods: Between November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data. Results: Of 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials. Conclusions: Given their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals' organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Level of Evidence Despite significant advancements in total knee arthroplasty (TKA), some patients require revision surgery (R‐TKA) due to complications such as infection, mechanical loosening, instability, periprosthetic fractures, and persistent pain. This study aimed to explore the specific causes leading to R‐TKA, associated complications, including infection, mechanical failure, and wound issues, as well as costs, mortality rates, and hospital length of stay (LOS) using data from a large national database.Data from the nationwide inpatient sample (NIS), the largest publicly available all‐payer inpatient care database in the United States were analysed from 1 January 2016 to 31 December 2019. The study included 44,649 R‐TKA cases, corresponding to 223,240 patients, with exclusions for nonelective admissions. Various statistical analyses were used to assess clinical outcomes, including in‐hospital mortality, postoperative complications, LOS, and hospitalization costs.Among 2,636,880 TKA patients, 8.4% underwent R‐TKA. R‐TKA patients had higher rates of chronic conditions, including mental disorders (36.4%) and renal disease (9.9%). Additionally, these patients often experienced instability, necessitating revision surgery. Infection (22.3%) was the primary reason for R‐TKA, followed by mechanical loosening (22.9%) and instability. Compared to primary TKA patients, R‐TKA patients exhibited higher in‐hospital mortality (0.085% vs. 0.025%), longer LOS (3.1 vs. 2.28 days), and higher total charges ($97,815 vs. $62,188). Postoperative complications, including blood transfusion (4.6% vs. 1.3%), acute kidney injury (4.4% vs. 1.8%), venous thromboembolism (0.55% vs. 0.29%), infection, and wound problems, were significantly higher in R‐TKA patients.This study provides detailed insights into t LOS, costs, and complications associated with specific etiologies of revision TKA. Our findings emphasize the need for targeted preoperative optimization and patient education. This approach can help reduce the incidence and burden of R‐TKA, improve patient care, optimize resource allocation, and potentially decrease the overall rates of complications in revision surgeries.Level III. [ABSTRACT FROM AUTHOR]

Therapeutic Communication is a form of treatment process by professional health service personnel on patients suffering from a certain disease, by staying in a certain inpatient room according to the type of disease they are experiencing, inpatient facilities are provided and run systematically by medical and non-medical personnel, provided by health service providers. Self-aware therapeutic communication aims for patient healing. Therefore, it is necessary to know how nurses understand the meaning and importance of therapeutic communication itself, because this understanding can affect the quality of therapeutic communication provided by nurses. The quality of therapeutic communication can be determined from the service felt by the patient and the level of satisfaction felt by the patient. The research design uses a qualitative research method with 11 samples. This study aims to determine the application of therapeutic communication in the inpatient room of Awal Bros Hospital Pekanbaru. The results of the study show that the communication between nurses and patients has gone well. This is reflected in the way nurses provide gentle direct communication and pleasant facial expressions. [ABSTRACT FROM AUTHOR]

Parkinson's Disease (PD) is a multifaceted and progressive disorder characterized by a diverse range of motor and non-motor symptoms. The complexity of PD necessitates a multidisciplinary approach to manage both motor symptoms, such as bradykinesia, gait disturbances and falls, and non-motor symptoms, including cognitive dysfunction, sleep disturbances, and mood disorders, which significantly affect patients' quality of life. Pharmacotherapy, particularly dopaminergic replacement therapy, has advanced to alleviate many symptoms. However, these medications can also induce side effects or aggravate symptoms like hallucinations or orthostatic dysfunction, highlighting the need for comprehensive patient management. The optimal care for PD patients involves a team of specialists, including neurologists, physical and occupational therapists, speech-language pathologists, psychologists, and other medical professionals, to address the complex and individualized needs of each patient. Here, we illustrate the necessity of such a multidisciplinary approach in four illustrative PD cases with different disease stages and motor and non-motor complications. The patients were treated in different treatment settings (specialized outpatient clinic, day clinic, inpatient care including neurorehabilitation). The biggest challenge lies in organizing and implementing such comprehensive care effectively across different clinical settings. [ABSTRACT FROM AUTHOR]

