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.     

Factors related to length of hospitalization of elderly patients during short stay

Length of stay of elderly patients in hospitals can be subdivised into a medical stay followed by a social stay. The average length of stay of 2134 patients aged 75 and over, admitted to 23 medical or geriatric acute wards in Aquitaine, was 13.6 days; 18% of the patients experienced a social stay of at least one day. The mean social stay was almost null (1 day) when the patient returned home, but could reach 5 days when he was discharged to a long term care facility. The kind of hospital, domicile in a rural area, the social network, and the grounds for hospitalization were significantly related to the total length of stay, but explained only 5% of variance if diagnosis was not taken into account. This percentage rose to 29% in the group with "bronchitis" as a main diagnosis. The length of social stay was related to the grounds for hospitalization, but also to recent family modifications; it did not depend on the kind of hospital. These results suggest a lack of accessibility to nursing-homes, following acute hospitalization.     

Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay.

OBJECTIVE: An evaluation of the impact of a social work preadmission program on length of stay (LOS) of orthopedic patients undergoing elective total hip or total knee replacement surgeries (under diagnosis-related groups [DRGs]) at the Hadassah Ein-Kerem Hospital in Jerusalem is Israel. INTERVENTION: The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning, coordination of nursing and physiotherapy evaluations, ensuring completion of all medical tests prior to admission, and additional psychosocial follow-up during hospitalization to carry out the original discharge plan or prepare alternatives. PATIENTS: The intervention patients were divided into two groups in order to see changes over time: May through December 1994 (n = 48), and January through December 1995 (n = 81). The comparison groups included patients operated on at the same hospital during 1993 (n = 51) and during January through April 1994 (n = 21) and at the Hadassah Mount Scopus Hospital during the same time periods. Patients in the comparison groups received usual social work intervention, as necessary, only after hospitalization. RESULTS: Mean LOS was reduced significantly in the intervention patient groups, as compared to the preintervention patient groups in the same hospital, from 14.2 days (standard deviation [SD], 4.7) in 1993 and 14.7 (SD, 5.1) in January through April 1994 to 10.9 (SD, 3.0) in May through December 1994 and to 9.1 (SD, 2.8) in 1995 (P < .01). Length of stay also was reduced in the comparison hospital, but by 1995 was longer than in the intervention patients. No differences in LOS by gender, age, or marital status were found. Length of stay was significantly longer for those undergoing total hip replacement as compared to those undergoing total knee replacement in all the groups. CONCLUSIONS: Preadmission screening and case management by a social worker can contribute to the efforts to decrease LOS of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.     

Early unplanned readmissions to social work of elderly patients: factors predicting who needs follow-up services.

There are some elderly patients who receive social work services during an initial hospitalization and experience an early unplanned readmission, when they again are in need of social work assistance. This research identified factors which differentiated social work patients who were readmitted to the hospital within one month and were again referred to social work services from those who were not readmitted. Three factors were found to be predictive of readmission to social work: longer length of stay in the initial hospitalization; presence of barriers which complicated the social work service plan undertaken in the first admission; and provision of social work services in the initial admission which were limited to information and referral only.     

Can physicians' admission evaluation of patients' status help to identify patients requiring social work interventions?

OBJECTIVE: To evaluate the utility of these physicians' initial clinical assessments in identifying patients admitted from their homes who subsequently require social work intervention for discharge planning. DESIGN: Retrospective chart review of discharge disposition correlated with a prospective physician evaluation of patients. SETTING: An academic medical center. Participants: Consecutive patients, (2,571) men and women, admitted at the New York Hospital between July 1, 1997 and October 31, 1997. MEASUREMENT: Prospective evaluation of clinical status, functional status, illness severity and stability by physicians within 24 hours of admission. RESULTS: Older patients, sicker and less functional, have higher needs for social work intervention (P < 0.001). New nursing home placement patients were older and had worse function (P < 0.001). Total cost of hospitalization and length of stay were predicted by discharge disposition. CONCLUSION: Early discharge intervention has often been targeted as a potential mechanism to lower hospitalization cost and reduce length of stay. Age and physician evaluation of functional status at admission may provide early identification of those who require social work assistance.     

