Burden of adult pneumonia in Thailand: a nationwide hospital admission data 2010.

OBJECTIVE: To quantify the admission mortality, pathogens,factors related to mortality, length of hospital stay, and healthcare costs in adult hospitalized pneumonia in Thailand MATERIAL AND METHOD: The data on hospitalized pneumonia for the 2010 fiscal year extracted from the three main health insurance coverage schemes in Thailand (the Social Security System (SSS), the Medical Welfare System (MWS), and the Civil Servant Medical Benefit System (CSMBS)) were analyzed RESULTS: Adult hospitalized pneumonia admissions numbered 136,696, with mortality rate 9.63%. The mortality increased with increasing age, 15.49% for age > 80 years. Influenza virus was the major etiology for 19 to 25 years old (49.30%) with low mortality (1-2%). S. pneumoniae and typical pathogens were found in every age group. The mortality rate for S. pneumoniae increased with age, viz. 0%, 1.96%, 5.56%, 7.02%, 6.98%, and 24.24% for 19 to 25, 26 to 40, 41 to 60, 61 to 70, 71 to 80, and 81+ years old. The mortality rate from C. pneumonia was about 10% and high among the younger age group. Gram-negative bacilli and Staphylococcus caused high mortality (about 20 to 35%), especially in the older age group. The major risk factors for increasing mortality were: elderly (OR 3.46, 95% CI 3.27-3.77), alcoholic liver disease (OR 3.26, 95% CI 2.85-3.72), cirrhosis (OR 3.45, 95% CI 2.93-4.08), heart disease (OR 2.47, 95% CI 2.38-2.56), ischemic heart disease (OR 2.21, 95% CI 2.07-2.36), renal failure (OR 5.26, 95% CI 5.07-5.49), and cerebrovascular disease (OR 3.62, 95% CI 3.43-3.82). The median length of hospital stay was four days (IQR, 3-7 days) and the median cost of treatment per admission was US$ 256.63 (IQR, US$ 147.81-531.21). Complications such as acute respiratory failure, acute respiratory distress syndrome (ARDS), septicemia, shock, and acute renal failure made hospital stays two to three days longer and costs three to seven times higher than no complications. CONCLUSION: The mortality from pneumonia among the elderly was high, especially for those over 80 and with multiple medical co-morbidities.

Features and outcomes of hospitalized Thai patients with pyogenic arthritis: analysis from the nationwide hospital database.

BACKGROUND: Pyogenic arthritis (PA) is still a problematic arthritic disease that requires hospitalization. OBJECTIVE: To study the epidemiological characteristics and predictors of treatment outcomes for Thai patients hospitalized with PA. MATERIALS AND METHODS: The nationwide hospital database from the 2010 fiscal year was analyzed. Patients 18 years of age onward, who had primary diagnosis of pyogenic arthritis, were included in this study. RESULTS: There were a total of 6242 PA admissions during 2010. It was ranked third among hospitalized musculoskeletal patients after osteoarthritis (OA) and gouty arthritis. The estimated prevalence of PA was 13.5 per 100 000 adult population. Geographic distributions of PA was related to the population density of each region; however it seemed more frequent in the northern and northeastern regions of Thailand. The prevalence increased with age, 3.6 and 43.6 per 100 000 in young adults and the elderly, respectively. Among the 2877 co-morbidities coded, diabetes was the most common, followed by crystal-induced arthritis, existing other foci of infections (urinary tract infection, skin and soft tissue infections and pneumonia) and pre-existing chronic joint diseases (OA,rheumatoid arthritis), respectively. Overall hospital mortality rate was 2.6%. Poorer outcomes were found among patients with chronic liver disease and other existing foci of infections. CONCLUSIONS: The prevalence of hospitalized PA is still modest in Thailand, showing the highest prevalence in the advanced age group. Diabetes was the most commonly co-morbidity found; however, poorer outcomes were noted among patients with chronic liver disease and existing multiple sites of infections.

Admission rate and characteristics of hospitalized systemic connective tissue disorders: analysis from a nationwide Thailand healthcare database.