Background: Estimating prognosis can be a barrier to timely palliative care involvement. The modified Hospitalized‐patient One‐year Mortality Risk (mHOMR) score uses hospital admission data to calculate the risk of death within 12 months and may be a useful tool to trigger a referral to palliative care. Methods: The mHOMR tool was retrospectively applied to consecutive acute admissions to a quaternary cancer center in Toronto, Canada from March 1 to May 31, 2018. The study aimed to investigate the association between dichotomized mHOMR scores (the cohort median score of 0.27 and the developer‐recommended score of 0.21) and the risk of death, and whether these could be used to identify patients who may benefit from timely palliative care involvement. Results: Of 269 inpatients, 87 were elective admissions and excluded from further analyses. At the median mHOMR score of 0.27, 91/182 patients (50%) were categorized as high‐risk of death within 12 months (mHOMR+), 53 (58%) were referred to palliative care. At the lower cut‐off of 0.21, 103 patients were mHOMR+, of whom 57 (55.3%) were referred to palliative care. The higher mHOMR was significantly associated with mortality (29.7% mHOMR− vs. 39.8% mHOMR+ at 12 months, log‐rank p < 0.05). The association between the developer‐recommended mHOMR cut‐off (≥ 0.21) and mortality was not significant (p = 0.15). Conclusions: A higher mHOMR score was significantly associated with the risk of mortality in patients with advanced cancer. However, the developer‐recommended mHOMR cut‐off of 0.21 failed to identify a statistically significant difference between patients with advanced cancer at low versus high scores. While mHOMR may be a useful tool to augment clinical judgment and identify inpatients with advanced cancer at high risk of death, who in turn may benefit from referral to palliative care, the optimal mHOMR cutoff may warrant adjustment for this population. [ABSTRACT FROM AUTHOR]

Background There are limited objective studies regarding the effectiveness of strategies to alleviate the documentation burden on resident physicians. Objective To develop and implement diagnosis-specific templates for the plan of care section of inpatient admission notes, aiming to reduce documentation time. Methods Twelve templates for the plan of care section of admission notes were written by the study authors, reviewed by attending physicians, and shared with the residents through the electronic health record (EHR) on September 23, 2022. EHR audit log data were collected to examine admission note writing times, supplemented by resident feedback on acceptability via an anonymous survey. Feasibility measures included time investment, experience with the EHR, and resident training. Results Between July 1, 2021 and June 30, 2023, 62 pediatric residents contributed 9840 admission notes. The templates were used in 557 admission notes. The mean total time spent on an admission note decreased from 97.9 minutes pre-intervention to 71.0 minutes post-intervention with the use of a template; an adjusted reduction of 23% (95% CI 16%-30%; P<.001). The mean attending time spent editing an admission note was unchanged. The survey results underscored wide acceptability of the templates among the residents. Feasibility data showed that the project required minimal time investment from the health care informatics team and minimal resident training. Conclusions Using templates in the care plan section of admission notes reduces the time residents spend writing admission notes. [ABSTRACT FROM AUTHOR]

