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"Avoidable admissions"

Bridie Angela Evans, Khalid Ali, Jenna Bulger, Gary A Ford, Matthew Jones, Chris Moore, Alison Porter, Alan David Pryce, Tom Quinn, Anne C Seagrove, Helen Snooks, Shirley Whitman, Nigel Rees
OBJECTIVE: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. DESIGN: Scoping review. DATA SOURCES: PubMed, CINAHL Web of Science, Scopus. STUDY SELECTION: Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. DATA EXTRACTION: We screened studies for eligibility and extracted data from relevant studies...
February 14, 2017: BMJ Open
Bruce W Sherman, Teresa B Gibson, Wendy D Lynch, Carol Addy
Employees face an increasing financial burden for health services as health care costs increase relative to earnings. Yet little is known about health care utilization patterns relative to employee wages. To better understand this association and the resulting implications, we examined patterns of health care use and spending by wage category during 2014 among 42,936 employees of four self-insured employers enrolled in a private health insurance exchange. When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4...
February 1, 2017: Health Affairs
Aileen Grant, Tobias Dreischulte, Bruce Guthrie
BACKGROUND: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice...
January 7, 2017: Implementation Science: IS
Matthew T Crim, Scott A Berkowitz, Mustapha Saheed, Jason Miller, Amy Deutschendorf, Gary Gerstenblith, Peter Hill, Frederick K Korley
BACKGROUND: Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS: We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital...
December 2016: Critical Pathways in Cardiology
Karen L Pellegrin, Les Krenk, Sheena Jolson Oakes, Anita Ciarleglio, Joanne Lynn, Terry McInnis, Alistair W Bairos, Lara Gomez, Mercedes Benitez McCrary, Alexandra L Hanlon, Jill Miyamura
OBJECTIVES: To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of medication-related hospitalization in older adults. DESIGN: Quasi-experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed-effects analysis that modeled the intervention as a time-dependent variable. SETTING: Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014...
October 7, 2016: Journal of the American Geriatrics Society
Yusuke Sasabuchi, Hiroki Matsui, Hideo Yasunaga, Kiyohide Fushimi
BACKGROUND: The Great East Japan Earthquake and subsequent tsunami and nuclear disaster on 11 March 2011 had a short-term influence on the increase in emergency department visits and hospital admissions due to various diseases. However, it remains unclear whether the earthquake and tsunami disaster affected the long-term health conditions of people in the affected areas. METHODS: Using a national inpatient database in Japan, we investigated people's ambulatory care sensitive conditions (ACSCs), which are defined as conditions for which effective management and treatment should prevent admission to a hospital...
September 9, 2016: Journal of Epidemiology and Community Health
Amaya L Bustinduy, Irina Chis Ster, Rebecca Shaw, Adam Irwin, Jaiganesh Thiagarajan, Rhys Beynon, Shamez Ladhani, Mike Sharland
OBJECTIVE: To explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED). DESIGN: Prospective observational study. SETTING AND PATIENTS: Febrile children attending a large tertiary care ED during the winter of 2014-2015. MAIN OUTCOME MEASURES: Ward and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use...
January 2017: Archives of Disease in Childhood
Thea F van de Mortel, Kenneth Marr, Elizabeth Burmeister, Hilton Koppe, Christine Ahern, Robert Walsh, Susan Tyler-Freer, Dan Ewald
OBJECTIVE: To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. DESIGN: A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service...
July 6, 2016: Australian Journal of Rural Health
Manjusha Rentala, Shari Andrews, Allison Tiberio, Kumar Alagappan, Tammy Tavdy, Patrick Sheppard, Robert Silverman
OBJECTIVES: The objective of the study is to evaluate whether patients with cellulitis can be safely discharged from a 24-hour clinical decision unit (CDU) with home infusion of intravenous (IV) antibiotics. METHODS: Clinical decision unit patients receiving IV antibiotics for cellulitis were screened for enrollment in a home infusion therapy (HIT) program. Inclusion criteria were patient ability and willingness to administer IV antibiotics at home and insurers' approval of home infusion services...
July 2016: American Journal of Emergency Medicine
Kim Oates, Cathy Vinters, John Cass-Verco, Mandy Fletcher, Narinder Kaur, Martha Mherekumombe, Alice Tang
BACKGROUND: To provide junior doctors with tools to improve patient care in their workplace, a partnership was developed between the Clinical Excellence Commission (CEC) and the Royal Australasian College of Physicians (RACP) to help trainee consultants carry out clinical practice improvement (CPI) projects during clinical work. METHODS: Based on a patient-care problem they wished to resolve, trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods, describe their proposals and refine them using CPI methodology...
May 3, 2016: Clinical Teacher
Mark Rhys Kingston, Bridie Angela Evans, Kayleigh Nelson, Hayley Hutchings, Ian Russell, Helen Snooks
INTRODUCTION: Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. AIM: To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. METHODS: We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models...