BACKGROUND: Reports of hospitalized systemic connective tissue disorders (SCNTD) are mostly disease-specific reports from institutional databases. OBJECTIVE: To clarify the admission rate, disease determination, hospital mortality rate, length of stay and hospital charges among hospitalized patients diagnosed with SCNTD. MATERIALS AND METHODS: The data were extracted from the 2010 national database of hospitalized patients provided by the Thai Health Coding Center, Bureau of Policy and Strategy, Ministry of Public Health, Thailand. Patients over 18 years having International Classification of Diseases (ICD)-10 codes for a primary diagnosis related to SCNTD were included. RESULTS: There were 6861 admissions coded as disorders related to SCNTD during the fiscal year 2010. The admission rate was 141 per 100,000 admissions. Among these, systemic lupus erythematosus (SLE) was the most common, followed by systemic sclerosis (SSc) and dermatomyositis/polymyositis (DM-PM). The overall mean length of hospital stay was 6.8 days. Small vessel vasculitis and Sjögren syndrome had the longest and the shortest hospital stays respectively (14.5 vs. 5.3 days). Hospital charges were highest among systemic vasculitis and DM-PM patients. CONCLUSION: The admission rate for SCNTD in Thailand was 141 per 100,000 admissions among which SLE was the most common. Overall hospital mortality was 4.1%. Although a lower prevalence was found among systemic vasculitis, it had a higher mortality rate, longer length of stay and greater therapeutic cost.

Disease patterns among Thai adult population: an analysis of data from the hospitalization National Health Insurance System 2010.

BACKGROUND: Disease pattern is an important informational tool used by policymakers in setting priorities, strategies and allocating budgets to address the precursors or causes of health problems. OBJECTIVE: To analyze the common diseases in the adult population using in-patient information from the three health insurance coverage schemes in the fiscal year 2010. MATERIAL AND METHOD: The authors analyzed the data on in-patients with 23 major disease groups as per ICD-10 coding. The data were analyzed to obtain the number of patients, number of admissions, number of hospital mortalities, mortality rates and length of hospital stays. RESULTS: The total number of adult in-patients was 3,876,792 presenting for admission 4,863,935 times. Infectious and parasitic diseases were the most common causes of admission. Diseases of the circulatory system resulted in the highest number of mortality rate (8.72%). Intracerebral hemorrhage, neoplasm, septicemia, liver failure, coronary heart disease, HIV/AIDS, status epilepticus, pneumonia, accidents and acute renal failure were the top ten diseases with a high mortality rate. CONCLUSION: The review indicated communicable diseases are the most common disease group although non-communicable diseases were also important because of their high mortality rate.

Health situation analysis of hospitalized Thai older persons in the year 2010.

BACKGROUND: Thailand has reached an ageing society on account of demographic transitions. Hospitalized elders are susceptible to having detrimental consequences in many aspects. Understanding the situation regarding elders being hospitalized would help allied-healthcare workers to focus and take necessary action on particular issues. OBJECTIVE: To demonstrate the admission rate of elders, common causes of hospitalization and their mortality rates. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospitals withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups and burdensome diseases. RESULTS: Elders posed the highest rate of all hospitalization (24.3/100 older persons) and the proportion increased with age. The top three common causes for hospitalization were diseases of respiratory tract (13%), circulatory (12%) and digestive system (11%). Mortality rates were highest in elders with pneumonia (129.7/100,000 persons). CONCLUSION: Older hospitalization was the highest for all hospitalization ages. Common causes for hospitalization are partly the consequences of modifiable factors. Thus, healthcare providers require extensive effort to enhance education and training to allied-healthcare workers regarding preventive and early diagnosis strategies to those with frequent illnesses.

Burden of human immunodeficiency virus (HIV) infection in hospitalized Thai adults: an analysis of data from the National Health Insurance System 2010.

BACKGROUND: Human immunodeficiency virus (HIV) infection continues to be a major health problem worldwide. Whether several intervention programs are successful enough to ameliorate the significant hospitalization burden created by these patients is not known. OBJECTIVE: To analyze the burden of HIV infection on patient-hospitalization and death in the adult population using in-patient information from the three health insurance coverage schemes from the fiscal year 2010. MATERIAL AND METHOD: The authors analyzed the data on in-patients with ICD-10 coding B20-B24 HIV disease to obtain the admission and mortality rate, length of hospital stay and hospital charges. RESULTS: The admission rate among adult HIV-infected patients was 91.8 times per 100,000 adult population. The most common age group affected by the disease was the 26-40 year-olds (59%). The most common condition causing hospitalization was opportunistic infection (83.6%), of which tuberculosis was the highest. The mortality rate was 10.3% and increasing with age. AIDS-related symptoms, malignancy and opportunistic infections were the major impacts on mortality. CONCLUSION: HIV/AIDS still constitutes a major disease burden among the adult Thai population. Increased public awareness and prevention and access to early HIV diagnosis and treatment could be key factors for lowering the burden of disease and improving clinical outcomes.