Purpose: To describe temporal trends in inpatient care use for adult mental disorders in Czechia from 1994 until 2015. Methods: Data from the nationwide register of inpatient care use and yearly census data were used to calculate (a) yearly admissions rates, (b) median length of stay, and (c) standardized inpatient-years for adult mental disorders (ICD-10 codes F0-F6] or G30). Segmented regressions were used to analyze age- and sex-specific temporal trends. Results: Admission rates were increasing in adults (average annual percent change = 0.51; 95% confidence interval = 0.16 to 0.86 for females and 1.01; 0.63 to 1.40 for males) and adolescents and emerging adults (3.27; 2.57 to 3.97 for females and 2.98; 2.08 to 3.88 for males), whereas in seniors, the trend was stable (1.22; -0.31 to 2.73 for females and 1.35; -0.30 to 2.98 for males). The median length of stay for studied mental disorders decreased across all age and sex strata except for a stable trend in male adolescents and emerging adults (-0.96; -2.02 to 0.10). Standardized inpatient-years were decreasing in adults of both sexes (-0.85; -1.42 to -0.28 for females and -0.87; -1.19 to -0.56 for males), increasing in female adolescents and emerging adults (0.95; 0.42 to 1.47), and stable in the remaining strata. Conclusion: Psychiatric hospital admissions were increasing or stable coupled with considerable reductions in median length of stay, suggesting that inpatient episodes for adult mental disorders have become more frequent and shorter over time. The overall psychiatric inpatient care use was decreasing or stable in adults and seniors, potentially implying a gradual shift away from hospital-based care. [ABSTRACT FROM AUTHOR]

Purpose: Evaluating the quality of psychiatric care from the patient's perspective is crucial to measure the effectiveness of the provided care. This study aimed to translate the original Swedish Quality in Psychiatric Care – Inpatient (QPC-IP) instrument into Faroese, adapting it to the specific context of psychiatric inpatient care in the Faroe Islands, conducting a detailed evaluation of its psychometric properties, and to describe patients' perception of quality of psychiatric care. Materials and methods: Following a thorough translation and back-translation, the content validity of the Faroese QPC-IP was confirmed by a group of Faroese patients. Subsequently, the instrument was completed by 61 psychiatric inpatients. Results: Item total correlations revealed that most items strongly correlated with their intended dimensions, mirroring the original Swedish version. However, a noteworthy exception was found in the discharge dimension, leading to the exclusion of an item related to helping find an occupation; this task was not performed by the ward. While the internal consistency of the overall scale was excellent, specific dimensions exhibited lower consistency. Conclusions: The translation and cultural adaptation of the Faroese QPC-IP proved satisfactory. The psychometric evaluation affirmed a shared understanding of the quality of psychiatric care in both Faroese and Swedish cultural contexts. As a result, the Faroese QPC-IP emerges as a valuable instrument for assessing the quality of psychiatric care in the Faroe Islands. Its utility extends to quality assurance initiatives and contributes to cross-cultural research examining the quality of psychiatric care from the patient's perspective. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Principal Findings Conclusion What is known on this topic What this study adds To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic.Administrative patient‐level data between 2017 and 2020 of eight high‐income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US).Multi‐country retrospective observational study using a federated data approach that evaluated age‐sex standardized rates of hospitalizations and ED visits for mental health conditions.There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre‐COVID‐19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID‐19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France.The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID‐19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID‐19 preparedness, and community‐based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high‐income countries, with substantial differences in access to effective care. The COVID‐19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high‐income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross‐country differences in acute care management of mental health conditions coinciding with the onset of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background The financial implications of central nervous system (CNS) cancers are substantial, not only for the healthcare service and payers, but also for the patients who bear the brunt of direct, indirect, and intangible costs. This study sought to investigate the impact of healthcare spending on CNS cancer survival using recent US data. Methods This study used public data from the Disease Expenditure Project 