术前洗必泰擦浴对降低椎管术后患者手术部位感染发生率的效果

目的了解术前洗必泰擦浴对降低椎管术后手术部位感染（SSI）发生率的效果。方法对2013年1月-2014年12月某院神经外科行椎管手术且无植入物的所有患者进行监测,将所选病例分为对照组（2013年1-12月的患者,未采取干预措施）和实验组（2014年1-12月的所有监测患者,术前两晚采用1.8%～2.2%洗必泰进行擦浴）,比较干预前后两组患者的SSI发生率,评价干预效果。结果共纳入椎管手术患者1 043例,发生SSI患者 41例,SSI发生率为3.93%,对照组和实验组SSI发生率分别为6.47%和2.34%,两组差异有统计学意义（P=0.001）。按对照组SSI发生率计算,实验组实际感染患者比预期感染患者少27例。SSI组患者平均住院费用为33 641.00元,非SSI组患者为23 072.50元,平均每例患者可节约住院费用10 568.50元。故通过采取干预措施共节约住院费用285 349.50元。减去实验组材料费费用2 100元,人力成本约12 820元,最终节约社会成本270 429.50元。对照组患者住院时间为10（8～12）d,实验组患者住院时间为9（8～12）d,经秩和检验,两者差异无统计学意义（Z=-0.68,P=0.50）。结论采取洗必泰擦浴进行干预,不仅可以降低手术部位感染发生率,还能节省住院费用,是否能缩短患者住院时间还需进一步研究的支持。     

影响平均住院日的主要因素分析与对策

平均住院日是评价医院效率、医疗质量、管理水平的综合性指标之一。通过对医院近3年来平均住院日等相关核心医疗指标的分析,找出影响医院平均住院日的主要因素,深入研究并提出对策,以便采取科学合理的措施,在确保医疗质量和医疗安全的同时,有效缩短平均住院日,降低患者医疗费用,提高医院的社会效益和经济效益。     

疼痛护理干预对优质护理服务的影响

目的：探讨有效改善疼痛的护理干预的效果。方法：选取本院行髋关节置换术的60例患者作为研究对象,按照随机数字表法将其分为对照组和观察组各30例,对照组3采用传统的按需给予疼痛干预方法。观察组采用新的干预法提前进行疼痛干预,观察比较两组术后疼痛情况、患者满意度、住院时间、出院总费用、功能康复等评分及总评分。结果：观察组的患者满意度、住院时间、出院总费用、功能康复、疼痛评估等评分及总评分均明显高于对照组,差异有统计学意义（P〈0.05）。结论：及时有效地早期给予疼痛护理干预可减少疼痛的发生,提高患者满意度,减少住院时间、费用,促进其康复。     

“五位一体”模式干预ICU患者多重耐药菌防治管理的应用研究

目的将"西医、中医、康复、营养、心理"五位一体模式应用于ICU多重耐药菌管控领域,旨在提高ICU管理质量,为该模式广泛应用提供参考。方法 2017年1月-2018年12月,整群抽样选择某院899例ICU患者,按入院时间分为对照组和干预组(对照组484例、干预组415例),对照组接受常规治疗,干预组在此基础上实施"五位一体"管理。收集2组多重耐药菌(MDROs)的发生率、住院时间、隔离时间、住院总费用等资料,分析"五位一体"模式的临床效益。结果干预后,ICU患者MDROs感染率(10.1%)较干预前(16.7%)明显下降(P<0.05);MDROs患者住院总费用由26.1万元减少到18.9万元;住院天数由71.3 d降至54.2 d;隔离天数由50.0 d减少到34.9 d(P<0.05)。结论 "五位一体"模式显著降低ICU多重耐药菌感染率,可缩短住院时间及隔离天数,能减少患者住院总费用;该管理模式可在临床上进一步推广。     

慢阻肺患者住院费用影响因素的通径分析

目的 为了解慢阻肺患者住院费用的主要影响因素,减缓住院费用过快增长,减轻患者、家庭及社会的经济负担,优化医疗服务价格体系提供科学依据。方法 收集贵州省某三甲医院2015—2019年的9 223例慢阻肺患者病案首页信息,对慢阻肺患者的住院费用和住院天数进行描述性分析,并采用多元回归分析拟合通径分析模型的方法,研究慢阻肺患者住院费用的影响因素。结果 慢阻肺患者的人均住院天数为12.4 d,人均住院费用为18 598.81元,60岁以上患者占比达87.3%,医保患者占73.5%,且住院天数是影响住院费用的主要因素,总效应系数为0.719,危重型患者总效应系数为0.181排第二位。通径分析研究结果显示,年龄、医保、公费、危重、手术、药物过敏、医嘱离院不仅对住院费用存在着直接影响的效应,同时还通过住院天数间接影响着住院费用。结论 在不影响医疗质量的情况之下,按照临床路径的程序,合理缩短住院天数,并加强对于可控因素的限制,采取有效的措施,最大可能的减轻患者住院费用的负担。     

