Operating conditions of psychiatric hospitals and early readmission--effects of high patient turnover.

OBJECTIVE: To study the association between hospitals' operating conditions and the risk of early readmission. The hypothesis was that high patient turnover might lead to a rise in the risk of readmission soon after discharge (within 30 days). METHOD: A multivariate model including hospital and patient variables was tested using Cox's regression analysis, adjusting for clustering effects. The material included data from 20 hospitals, with 5,520 patients in the final model. RESULTS: High patient turnover (annual discharges per bed) was significantly associated with an increased risk of readmission (hazard ratio (HR)= 3.37 (95% CI = 2.39-4.75)). In addition, being discharged from a ward with relatively low access to therapists increased the hazard further. CONCLUSION: High patient turnover at the discharging ward was found to increase the patients' hazard of early readmission. This observation supports the hypothesis of a link between the operation conditions of the hospitals and patient outcome on a short time-scale.

[Can case-mix explain differences in involuntary admissions?]. / Kan ulik pasientsammensetning forklare forskjeller i tvangsinnleggelser?

BACKGROUND: The proportion of patients admitted involuntarily varies considerably among Norwegian psychiatric hospitals. We tested the hypothesis that these variations are the result of differences in case-mix. MATERIAL AND METHODS: The observed differences in involuntary admissions to Norwegian psychiatric hospitals were compared to those expected on the basis of their case-mix, as predicted by our multivariate model (multinomial logistic regression). The material was based on a cross-sectional registration of hospitalized patients in Norwegian psychiatric hospitals as of 1 November 1999. Thirty-two hospitals (all Norwegian hospitals that take involuntary admissions) supplied data on a total of 1,500 patients. RESULTS: The analysis shows that a large amount of the observed variation in involuntary admissions is related to differences in case-mix. However, for patients involuntarily admitted for observation, the case-mix was found to have less explanatory effect. Age, sex, previous admissions and diagnoses were used to operationalize hospital case-mix. INTERPRETATION: The analysis also indicated that other explanatory factors should be explored, such as differences in admission threshold and in medical decision in explaining variation in involuntary psychiatric admissions.

Prevalence of eating disorders in Norwegian general hospitals 1990-1994: admissions per year and seasonality.

OBJECTIVE: To study the occurrence of eating disorders in patients admitted to somatic hospitals. METHOD: For all, approximately 3.3 million, admissions to Norwegian general hospitals in the period 1990-1994, admissions with the primary diagnoses for the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) were selected. Data on gender, age groups, emergency admission, different hospital types, length of stay, seasonal differences, and differences along the latitudes were related to the primary diagnosis. RESULTS: A small number of men with eating disorders were admitted; 9-17 times more women were admitted (140-183 female and 11-15 male admissions per year). The male/female ratio was on the mean 8% for the period. About two thirds to three fourths were emergency admissions. The mean length of stay was 12-19 days, and the median stay was 6-8 days. A significant (p = .03) season of admission was found. A significant number of admissions occurred in the beginning of March and a minimum in June. The best model was two harmonics without trend. DISCUSSION: There are few reports on eating disorders in somatic inpatients in the literature, but our results indicate that it is important to consider the general hospital in this connection. Bulimia nervosa was rather unusual in the present study, while anorexia nervosa was prevalent, specifically for women. Seasonality has rarely been reported in relation to hospitalization.

Management of early prostatic cancer in the Nordic countries: variations in clinical policies and physicians' attitudes toward radical treatment options.

To explore the treatment of patients with early localized prostatic carcinoma, we surveyed the departments of urology and general surgery in Denmark, Finland, Norway, and Sweden. Clinical policies and physicians' attitudes toward the radical treatment options varied widely between the countries. A correlation seems to exist between practice patterns and national attitudes toward special technologies.

[Air ambulance services in Norway]. / Luftambulansetjenesten i Norge.

Norway has ten bases for helicopters manned by aeromedical doctors, five for fixed-wing aircraft, and five for search-and-rescue helicopters. In 1992 there were 4,197 helicopter missions and 4,078 patients were transported by plane, figures representing 20 and 30 per cent increases, respectively, as compared with 1988. In addition, the teams used motor transport to cater to 1,699 patients at locations close to the helicopter bases. Utilisation of aero-medical services was correlated to geographic availability, and can be seen as compensating for the uneven distribution of advanced emergency medical resources.

[Prostate cancer in Scandinavia. Variations in practice and attitude to radical treatment]. / Prostatacancer i Norden. Variasjoner i praksis og holdninger til radikal behandling.

Some controversy persists as to the optimal assessment and treatment of prostate cancer, a lack of consensus reflected in differences in clinical practice. Our survey among departments of urology and general surgery in the Nordic countries showed Danish physicians to be the most conservative, while the most active intervention strategies were found in Finland.

[Consequences of diagnostics with magnetic tomography]. / Konsekvenser av diagnostikk med magnettomografi.

Physicians referring patients to examinations by magnetic resonance tomography (MT) were asked to answer almost identical questionnaires before and after the examination. The questions referred to diagnosis and planned patient management. Impact of MT was measured by examining the changes in patient diagnoses and planned management after the MT scans. In 33% of the group (400 patients) the main diagnosis (four digit ICD-9 code) changed after MT. Diagnostic security was better for 43%, and further diagnostic follow-up changed for 56%, surgery for 20% and radiation therapy for 11%. MT was assumed to have had real consequences for 33% of the patients in terms of significant changes in the doctors planned management or in his concept of the disease. In a follow-up study 1.5-2 years after MT, 64% of the referring doctors were of the opinion that the MT scan had had consequences for the patient and they placed the emphasis on less active patient follow-up after MT.