Evaluation of hospital stays linkage quality to study health spatial variation. a feasibility study in three French regions

BackgroundSince 2001, the French hospital stay databases (Programme de médicalisation des systèmes d’information, PMSI) have included a unique and anonymous identifier in order to cross-link discharge abstracts from a given patient, within and across hospitals. These data could be used to estimate prevalence for some diseases at a territorial level provided that linkage quality is good enough. Few morbidity data are available at this scale. This study analyzes the link between linkage quality and hospitalization rates in three French regions (Picardy, Brittany and Provence-Alpes-Côte d’Azur–Paca).MethodsWe studied short stays in medicine-chirurgical-obstetrical units for the 2004–2005 period (all stays, and stays with mention of cancer or asthma). To study linkage quality, the percentage of linkable stays (no error during the production of the anonymous identifier) was calculated at regional and territorial levels (areas used by regional health authorities). The interquartile range (IQR = third quartile – first quartile) of the percentage of linkable stays was calculated and the link between this percentage and standardized rates of people hospitalized at least once in 2004 or 2005 tested by Spearman correlation coefficients.ResultsFor all stays, percentages of linkable stays were 94.4%, 96.6% and 97.0% in Picardy, Paca and Brittany respectively in 2004–2005. Geographical variation at the territorial level was higher in Picardy (IQR between 4 and 6) than in the two other regions (IQR between 1 and 2). The percentage of linkable stays was positively and significantly associated with the hospitalization rate for all stays and those with mention of cancer in Picardy only.ConclusionAccording to these results, PMSI data earlier than 2006 should be used with precaution; linkage quality should be analyzed before making geographical or time comparisons of hospitalization rates. Comparisons cannot always be made. Other studies should be carried out in other regions, and to analyze recent trends in linkage quality.     

Identifying types of nursing facility stays using medicare claims data: an algorithm and validation

Nursing facilities provide skilled nursing and rehabilitative care to patients for short stays and custodial care to patients for long stays. The type of nursing facility stay (short- or long-term) is a potentially important risk factor and health outcome in health services research and is informative from both medical and fiscal perspectives. The purpose of this study was to develop and validate an algorithm to identify the use of nursing facility services and differentiate short- from long-term care using Medicare claims data. We used claims data for a 5% sample of Medicare beneficiaries to develop an algorithm to detect the use of nursing facility services and to distinguish between short- and long-term stays. We tested this algorithm using residency status from Medicaid long-term care claims for dually eligible beneficiaries and using residency status from the Medicare Current Beneficiary Survey (MCBS). Among 1,694,051 beneficiaries included in the baseline cohort, 25.6% had some indication of nursing facility residency. Using our algorithm, 59.8% of beneficiaries using any nursing facility care were classified as long-term residents. Validation of the algorithm against Medicaid long-term care claims and MCBS yielded high sensitivity and specificity. To our knowledge, this is the first paper to present a validated algorithm for identification of use of nursing facility services among Medicare beneficiaries that differentiates between short- and long-term care residency status.     

2009-2013年某医院发表论文的计量学分析

目的 对某医院2009-2013年发表的论文进行计量学分析,为医院科研管理决策提供依据.方法 查阅某医院科研论文统计资料,用Excel进行统计,用文献计量学的方法对论文数量、论文期刊分布、论文学科分布、作者职称以及核心著者分布等进行分析.结果 5年来该院发表科研论文772篇;期刊以本地期刊为主;第一作者职称以高、中级为主,占75.52％;核心作者86人,共发表论文378篇,占论文总数的48.96％.结论 科研论文的数量基本呈逐年上升趋势,但数量与质量都有所欠缺,科研管理部门应引导和鼓励研究人员把高水平科研论文投向高质量的期刊,促进科研论文数量和质量的全面提高.     

Quality assessment of discharge letters in a French university hospital

The quality of discharge letters has been evaluated in order to initiate a process of improved communications between the hospital and general practitioners. From each of 37 volunteer clinical departments of the hospital, a random sample of 30 stays was selected among the hospitalisations for one year. The quality of discharge letters was assessed according to recipients' needs and to French legislation. In total, 1,024 medical records were relevant and were analysed. This study showed deficiencies in management of discharge letters in the hospital. It constitutes the first step of a quality improvement process based on the awareness of concerned actors through information feedback and the follow-up of specific indicators.     