万元以上出院者住院费用分布及影响因素研究

目的分析出院者万元以上住院费用分布及其影响因素,为医院制定住院费用措施提供决策依据.方法选择某三级医院2003年全年出院病人,分析住院费用超过万元患者的费用情况、住院日等,并利用多因素模型对其影响因素进行综合分析.主要结果万元以上患者平均住院费、住院日等显著高于万元以下患者.万元以上住院费用的影响因素为：性别、年龄、住院日、出院情况、入院病情、护理级别等.结论控制大额医疗费用,须从缩短住院日、防治慢性病等因素入手.     

基于倾向性评分匹配的CRE感染经济负担增量研究

目的 探讨重症监护病房(ICU)患者发生耐碳青霉烯类肠杆菌目(CRE)感染归因住院时间、住院费用和病死率。 方法 选取某三甲医院2017—2022年入住ICU的患者为研究对象, 依据是否发生CRE感染分为感染组和非感染组。采用倾向性评分匹配法对感染组和非感染组患者进行1 ∶1匹配, 统计分析匹配后患者的住院时间、住院费用和病死率。建立广义线性模型再次计算匹配后患者的住院时间、住院费用和病死率的比值比(OR值)。 结果 经过倾向性评分匹配, 感染组较非感染组患者住院日数延长10.56 d(P＜0.001), 住院费用增加36 021.02元(P＜0.001), 病死率增加6.70%(P＝0.035)。广义线性模型结果显示, CRE感染患者相较于非感染患者, 住院日数、住院费用和病死率OR值分别为1.187(95%CI: 1.013~1.393)、1.134(95%CI: 0.975~1.318)和1.130(95%CI: 1.049~1.218), 除住院费用外, 两组住院日数和病死率比较, 差异均存在统计学意义(均P < 0.05)。 结论 ICU患者发生CRE感染会增加患者住院时间, 加重患者经济负担, 增加病死率, 应采取措施进行防控。     

急性白血病患者口腔感染直接经济损失分析

目的了解急性白血病（AL）患者口腔感染所致的直接经济损失。方法对2011年1月—2013年12月山东省某三级甲等医院血液病房AL口腔感染患者进行调查,采用病例对照的方法进行1︰1配对,比较口腔感染组（病例组）与未感染组（对照组）AL患者的住院费用及住院日数等情况。结果共监测AL患者994例,发生医院感染277例,其中口腔感染17例（5.56%）。病例组患者住院费用中位数为37 327元,对照组为13 176元,病例组患者总住院费用是对照组的2.83倍,差异具有统计学意义（Z=-3.621,P＜0.001）。病例组各项住院费用均高于对照组,住院费用增加最多的是西药费、输血费、化验费和治疗费。病例组住院日数中位数为17 d,对照组为11 d,经秩和检验,两组患者住院日数中位数比较,差异具有统计学意义（Z=-3.627,P＜0.001）。结论AL患者发生口腔感染后导致住院费用增加,住院日数延长,增加了患者的经济负担。     

The Use of Single-Group Sessions in Discharge Planning

ABSTRACT

In recent years we are witnessing a growing demand in the health care system for improved economic efficiency and reduction in length of hospital stay. These facts have increased the pressure for planning effective short-term therapeutic methods that will assist the patient's return to family and community life. This situation led the social workers in the internal medicine units to initiate one-session group meetings for patients and families that would provide a response to the distress of primary caregivers and increase access to social work intervention of families with discharge needs.

A model of single-sessions intervention, which had been experienced for the first time in the Sheba Medical Center at Tel-Hashomer, will be presented and evaluated. The presented intervention enabled to reduce anxiety and increase the capabilities of family members to organize and cope with the situation. The intervention also enabled to identify families in need, to emphasize more on the discharge planning as part of the social work function in the hospital setting and help the multi-disciplinary team in the discharge process.     

Effect of pressure ulcers on length of hospital stay.

OBJECTIVE: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. DESIGN: Cross-sectional, observational study. SETTNG: Tertiary-care referral and teaching hospital in Australia. PATIENTS: Two thousand hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units. METHODS: Two thousand participants were randomly selected from 4,500 patients enrolled in a prospective survey conducted between October 2002 and January 2003. Quantile median robust regression was used to assess risk factors for excess length of hospital stay. RESULTS: Having a pressure ulcer resulted in a median excess length of stay of 4.31 days. Twenty other variables were statistically significant at the 5% level in the final model. CONCLUSIONS: Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis. However, our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers; existing estimates may overstate the true economic cost.     