2016 and the Global Burden of Disease Study 2019. The primary outcome was the annual healthcare spending trend from 1996 and 2016 on CNS tumors adjusted for disease prevalence, alongside morbidity and mortality. Secondary outcomes included drivers of change in healthcare expenditures for CNS cancers. Subgroup analysis was performed stratified by age group, expenditure type, and care type provided. Results There was a significant increase in total healthcare spending on CNS cancers from $2.72 billion (95% CI: $2.47B to $2.97B) in 1996 to $6.85 billion (95% CI: $5.98B to $7.57B) in 2016. Despite the spending increase, the mortality rate per 100 000 people increased, with 5.30 ± 0.47 in 1996 and 7.02 ± 0.47 in 2016, with an average of 5.78 ± 0.47 deaths per 100 000 over the period. The subgroups with the highest expenditure included patients aged 45 to 64, those with private insurance, and those receiving inpatient care. Conclusions This study highlights a significant rise in healthcare costs for CNS cancers without corresponding improvements in mortality rate, indicating a mismatch of healthcare spending, contemporary advances, and patient outcomes as it relates to mortality. [ABSTRACT FROM AUTHOR]

This cohort study examines the risk of pneumonia associated with the use of antipsychotics in patients with schizophrenia. Key Points: Question: What antipsychotics are associated with pneumonia, which is the fourth leading cause of death in patients with schizophrenia? Findings: In this cohort study of 61 889 people with schizophrenia, antipsychotics with high anticholinergic burden were associated with an increased incidence of pneumonia. Significantly higher risks were detected for clozapine (≥180 mg/d), quetiapine (≥440 mg/d), and olanzapine (≥11 mg/d). Meaning: Findings of this study suggest that in patients with schizophrenia, pneumonia is associated with the use of specific antipsychotics, setting the stage for personalized prevention strategies to decrease the incidence of this life-threatening condition in patients with schizophrenia. Importance: Antipsychotic drugs (particularly clozapine) have been associated with pneumonia in observational studies. Despite studies of the associations between antipsychotic use and incident pneumonia, it remains unclear to what degree antipsychotic use is associated with increased risk of pneumonia, whether dose-response associations exist, and what agents are specifically associated with incident pneumonia. Objective: To estimate pneumonia risk associated with specific antipsychotics and examine whether polytherapy, dosing, and receptor binding properties are associated with pneumonia in patients with schizophrenia. Design, Setting, and Participants: This cohort study identified patients with schizophrenia or schizoaffective disorder (hereafter, schizophrenia) aged 16 years or older from nationwide Finnish registers from 1972 to 2014. Data on diagnoses, inpatient care, and specialized outpatient care were obtained from the Hospital Discharge Register. Information on outpatient medication dispensing was obtained from the Prescription Register. Study follow-up was from 1996 to 2017. Data were analyzed from November 4, 2022, to December 5, 2023. Exposures: Use of specific antipsychotic monotherapies; antipsychotics modeled by dosage as low (<0.6 of the World Health Organization defined daily dose [DDD] per day), medium (0.6 to <1.1 DDDs per day), or high dose (≥1.1 DDDs per day); antipsychotic polypharmacy; and antipsychotics categorized according to their anticholinergic burden as low, medium, and high. Main Outcomes and Measures: The primary outcome was hospitalization for incident pneumonia. Pneumonia risk was analyzed using adjusted, within-individual Cox proportional hazards regression models, with no antipsychotic use as the reference. Results: The study included 61 889 persons with schizophrenia (mean [SD] age, 46.2 [16.0] years; 31 104 men [50.3%]). During 22 years of follow-up, 8917 patients (14.4%) had 1 or more hospitalizations for pneumonia and 1137 (12.8%) died within 30 days of admission. Compared with no antipsychotic use, any antipsychotic use overall was not associated with pneumonia (adjusted hazard ratio [AHR], 1.12; 95% CI, 0.99-1.26). Monotherapy use was associated with increased pneumonia risk compared with no antipsychotic use (AHR, 1.15 [95% CI, 1.02-1.30]; P =.03) in a dose-dependent manner, but polytherapy use was not. When categorized by anticholinergic burden, only the use of antipsychotics with a high anticholinergic burden was associated with pneumonia (AHR, 1.26 [95% CI, 1.10-1.45]; P <.001). Of specific drugs, high-dose quetiapine (AHR, 1.78 [95% CI, 1.22-2.60]; P =.003), high- and medium-dose clozapine (AHR, 1.44 [95% CI, 1.22-1.71]; P <.001 and AHR, 1.43 [95% CI, 1.18-1.74]; P <.001, respectively), and high-dose olanzapine (AHR, 1.29 [95% CI, 1.05-1.58]; P =.02) were associated with increased pneumonia risk. Conclusions and Relevance: Results of this cohort study suggest that in patients with schizophrenia, antipsychotic agents associated with pneumonia include not only clozapine (at dosages ≥180 mg/d) but also quetiapine (≥440 mg/d) and olanzapine (≥11 mg/d). Moreover, monotherapy antipsychotics and antipsychotics with high anticholinergic burden are associated with increased pneumonia risk in a dose-dependent manner. These findings call for prevention strategies aimed at patients with schizophrenia requiring high-risk antipsychotics. [ABSTRACT FROM AUTHOR]

With limited healthcare resources, it is important to provide the right level and form of care. The aim of this study was to determine whether selected single-jaw orthognathic surgery in outpatient care (OPC) generates lower healthcare costs than in inpatient care (IPC). The costs of surgically assisted rapid maxillary expansion (SARME), Le Fort I osteotomy (LFI), and bilateral sagittal split osteotomy (BSSO) were calculated for 165 patients, 107 treated in OPC and 58 in IPC. Additionally, costs for revisits, emergency visits, emergency phone calls, re-operations, and plate removal during the first 12 months postoperatively were recorded. The total mean costs of the different operations including revisits, emergency visits, and phone calls were 34.2–48.8% lower in OPC than in IPC at 12 months postoperatively. Operation costs were lower for LFI in OPC (P = 0.009) and for SARME in IPC (P = 0.007). Anaesthesia costs were lower for LFI (P < 0.001) and BSSO (P < 0.001) in OPC, and there were fewer revisits (P = 0.001) and lower costs (P = 0.002) after LFI in OPC compared to IPC. This study showed that selected single-jaw orthognathic surgeries in outpatient care are associated with lower healthcare costs compared to inpatient care. [ABSTRACT FROM AUTHOR]

Aims: Many European healthcare providers struggle to adopt multidisciplinary, integrated care pathways for people with heart failure (HF) as recommended by the European Society of Cardiology. PRO‐HF (Program to Optimize Heart Failure Patient Pathways) was developed to help clinicians identify strengths, gaps, and shortcomings in their HF pathways and support tailored interventions to optimize pathways and enhance patient care. We report initial findings from baseline assessments of HF pathway characteristics and challenges from 10 hospitals in six European countries (France, Ireland, Portugal, Spain, The Netherlands, and United Kingdom). Methods and results: Baseline assessments were holistic appraisals of full HF services to calibrate current status and development needs and assist management teams in prioritizing improvement projects. Assessments were performed using a comprehensive checklist of measures covering the HF patient journey from diagnosis to ongoing follow‐up. These included a digital survey sent to full HF care teams and one‐to‐one interviews. The digital survey focused on four key areas (HF outpatient clinic; remote patient management; efficient device implantation and inpatient pathways; and network maximization) and 16 dimensions of excellence. Priority areas and themes for action identified in baseline assessments were (i) provision of HF specialist care; (ii) data capture and analysis; (iii) institutional care protocols; (iv) hospital‐wide strategies; and (v) multidisciplinary teams (MDTs). Suboptimal specialist care of emergency inpatients was an issue at all hospitals and prioritized at 8/10. Availability and accessibility of data on patients, activities, and outcomes was an issue at all hospitals and prioritized by 4/10. A lack of clear protocols, templates, and tools for some HF activities created variability in patient care (e.g., HF specialist consultations, diagnostic testing, follow‐up appointments, medications, and device eligibility) and inefficient use of clinician time. This made it difficult to initiate new technologies (e.g., remote patient monitoring) due to the risk of overburdening staff. MDTs were frequently understaffed. Multiple interventions were identified to address gaps and shortcomings that could be tailored to specific needs of individual hospitals (e.g., inpatient pathway optimization, creation/optimization of HF outpatient clinics, development of an HF performance dashboard, enhancement of protocol adherence, streamlining cardiac resynchronisation therapy pathways, and MDT coordination). Conclusions: PRO‐HF provides a valuable opportunity to identify gaps and significant shortcomings in HF pathways in European hospitals. Preliminary findings from hospitals that have initiated suggested changes to address these challenges are encouraging, though longer‐term follow‐up from more hospitals is needed to confirm the impact of PRO‐HF on HF pathway optimization and patient care. [ABSTRACT FROM AUTHOR]

