Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals

Kunisawa, Susumu; Fushimi, Kiyohide; Imanaka, Yuichi

doi:10.1371/journal.pone.0166269

Cited by 22 publications

(31 citation statements)

References 6 publications

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“…The collection of data is funded by Japan’s Ministry of Health, Labour and Welfare. These data are obtained from approximately 80% of all DPC hospitals, and encompass approximately 8 million inpatient episodes per year [ 13 ]. The DPC database includes summarized inpatient information, such as recorded diagnoses of the disease that resulted in hospitalization, other major diagnoses, Killip class on admission, comorbidities on admission, and discharge status.…”

Section: Methodsmentioning

confidence: 99%

Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan

et al. 2018

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BackgroundPatients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients.Methods and resultsUsing a large nationwide administrative database, we analyzed 103,908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03–1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions.ConclusionsIn-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend daytime admissions may be a potential target for improvement in the Japanese healthcare system.

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Section: Methodsmentioning

confidence: 99%

Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan

et al. 2018

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“…We used data obtained from the DPC database which contains administrative claims data and discharge clinical summaries. The data were collected by the DPC research group from voluntarily participating hospitals, which account for approximately 50% of acute care hospitals in Japan [11]. The data were electronically collected through the uniform format stipulated by the Japanese Ministry of Health, Labour and Welfare for comparative analysis of many hospitals throughout Japan.…”

Section: Data Sourcementioning

confidence: 99%

Association between clinic physician workforce and avoidable readmission: a retrospective database research

Hirota

Kunisawa

Fushimi

et al. 2020

BMC Health Serv Res

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Background: To reduce hospitalization costs, it is necessary to prevent avoidable hospitalization as well as avoidable readmission. This study aimed to examine the relationship between clinic physician workforce and unplanned readmission for ambulatory care sensitive conditions (ACSCs). Methods: The present study was a retrospective database research using nationwide administrative claims database of acute care hospitals in Japan. We identified patients aged ≥65 years who were admitted with ACSCs from home and discharged to home between April 2014 and December 2014 (n = 127,209). The primary outcome was unplanned readmission for ACSCs within 30 or 90 days of hospital discharge. A hierarchical logistic regression model was developed with patients at the first level and regions (secondary medical service areas) at the second level.Results: The 30-day and 90-day ACSC-related readmission rates were 3.7 and 4.6%, respectively. The high full-time equivalents (FTEs) of clinic physicians per 100,000 population were significantly associated with decreased odds ratios for 30-day and 90-day ACSC-related readmissions. This association did not change even when sensitivity analyses was conducted.Conclusions: Among patients who had history of admission for ACSCs, greater clinic physician workforce prevented the incidence of readmission because of ACSCs. Regional medical plans to prevent avoidable readmissions should incorporate policy interventions that focus on the clinic physician workforce.

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“…In cancer patients, depending on the type of primary tumour and degree of disease, weight loss and malnutrition in the range of 20% and 85% can develop (Aria Guerra et al, ; Bozzetti et al, ; Culine et al, ; Dreesen et al, ; Girke et al, ) and especially for patients with gastrointestinal system cancers or for cancer patients at the end of their lives, there is a requirement for Total Parenteral Nutrition (TPN) due to nausea vomiting and lack of oral intake (Bozzetti et al, ; Chermesh et al, ; Cotogni et al, ; Culine et al, ; Drissi et al, ; Higuera et al, ; Senesse et al, ). Patients having nausea and vomiting contact emergency services due to insufficient oral intake and thus are admitted to the hospital, or in countries such as Canada, Spain and USA Home Parenteral Nutrition (HPN) is offered (Ang et al, ; Gomez‐Candela et al, ; Higuera et al, ; Hong et al, ; Kunisawa, Fushimi, & Imanaka, ; Mackenzie & Gramlich, ; Merchant et al, ; Shatnawei et al, ; Weaver et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…In other studies, the ratio of cancer patients’ contacting emergency services and being admitted to the hospital again was 30% (Ang et al, ; Hong et al, ). The most important reason for these admissions was related to gastrointestinal problems such as nausea, vomiting and lack of oral intake within a range between 20% and 40% (Kunisawa et al, ; Merchant et al, ; Weaver et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…2016; Kunisawa, Fushimi, & Imanaka, 2016;Mackenzie & Gramlich, 2008;Merchant et al, 2015;Shatnawei et al, 2013;Weaver et al, 2006). Total Parenteral Nutrition began to be applied frequently in the houses of patients starting from the 1990s (Gomez-Candela et al, 2014;Higuera et al, 2014;Mackenzie & Gramlich, 2008;Shatnawei et al, 2013) and is stated in literature as HPN (Bozzetti et al, 2015;Chermesh et al, 2011;Culine et al, 2014;Drissi et al, 2015;Gomez-Candela et al, 2014;Shatnawei et al, 2013).…”

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Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter‐related complications: A systematic review

2019

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Purpose Total Parenteral Nutrition began to be applied frequently in the houses of patients starting from the 1990s and is stated in literature as Home Parenteral Nutrition (HPN). The purpose of this review is to answer the question of whether or not HPN is safe for cancer patients. Methods Searches were conducted in Cochrane, CINAHL, PubMed, Springer, Google Scholar, and the Web of Science databases. Results The 1,949 articles were accessed in the total, and 20 articles have been included in the review. In the studies being evaluated, it can be determined that HPN has influenced the quality of life, performance status, and the nutrition level of cancer patients positively. Most frequently seen complications were infections relating to the catheter, the mechanical obstruction in the catheter and venous thrombosis. For each 1,000 days with HPN or a catheter, infections in the interval of 0.05 and 3.08, mechanical problems in the interval of 0.07 and 2.13, and thrombosis in the interval of 0.05 and 0.20 were determined. Conclusions While HPN influenced quality of life, nutrition, and the personal performance of cancer patients positively, the rate of complications is at a level that can be managed at home.

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Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals

Cited by 22 publications

References 6 publications

Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan

Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan

Association between clinic physician workforce and avoidable readmission: a retrospective database research

Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter‐related complications: A systematic review

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