Sensitivity and specificity of two methods used to identify incident breast cancer in specialized units using claims databases

BACKGROUND: Hospital claims databases from acute care units are available nationwide and contain most patients at the beginning of their cancer. The goal is to define the ability of these databases to provide a number of incident breast cancer cases using identification methods. Two identification methods were assessed in three specialized sections of a teaching hospital. METHODS: The first method identified women who had at least one stay with a principal diagnosis of breast cancer. The second, which is more restrictive, identified women who had at least one stay with a principal diagnosis of breast cancer and a breast cancer-specific surgical treatment code. Both methods were applied to 4588 women 20 Years of age or older hospitalized in three specialized sections of the Hospices Civils de Lyon in 2000. To categorize these women in two groups, incident breast cancer cases or non-incident breast cancer cases, 150 women were randomized in each of two groups, one for incident breast cancer cases and one for non-incident breast cancer cases. Their medical records were used as references. RESULTS: Sensitivity, specificity and their credibility intervals were respectively 99.4% (84-99.9) and 91.7% (90.3-93.3) for the first method and 93.8% (76.2-98.7) and 97.3% (96.1-98) for the second. Among women wrongly identified with an incident breast cancer in 2000, 75.4% (43/57) had a breast cancer that was not incident that Year with the first method, compared to 96% (24/25) with the second. Among these women wrongly identified with an incident breast cancer, coding errors of the principal diagnosis were found for 24.6% (14/57) of patients with the first method and for 4% (1/25) with the second. Their correction led to 99.2% (86.5-99.9) sensitivity and 92.9% (91.4-94.6) specificity for the first method and to 94.2% (76.5-98.7) sensitivity and 97.3% (96.2-98.1) specificity for the second. CONCLUSIONS: The second method using cancer-specific surgical codes appeared more specific with a slight loss in sensitivity. The use of identification methods to assess the number of incident cancer cases still have to be defined.     

Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital

Vancomycin-resistant enterococci (VRE) are emerging in French hospitals. A VRE outbreak occurred in our hospital, prompting efforts to eradicate the organism. The following interventions were implemented simultaneously to control the outbreak: (1) creation of a VRE control committee; (2) cohorting of VRE carriers in a dedicated ward; (3) extensive screening of contact patients; (4) use of a sensitive technique for detecting VRE in rectal samples; (5) intervention of a dedicated team to reduce consumption of selected antibiotics; (6) information for, and education of, all hospital staff; and (7) electronic tracking of in-hospital transfer and readmission of VRE carriers and contact patients. Over a four-week period following admission of the index case, 37 carriers of a single strain of vanA vancomycin-resistant Enterococcus faecium were identified across seven units. A single additional readmitted contact patient was identified later. Of the 39 VRE-positive patients, two had urinary tract infections and 37 were colonised. Of the 32 patients with known VRE stool concentrations, 23 had low and nine high concentrations. One low-concentration patient precipitated transmission in another unit. This aggressive, co-ordinated, multifaceted strategy was successful in halting a widespread VRE outbreak in our hospital.     

An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital

Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six‐month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one‐page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD‐10‐AM diagnoses coding was used. Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0‐0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.     

Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays

IntroductionGrowing numbers of older patients occupy hospital beds despite being ‘medically fit’ for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people''s and caregivers'' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge.MethodsA multimethod qualitative study was carried out. Content analysis was carried out of older people''s experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months.ResultsOnline accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview‐generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care.ConclusionPoor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient‐centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital.Patient or Public ContributionThe Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID‐19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.     

Studies of hospital social stays in the frail elderly and their relationship to the intensity of social work intervention.

The elderly frequently suffer long lengths of hospital stay (LOS). These long stays are often associated with long social care stays which occur when patients no longer require acute care and are awaiting post-discharge services. In this study, actual acute care LOS and social care LOS were studied specifically in hospitalized frail elderly. Our data demonstrate that frail elderly receiving only acute care do not suffer markedly prolonged total LOS (TLOS). However, in hospitalized frail elderly patients who experience acute care and social care stays, social care LOS accounts for over half of all hospital days. When patients were grouped and studied according to the type of post-discharge services being sought by the health care team, significant differences in acute LOS and social care LOS were noted. Subgroups of patients were also identified among the various groups which differed significantly in their LOS parameters. Patients who required more than one discharge plan during the course of hospitalization experienced the longest hospital stays of all groups, and spent almost 70% of these days receiving non-acute social care. In a study of the relationship between the intensity of social work intervention and social care LOS in the frail elderly, a statistically significant relationship was noted between the timing and frequency of social work intervention and the actual length of social care stays. Early and frequent social work interventions were associated with significantly shorter social care LOS. We conclude that the study of TLOS should include acute LOS and social care LOS to obtain a reliable measure of the course and cost of hospital care for the frail elderly. The study of social care subgroups may facilitate future investigations to define the social care problems which contribute most to TLOS, and the patient populations which should be most heavily targeted for early and intensive social work intervention.     

法国医院管理政府机构的职能分工定位及分析

法国医院管理机构在经济社会变化的背景下几经变革,形成了主要由中央和大区机构管理医院的格局.本文通过对法国政府医院管理机构及其职责的介绍和分析,对我国医院的管理得出几点启示:以公立医院为卫生服务提供主体利于公共服务的实现;公立医院和私立医院可在政府调控下共同完成公共服务的职能;国家对医院的管理侧重对医疗资源的控制;医疗服务体系运转需要统一的宏观政策指引;医院管理组织在改革中应注意精简.     