Introduction: Infliximab (IFX) is a standard, inpatient salvage therapy for the treatment of refractory acute severe ulcerative colitis (ASUC). Remicade™ is the originator IFX. Its biosimilar Renflexis™ offers a reduced cost structure. We performed a cost-minimization analysis to compare costs with Remicade™ and Renflexis™ for the inpatient treatment of ASUC. Methods: Retrospective clinical and financial data were obtained from 34 inpatients with refractory ASUC who received Renflexis™ (n = 17) or Remicade™ (n = 17) between 2019 and 2021. Clinical data included admission and discharge laboratory values. Financial data included a decision support drug cost (DSDC), constituting the total cost associated with inpatient IFX administration, and total inpatient cost of care. The following equation generated a ratio (rDSDC) representing the percentage of drug cost (or DSDC) of the total inpatient cost of care, after controlling for IFX dose and length of stay: [DSDC of IFX/Number of Units of IFX] ÷ [Total Inpatient Cost of Care/Length of Stay in Days]. Median and non-parametric Wilcoxon ranked sum test were used for analyzing patient demographics, clinical, and financial data. Results: No differences were found in baseline or discharge clinical parameters. The median unadjusted ratio of DSDC to total inpatient cost of care was 0.387 versus 0.241 in the Remicade™ versus Renflexis™ groups (p = 0.0025), respectively, representing an absolute difference of ∼14%. Median adjusted rDSDC were 0.04 versus 0.024 in the Remicade™ versus Renflexis™ groups, respectively, representing a relative cost reduction of ∼40% (p = 0.0001). Discussion: The unadjusted absolute cost reduction and adjusted relative cost reduction were, respectively, 14% and 40% in the Renflexis™ group as compared to Remicade™, when treating inpatient ASUC. Our calculation included median DSDC as a percentage of the total inpatient cost of care, controlling for IFX dose and length of stay. This reduced cost structure promotes use of Renflexis™ for ASUC inpatients and may reduce costs systemically. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to conduct a comparative analysis of the previously valid “Card” with a new form of “Card” filled in for patients receiving medical care in a hospital setting with the focus of the attention of practitioners on the new paragraphs of this document.Materials and methods: a comparative analysis of the medical record of an inpatient patient approved by the order of the Ministry of Health of the USSR dated October 4, 1980 was carried out. No. 1030 “On Approval of Forms of primary Medical Documentation of healthcare institutions” and the Medical record of a patient receiving medical care in inpatient conditions, in a Day hospital, approved by the Order of the Ministry of Health of the Russian Federation dated August 5, 2022 No. 530n “On Approval of Unified Forms of medical documentation used in medical organizations providing medical care in inpatient conditions, in the conditions of the day hospital and the procedures for their management”.Results: based on the results of the study of two forms of “Cards”, the advantages of the new form have been established, which improve the quality of medical documentation and, as a result, taking into account the fact that the ECMP is carried out according to medical documentation, lead to a reduction in the risks of imposing financial sanctions on medical organizations during the relevant examinations. In particular, a number of shortcomings of the new form of the “Map” are indicated, requiring additional study and discussion with possible additions in the future.Conclusions: the relevance of the examination of the quality of medical care, which, as a rule, is carried out according to the medical documentation of completed cases, is reflected. It is noted that the correct filling in of all the provided graphs and lines will minimize the number of defects in the registration of medical documentation, which in turn will reduce the financial sanctions imposed on medical organizations during the ECMP.

