Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co‐morbidity

Barisonzo, Riccardo; Wiedermann, Wolfgang; Unterhuber, Matthias; Wiedermann, Christian J.

doi:10.1111/j.1365-2753.2011.01775.x

Cited by 28 publications

(26 citation statements)

References 26 publications

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“…Para lidar com a variação das práticas de alta adotadas pelos hospitais, Jarman et al 21 utilizaram o tempo de permanência como variável de ajuste da mortalidade hospitalar, a exemplo de alguns estudos pioneiros 35 . Outros estudos não costumam incluir esta variável, mas sim considerá-la uma medida relacionada ao processo de cuidado e à eficiência técnica 9,36 . A discussão a respeito do significado de determinado padrão do tempo de permanência é complexa, uma vez que seu efeito sobre a mortalidade é ambíguo e os seus determinantes são diversos.…”

Section: Discussionunclassified

“…Além dos motivos clínicos, há práticas gerenciais voltadas para a maior eficiência, que podem estimular a redução no tempo de permanência, e gerar inclusive altas precoces. A disponibilidade de leitos de longa permanência ou unidades de reabilitação também pode afetar o tempo de permanência e não representar necessariamente inadequações no processo de cuidado 19,35,36 . Por outro lado, as mortes ocorridas no primeiro dia de internação podem decorrer da gravidade do caso, barreiras de acesso ou inadequação do cuidado de emergência.…”

Section: Discussionunclassified

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Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil

Machado¹,

Martins

Leite

2016

Cad. Saúde Pública

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Resumo: No Brasil, a convivência público-privado no financiamento e na prestação do cuidado ganha nítidos contornos na assistência hospitalar. Os arranjos de financiamento adotados pelos hospitais (Sistema Único de Saúde - SUS e/ou planos de saúde e/ou pagamento particular) podem afetar a qualidade do cuidado. Alguns estudos buscam associar a razão de mortalidade hospitalar padronizada (RMHP) a melhorias na qualidade. O objetivo foi analisar a RMHP segundo fonte de pagamento da internação e arranjo de financiamento do hospital. Analisaram-se dados secundários e causas responsáveis por 80% dos óbitos hospitalares. A RMHP foi calculada para cada hospital e fonte de pagamento. Hospitais com desempenho pior que o esperado (RMHP > 1) foram majoritariamente públicos de maior porte. A RMHP nas internações SUS foi superior, inclusive entre internações no mesmo hospital. Apesar dos limites, os achados indicam iniquidades no resultado do cuidado. Esforços voltados para a melhoria da qualidade de serviços hospitalares, independentemente das fontes de pagamento, são prementes.

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Section: Discussionunclassified

Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil

Machado¹,

Martins

Leite

2016

Cad. Saúde Pública

View full text Add to dashboard Cite

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“…Due to the generality of the hospital, the presence of various specialties, and the inter-ward relationships, problems with medical counseling and delays are common. In another study by Barisonzo et al conser-vative performance (39%), results of diagnostic tests (21%), and counseling services (18%) were the contributory factors in inappropriateness of admissions or hospital days (2). The results of the study showed that the likelihood of inappropriateness of hospitalization days increased with the prolonged patients' length of hospital stay.…”

Section: Discussionmentioning

confidence: 85%

“…In a study in which AEP was the criterion for the rate of appropriateness or inappropriateness of stays, Soria-Aledo et al found that this rate was 24.6% (8). Conversely, in studies in which the above-mentioned protocol was not the basis of estimation, this rate was reported as 35.3% (2,20,30). This may be due to the issue that such a protocol includes stricter criteria for the evaluation of appropriateness.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital bed management is one of the issues that contribute to controlling the increasing costs of the health system. The increases in health care costs and patients' age, as well as the presence of acute diseases, duplicate the needs for effective management of hospital beds (2). Inappropriate healthcare services are one of the problems that impose more pressure on hospitals and result in the likelihood of wrong admissions (3).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

et al. 2019

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Background: Appropriate allocation of resources is an important issue in the delivery of services that can reduce the health system costs. The inappropriateness of healthcare services is one of the problems that increase the pressure on hospitals and patients. Methods: In this study, the data were collected using the appropriateness evaluation protocol by a medicine specialist at Rasoul Akram Hospital. In total, 248 participants were selected through systematic sampling. To calculate the financial burden simultaneously with the evaluation of inappropriate hospitalization days, the medicine and facility costs along with the cost of bed-day were estimated. Data were analyzed by SPSS software. Results: The type of treatment was surgery in 56.8% of the patients and 43.2% of them were admitted to the hospital for internal medicine. The mean length of stay was 4 ± 6 days. The inappropriate admission rate was estimated at about 6% and the rate of inappropriate hospital stays was 21.5%. The most important factors influencing the inappropriateness of hospitalization were delayed medical consultations, delayed surgery, conservative practitioner, and the follow-up of clinical test results. The sum of the direct financial burden of inappropriate hospitalization for the patients was estimated at around 1060 dollars. Conclusions: The findings of this study indicated that inappropriate hospitalization and admission imposed a huge financial burden on the health system and community. Hospital authorities by considering issues such as delayed medical consultations and delayed surgery can decrease the financial burden of inappropriate hospitalization to a large extent.

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Socioeconomic Factors Are Associated With Severity of Hospitalization in Pediatric Lupus: An Analysis of the 2016 Kids’ Inpatient Database

Soulsby

Lawson

Okumura

et al. 2023

Arthritis Care & Research

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ObjectiveHealth disparities in adult lupus, including higher disease severity and activity among those in poverty, have been identified. Similar associations in pediatric lupus have not been clearly established. This study was undertaken to investigate the relationship of income level and other socioeconomic factors with length of stay (LOS) in the hospital and severe lupus features using the 2016 Kids’ Inpatient Database (KID).MethodsLupus hospitalizations were identified in children ages 2–20 years in the 2016 KID using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD‐10) codes (M32). Univariate and multivariate negative binomial regression analyses were used to analyze the association of income level, race and ethnicity, and insurance status with LOS in the hospital. Univariate and multivariate logistic regression analyses were used to analyze the association of the same predictors with the presence of severe lupus features, defined using ICD‐10 codes associated with lupus sequelae (e.g., lupus nephritis).ResultsA total of 3,367 unweighted (4,650 weighted) lupus hospitalizations were identified. Income level was found to be a statistically significant predictor of increased LOS in the hospital for those in the lowest income quartile (adjusted incidence rate ratio 1.12 [95% confidence interval (95% CI) 1.02–1.23]). Black race, “other” race, and public insurance were also associated with severe lupus features (adjusted odds ratio [ORadj] 1.51 [95% CI 1.11–2.06]; ORadj 1.61 [95% CI 1.01–2.55]; and ORadj 1.51 [95% CI 1.17–2.55], respectively).ConclusionUsing a nationally representative data set, income level was found to be a statistically significant predictor of LOS in the hospital among those with the lowest reported income, highlighting a potential target population for intervention. Additionally, Black race and public insurance were associated with severe lupus features.

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Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co‐morbidity

Cited by 28 publications

References 26 publications

Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil

Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

Socioeconomic Factors Are Associated With Severity of Hospitalization in Pediatric Lupus: An Analysis of the 2016 Kids’ Inpatient Database

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