March 1, 2016: BMJ Open
Marcela Paschoal Popolin, Michelle Mosna Touso, Mellina Yamamura, Ludmila Barbosa Bandeira Rodrigues, Maria Concebida da Cunha Garcia, Luiz Henrique Arroyo, Antônio Carlos Vieira Ramos, Thais Zamboni Berra, Marcelino Santos Neto, Juliane de Almeida Crispim, Francisco Chiaravalotti Neto, Ione Carvalho Pinto, Pedro Fredemir Palha, Severina Alice da Costa Uchoa, Luís Velez Lapão, Inês Fronteira, Ricardo Alexandre Arcêncio
BACKGROUND: The early identification of the Breathing Symptoms within the scope of Primary Health Care is recommended, and is also one of the strategies of national sanitary authorities for reaching the elimination of tuberculosis. The purpose of this study is to consider which attributes and which territories have shown the most significant progress in Primary Health Care, in terms of coordination of Health Care Networks, and also check if those areas of Primary Health Care that are most critical regarding coordination, there were more or less cases of avoidable hospitalizations for tuberculosis...
March 1, 2016: BMC Health Services Research
Eleni Karasouli, Daniel Munday, Cara Bailey, Sophie Staniszewska, Alistair Hewison, Frances Griffiths
OBJECTIVES: The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital...
February 25, 2016: BMJ Open
Steve Kisely, Carolyn Ehrlich, Elizabeth Kendall, David Lawrence
OBJECTIVE: Quality of care for comorbid physical disorders in psychiatric patients can be assessed by the number of avoidable admissions for ambulatory care sensitive (ACS) conditions. These are admissions for physical conditions that, with appropriate primary care, should not require inpatient treatment. Avoidable admissions for ACS conditions feature prominently in Australia's National Health Performance Framework and have been used to assess health care provision for marginalized groups, such as Indigenous patients or those of lower socioeconomic status...
November 2015: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
João Sarmento, Conceição Alves, Paula Oliveira, Rita Sebastião, Rui Santana
INTRODUCTION: The aim of this study is to evaluate the health systems performance through the avoidable hospital admissions, once these have gained international relevance. We used two different methods to identify the admissions for Ambulatory Care Sensitive Conditions, describing the Portuguese reality and evolution. MATERIAL AND METHODS: Over 12 million hospitalizations were analyzed between 2000 and 2012 using the national hospital discharge databases. We used two different methodologies to identify the hospitalizations for Ambulatory Care Sensitive Conditions, determining their concordance...
September 2015: Acta Médica Portuguesa
Ritchard Ledgerd, Juanita Hoe, Zoë Hoare, Mike Devine, Sandeep Toot, David Challis, Martin Orrell
BACKGROUND: Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises. OBJECTIVE: Our objective was to identify the main causes of crisis and interventions to treat or prevent crisis in persons with dementia based on different stakeholder perspectives. METHODS: An online questionnaire was developed to identify the causes of crisis and appropriate interventions in a crisis...
June 2016: International Journal of Geriatric Psychiatry
Rachel Thwaites, Jon Glasby, Nick le Mesurier, Rosemary Littlechild
This paper reports the findings of a review of the literature on emergency admissions to hospital for older people in the UK, undertaken between May and June 2014 at the Health Services Management Centre, University of Birmingham. This review sought to explore: the rate of in/appropriate emergency admissions of older people in the UK; the way this is defined in the literature; solutions proposed to reduce the rate of inappropriate admissions; and the methodological issues which particular definitions of 'inappropriateness' raise...
January 2017: Health & Social Care in the Community
Alicia O'Cathain, Emma Knowles, Janette Turner, Enid Hirst, Steve Goodacre, Jon Nicholl
OBJECTIVE: To identify factors affecting variation in avoidable emergency admissions that are not usually identified in statistical regression. METHODS: As part of an ethnographic residual analysis, we compared six emergency and urgent care systems in England, interviewing 82 commissioners and providers of key emergency and urgent care services. RESULTS: There was variation between the six cases in how interviewees described three parts of their emergency and urgent care systems...
January 2016: Journal of Health Services Research & Policy
Fernando Verdugo, Francisco Pinto, Paulo Charpentier, Christian Von Mühlenbrock, Andrés Soto, Jeannette Dabanch, Alberto Fica
INTRODUCTION AND AIMS: Despite general availability of HAART in Chile, admissions of HIV/AIDS patients to Intensive-Intermediate Care Units (IICU) are still happening, and a characterization of patient's profile, mortality and potentially avoidable admissions is necessary. METHODS: Observational retrospective study in one general hospital in Chile of HIV/AIDS patients admitted to IICU during 9 years. RESULTS: During 2005-2013, 32 patients were admitted to IICU, with 87,5% in AIDS stage, only 53,1% knew his/her condition, 43,8% were receiving HAART and 16...
June 2015: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Jonathan Stokes, Maria Panagioti, Rahul Alam, Kath Checkland, Sudeh Cheraghi-Sohi, Peter Bower
BACKGROUND: An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. METHODS AND FINDINGS: We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care...
2015: PloS One
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