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, inpatient nurses faced various work stressors. Little is known about organizational interventions that can mitigate the negative consequences of pandemic-related stressors. Objective The aim was to provide a synopsis of the literature concerning the types and outcomes of organizational interventions performed during the COVID-19 pandemic that directly (re)organized the work structures of inpatient nurses to address pandemic-related work stressors or to increase nurses’ ability to cope. Methods Within this preregistered systematic literature review, we searched four databases (PubMed, PsycINFO, PsycARTICLES, CINAHL) and two preprint databases (MedRxiv, PsyArXiv) for interventional studies of organizational interventions published between 01/2020 and 03/2023 (k = 990 records). We included 12 primary studies after title-abstract and full-text screening. A synthesis of results without meta-analysis was conducted. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials – version 2 (RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results All interventions were implemented in hospitals. The reasons given for implementation included pandemic-related work stressors such as a high workload, understaffing, and a lack of medical resources. To respond to the various work stressors, half of the studies took a multilevel approach combining organizational and person-oriented interventions (k = 6). Most studies (k = 8) took a secondary prevention approach, focusing on the organization of rest breaks (k = 5). With respect to outcomes, the studies examined nurse-related stress and resilience, turnover intention, job satisfaction, and other factors. Risk-of-bias analyses revealed that conclusions about the effectiveness of the interventions are limited due to confounding factors and self-selection. Conclusions The identified interventions provide a basis for future research to draw conclusions on the effectiveness of organizational interventions during pandemics. The promotion of adequate work breaks could be useful if the work stressors associated with strain and negative consequences cannot be changed directly. However, the same stressors (e.g., high workload) can hinder nurses from participating in offered interventions. This emphasizes the importance of directly addressing inpatient nurses’ work stressors. Registration Prospero-ID CRD42023364807 (March 2023).

Abstract We investigate the factors that influence the variance in hospital charges and inpatient care for kidney transplant cases in the US. Using the AHRQ’s (Agency for Healthcare Research and Quality) HCUP’s (Hospital Cost and Utilization Project) NIS (National Inpatient Sample) database, we find that variance in hospital charges and inpatient care is driven by patient demographics and hospital variables. We find that variance in hospital charges and inpatient care is determined by patient-specific factors including age, gender, race, and income, and hospital factors such as size, type, and location. Our results provide a deeper understanding of the non-clinical factors that impact hospital charges and inpatient care for kidney transplant patients.

Abstract Background The emergence of COVID-19 precipitated containment policies (e.g., lockdowns, school closures, etc.). These policies disrupted healthcare, potentially eroding gains for Sustainable Development Goals including for neonatal mortality. Our analysis aimed to evaluate indirect effects of COVID-19 containment policies on neonatal admissions and mortality in 67 neonatal units across Kenya, Malawi, Nigeria, and Tanzania between January 2019 and December 2021. Methods The Oxford Stringency Index was applied to quantify COVID-19 policy stringency over time for Kenya, Malawi, Nigeria, and Tanzania. Stringency increased markedly between March and April 2020 for these four countries (although less so in Tanzania), therefore defining the point of interruption. We used March as the primary interruption month, with April for sensitivity analysis. Additional sensitivity analysis excluded data for March and April 2020, modelled the index as a continuous exposure, and examined models for each country. To evaluate changes in neonatal admissions and mortality based on this interruption period, a mixed effects segmented regression was applied. The unit of analysis was the neonatal unit (n = 67), with a total of 266,741 neonatal admissions (January 2019 to December 2021). Results Admission to neonatal units decreased by 15% overall from February to March 2020, with half of the 67 neonatal units showing a decline in admissions. Of the 34 neonatal units with a decline in admissions, 19 (28%) had a significant decrease of ≥ 20%. The month-to-month decrease in admissions was approximately 2% on average from March 2020 to December 2021. Despite the decline in admissions, we found no significant changes in overall inpatient neonatal mortality. The three sensitivity analyses provided consistent findings. Conclusion COVID-19 containment measures had an impact on neonatal admissions, but no significant change in overall inpatient neonatal mortality was detected. Additional qualitative research in these facilities has explored possible reasons. Strengthening healthcare systems to endure unexpected events, such as pandemics, is critical in continuing progress towards achieving Sustainable Development Goals, including reducing neonatal deaths to less than 12 per 1000 live births by 2030.