The impact of preadmission approval and continued stay review on hospital stay and outcome among children and adolescents

Managed care has emerged as the centerpiece of the health care industry's efforts to control costs and ensure appropriate use of hospital services. This study assesses the impact of managed care by preadmission approval and/or continued stay review on length of psychiatric hospitalization and clinical outcome of children and adolescents. The sample included 277 cases hospitalized in nine psychiatric specialty hospitals in 1990. Demographic and clinical characteristics, hospital ownership type, and preadmission approval or continued stay review were used as independent variables in a multiple regression model to predict length of stay and clinical outcome. Results indicate that the model accounted for 27% of the variance in length of stay. Previous psychiatric hospitalization and for-profit hospital status predicted longer hospitalization. Clinical outcome was not significantly predicted by the model. Managed care did not predict either length of stay or clinical outcome. Implications for health care reform are discussed.     

Assessment of the future resources and needs for hospitalization in Hong Kong SAR (Special Administrative District)

OBJECTIVES: To study the 'compression of morbidity' theory in the Hong Kong SAR by analysing the age and gender-specific hospitalization rates and the expected length of stay per patient for the period 1996-2000. 'Compression of morbidity' refers to the hypothesis that medical progress will reduce the duration of morbidity during life more significantly than increasing morbidity by extending life. DESIGN: This is a retrospective study based on hospital admissions data from the Hospital Authority of Hong Kong which covers 93% of the patient population. SETTING: Age and gender-specific hospitalization rates, expected length of stay and hospitalization needs for each specific age group in Hong Kong from 1996 to 2000, are estimated. MAIN RESULTS: There is no empirical support for compression theory; and there is no significant change in the hospital admission rates for the period 1996-2000. The total number of patient days is expected to increase by 80% because of the ageing effect alone. It is projected that the geriatric service will account for more than 60% of the hospital patient days utilization in 2029. The elderly dependency ratio will increase and the social burden for the next generation will be increased, as the working populations size continues to decrease due to low fertility in the Hong Kong SAR. CONCLUSION: The health care burden on the government is large and increasing. It is therefore essential to make plans to deal with the ageing population, which is predicted to be at its highest in 2020. The rising effect of public expectations on hospital services exerts further pressure on demand.     

导管相关性尿路感染的预后评估

目的了解导管相关性尿路感染(catheter-associated urinary tract infection,CAUTI)对留置尿管的ICU患者临床预后的影响程度。方法基于ICU医院感染目标性监测数据库,对2015年4月-2018年3月进入四川大学华西医院5个成人ICU留置尿管>2天的患者开展回顾性队列研究,以住ICU期间发生CAUTI为暴露因素,通过倾向性评分(propensity score,PS)匹配法控制混杂因素的影响,分析CAUTI对留置尿管患者预后指标的影响。结果共纳入留置尿管>2天的患者11163例,使用尿管107566患者日,发生CAUTI 185人次、192例次,例次感染率为1.7%、导管千日感染率为1.8‰。经PS匹配后的单因素分析结果显示:CAUTI患者较无CAUTI的患者:留置尿管总天数延长23天、住ICU天数延长23天、住院天数延长22天,住院总费用增加11.1万元;多因素回归分析结果显示:留置尿管总天数、住ICU天数、住院天数和住院总费用为CAUTI独立危险因素(P<0.05);CAUTI并不增加ICU全因死亡和出院全因死亡的风险。结论CAUTI或许不增加留置尿管患者的住院死亡风险,但可明显延长其留置尿管时间、住ICU时间和住院时间,增加住院花费,浪费我国有限的医疗资源。因此,依然有必要采取适当的干预措施对其进行防控。     

Relationship of chronic stress, social support, and coping style to health among Namibian refugees

This study investigates how social support and coping style affect the relationship between a traumatic chronic stressor and health status. A population of 88 Namibian refugees living in an equatorial region of Africa participated in the study. The central hypothesis was that social support and coping style moderate the relationship between length of stay in exile (a proxy measure of chronic stress) and health status (symptoms of generalized anxiety disorders, self-reported physical health status and length of stay in hospital). The results show that when social support is high the relationship between length of stay in exile and all three health outcomes is substantially reduced. When social support is low, the relation between stress and poor health outcomes is high. Coping style moderates the relationship between length of stay in exile and period of hospitalization but has no effect on level of anxiety or perceived health status. When both social support and coping style are simultaneously considered, the best results emerge.