Assessing the cost of occupational exposures to blood, in a French university hospital

The management of occupational exposure to blood has an important economic impact. Few studies have estimated the real cost of these exposures. METHOD: This retrospective study was made on occupational exposures to blood reported in the Poitiers University Hospital, in 2000. Items concerning the management of these accidents were listed: consultations, post-exposure prophylaxis, laboratory testing, leave time for health care workers (HCW). RESULTS: In 2000, 243 occupational exposures to blood were reported to the Department of Occupational Medicine. Nurses (39.5%), physicians (21.8%), and students (13.6%) were the most frequently concerned. Most of these accidents occurred in the Department of Surgery (29.2%) and Department of Internal Medicine (24.3%). Deep needle-stick injuries accounted for 48.7% of occupational exposures to blood. The source patient serology was unknown in 15.6% of the cases. This study showed that the cost of these occupational exposures to blood was high in 2000 (68310 Euros). This global cost was due to consultations (11122 Euros), laboratory testing (45995 Euros), and post-exposure prophylaxis (5067 Euros). The cost of leave time for injured workers was 6126 Euros. CONCLUSION: The economic impact of occupational exposures to blood is high for a hospital. Before the introduction of safety devices, a cost-benefit analysis must be made to assess the benefits brought about by preventing accidents.     

Bacteremia and French computerized disease surveillance system: financial valorisation of an infectious diseases specialist in a hospital

Objective

Bacteremia surveillance is a mission assumed by the referent person for antimicrobial therapy. We propose an original financial valorization of this activity, using the computerized disease surveillance system (CDSS).

Material and methods

A database collecting community-acquired and care-associated bacteremia was created on January 1, 2009 at the Bethune Hospital, France, using EPI-Info software (EPI Data). This database was used to complete missing data (presence of bacteremia, origin [community-acquired or care-associated], site of infection) in CDSS codes of patients hospitalized in surgical and medical wards (410 beds) during 2009. Financial benefit was assessed by the difference of funds allocated on the basis of CDSS, before and after completion of the missing data.

Results

In 2009, 383 out of the 35,000 patients presented with bacteremia. When missing CDSS codes were added, a financial gain of 229,291 euros was obtained, concerning 64 patients.

Conclusion

Bacteremia surveillance is a transversal task based on quality of care, which may have a positive financial impact. This study may be helpful for clinicians with transversal activities, for whom financial valorization is difficult to implement in the CDSS, particularly without hospitalization beds. The lack of complete notification in the CDSS may cause a substantial financial loss.     

Nosocomial infection in surgery wards: A controlled study of increased duration of hospital stays and direct cost of hospitalization

Excess length of hospital stays and associated costs were assessed in patients hospitalized in the department of general and digestive surgery who acquired nosocomial infections. A prospective study of matched infected-uninfected patients nested in a cohort was used to estimate the length of the hospital stay of infected patients. Matched controls were obtained with respect to patient exact primary diagnosis, operative procedure and classification, age and, if possible, underlying disease, elective or emergency procedure and invasive devices. Superficial surgical wound infection prolonged the average hospital stay of the nosocomially infected patient by an average of 12.6 days, wound infection (deep and superficial) by 14.3 days and infections other than wound infection by 7.3 days as compared to the uninfected matched controls.     

Methods to identify and compare parenteral nutrition administered from hospital-compounded and premixed multichamber bags in a retrospective hospital claims database

Purpose: Use of parenteral nutrition (PN) is indicated for patients who are unable to meet their needs enterally. PN may be administered via custom‐compounded mix or commercially available ready‐to‐use multichamber bags (MCB), but little is known about potential differences in clinical outcomes between these delivery systems. This study was undertaken to assess the feasibility of comparing custom‐compounded and MCB PN in a large hospital claims database. Methods: Hospital claims data from the Premier Perspective Comparative Hospital Database (PCD) reported from 2005 through 2007 were analyzed. The authors searched the data for patients who received any PN products, including compounded PN and MCB PN. Coding algorithms for identifying patient characteristics, risk factors, and outcomes of interest were explored. Results: Using hospital billing claims, the authors identified patients in the database treated with premixed PN from multichamber bags (“MCB only,” n = 4699) and patients treated with custom‐compounded PN solution (“compounded PN,” n = 64,315). Methods of identifying PN administration groups, patient characteristics and risk factors, outcomes of interest, and data limitations are described. Conclusions: Exploratory analysis suggests that comparisons of PN administered via compounding and MCB are possible using the Premier data. The ability to control for many identifiable risk factors allows data to be presented for the use of PN and related outcomes in both a clinically sensible and relevant manner, albeit with some limitations.     

A comparison of hospital and state agency efficiency in processing medicaid claims in Washington state.

The performance of the Washington State Medicaid agency in processing Medicaid claims was compared with that of hospital providers for one year. We found that the in-hospital processing time was approximately twice that of the Medicaid processing agency. In-agency processing time was found to be significantly related to the size and disposition of a claim, while in-hospital processing time showed a significant relation to hospital dependence on Medicaid reimbursement, the amount of the claim not allowed reimbursement by the Medicaid agency, hospital expense per admission, and the question whether the claim was submitted by the university hospitals. We concluded that lengthy turnaround time for Medicaid reimbursement of hospitals in Washington State was primarily related to hospital speed in submitting claims.