AbstractBackground: Borderline personality disorder (BPD) affects 0.7 to 2.7% of the adult population and higher rates are reported in inpatient care. Hospitalizations of BPD patients are a complex and controversial challenge for mental health professionals. Recurrent hospitalizations are common and it is essential to identify risk factors that characterize patients who benefit from their hospitalization and those who return to the ward shortly after discharge. Aim: To investigate the potential link between BPD patients’ socio-demographic factors and the expected time interval between their successive hospitalizations. Methods: A retrospective analysis of 1051 hospitalization records from 174 BPD patients. Through univariate, bivariate, and multivariate analyses, we investigated the possible relationship between patients’ primary socio-demographic factors and the time between their successive hospitalizations. Results: Patients’ age, marital status, and living arrangement were found to be statistically connected with the time interval between successive hospitalizations. Specifically, being older, married and/or patients to live with one’s spouse/partner seem to be linked with a longer time interval between successive hospitalizations compared to patients who are young, single/divorced and/or those who live with their parents. Conclusions: The expected time interval between successive hospitalization of BPD patients can be partly explained by their socio-demographic characteristics. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the frequency of hospital attendances, emergency care attendances and geographical influences on service interaction in cohorts of patients with primary and secondary antibody deficiency, to inform future service planning and delivery. Methods: The COVID-19 in Antibody Deficiency (COV-AD) study was a United Kingdom study that enrolled 525 participants between April 2021 and September 2022. Data on health care utilisation was extracted from a screening cohort of participants at one participating site (Birmingham, UK). Hospital attendance (i.e. all outpatient and inpatient care episodes, including hospital-based IVIG treatment) and emergency care attendance patterns were analysed. Geographical differences in travel times to hospitals and associated costs were considered for all participants at all recruiting sites. Results: Individuals with antibody deficiency had a median of 7 hospital attendances per year. A diagnosis of secondary antibody deficiency, and antibody deficiency severe enough to require treatment with immunoglobulin replacement were associated with an increased frequency of hospital attendance. 12.7% of the cohort attended the Emergency Department at least once in the preceding twelve months. Individuals with secondary antibody deficiency were at greater risk of requiring emergency care over the preceding one-year and five-year periods. Individuals receiving subcutaneous immunoglobulin lived further from their local immunology centre and were more likely to engage with the COV-AD research study remotely, via dried blood spots sampling. Conclusion: This study highlights the utilisation of emergency and secondary care usage amongst patient with immunodeficiency and may inform service adaptation and development to better accommodate patient needs and circumstances. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, inpatient nurses faced various work stressors. Little is known about organizational interventions that can mitigate the negative consequences of pandemic-related stressors. Objective: The aim was to provide a synopsis of the literature concerning the types and outcomes of organizational interventions performed during the COVID-19 pandemic that directly (re)organized the work structures of inpatient nurses to address pandemic-related work stressors or to increase nurses' ability to cope. Methods: Within this preregistered systematic literature review, we searched four databases (PubMed, PsycINFO, PsycARTICLES, CINAHL) and two preprint databases (MedRxiv, PsyArXiv) for interventional studies of organizational interventions published between 01/2020 and 03/2023 (k = 990 records). We included 12 primary studies after title-abstract and full-text screening. A synthesis of results without meta-analysis was conducted. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials – version 2 (RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results: All interventions were implemented in hospitals. The reasons given for implementation included pandemic-related work stressors such as a high workload, understaffing, and a lack of medical resources. To respond to the various work stressors, half of the studies took a multilevel approach combining organizational and person-oriented interventions (k = 6). Most studies (k = 8) took a secondary prevention approach, focusing on the organization of rest breaks (k = 5). With respect to outcomes, the studies examined nurse-related stress and resilience, turnover intention, job satisfaction, and other factors. Risk-of-bias analyses revealed that conclusions about the effectiveness of the interventions are limited due to confounding factors and self-selection. Conclusions: The identified interventions provide a basis for future research to draw conclusions on the effectiveness of organizational interventions during pandemics. The promotion of adequate work breaks could be useful if the work stressors associated with strain and negative consequences cannot be changed directly. However, the same stressors (e.g., high workload) can hinder nurses from participating in offered interventions. This emphasizes the importance of directly addressing inpatient nurses' work stressors. Registration: Prospero-ID CRD42023364807 (March 2023). [ABSTRACT FROM AUTHOR]