Hospitalized incidence and outcomes of upper gastrointestinal bleeding in Thailand.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common emergency gastrointestinal problem which has substantial mortality and health care resources use. The nationwide basic information on UGIB is not available in Thailand. OBJECTIVE: To identify the hospitalized incidence, outcomes and hospitalization cost of patients who presented with UGIB in Thailand. MATERIAL AND METHOD: Information on illness of in-patients from hospitals nationwide was retrieved from three major health schemes database in fiscal year 2010. RESULTS: The hospitalized incidence rate of UGIB was 166.3 admissions per 100,000 populations and the hospitalized incidence rate of non-variceal upper gastrointestinal bleeding (NVUGIB) and variceal bleeding were 152.9 and 13.5 admissions per 100,000 populations respectively. Endoscopic procedure was undertaken in 27.6% of NVUGIB admissions and 80.7% of variceal bleeding admissions. The in-hospital mortality rate, hospitalization cost and length of stay were higher in variceal bleeding patients compared with NVUGIB patients. CONCLUSION: UGIB is an important emergency gastrointestinal problem which has significant mortality and substantial health care resources consumption.

Cost of colorectal cancer care in hospitalized patients of Thailand.

BACKGROUND: Colorectal cancer incidence rate is high and expected to increase in Thailand. But it is a preventable and curable disease if found in the early stage of development. The overall data regarding admission rates and healthcare cost in Thai patients are lacking. OBJECTIVE: To identify admission rates and healthcare cost of colorectal cancer. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population and were analyzed by age groups, hospital level and insurance schemes in patients with colorectal cancer. RESULTS: Colorectal cancer occurred in 45,692 of all admissions, contributing to admission rates of 98.5 per 100,000 persons. These figures increased with age. The highest admission was found in the central region including Bangkok (43%) followed by the northeast region (23%). The average hospital charges per admission in three insurance schemes groups: government welfare, social welfare and universal coverage were 64,241, 49,490 and 28,588 Baht, respectively CONCLUSION: Admission rates showed that colorectal cancer increased with age. The highest rate was observed in sixty years and older The hospital charges were extensive, especially in those on the government welfare scheme. Thus, screening programs, cost-effective analysis of treatment modalities and treatment protocol for the elderly should be examined.

Lung cancer in hospitalized patients of Thailand.

OBJECTIVE: To identify admission rates, treatments and healthcare cost of lung cancer MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in the fiscal year 2010. The data included 96% of the population and were analyzed by age groups, hospital levels, treatment and insurance schemes in patients with lung cancer. RESULTS: Lung cancer occurred in 27,896 of all admissions, contributing to admission rate of 60 per 100,000 persons. The admission rates were markedly increased in male more than 60 years old. The majority of treatments were palliative care 61.38%, chemotherapy 36.81%. The average length of stay and hospital charges in three insurance schemes groups: government welfare, social welfare and universal coverage were 40,571.29 Baht/9.86 days, 43,342.54 Baht/8.24 days and 17,897.75 Baht/6.08 days, respectively. CONCLUSION: Admission rates showed that lung cancer increased with age. The highest rate was observed in more than 60 years old. The window gap in hospital charges and length of stay in three insurance schemes are interesting. Thus, analysis of treatment protocol should be examined.

Patterns of chemotherapy usage in hospitalized breast cancer patients.

BACKGROUND: Breast cancer is the leading cancer in Thai women. Systemic chemotherapy is one of the main treatment options in both adjuvant and metastatic disease. Patterns of chemotherapy usage and hospital cost data are lacking. OBJECTIVE: To identify overall admission rate, chemotherapy admission and hospital cost data of breast cancer patients. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in the fiscal 2010. The data included 96% of the population. The data were analyzed by age groups, regions, hospital levels and insurance schemes in breast cancer patients. RESULTS: Admissions from breast cancer occurred for 35,490 in the year 2010. Admissions for systemic chemotherapy accounted for 53.1% of all breast cancer admissions and accounted for 17.3% of all admissions for chemotherapy. Most of chemotherapy admissions were in tertiary care hospital level. Mean length of stay for chemotherapy in breast cancer was 2.33 days compared to 5.30 days in other cancers. Mean hospital charge for chemotherapy for breast cancer was 13,904 THB compared to 33,693 THB for other cancers. The mean hospital charge three insurance schemes groups: government welfare, social welfare and universal coverage were 33,096, 19,932 and 9,599 THB, respectively. CONCLUSION: Admission rate for chemotherapy in breast cancer was not high. The cost of chemotherapy in each admission in breast cancer is nearly 50% lesser than chemotherapy for other cancers. Thus, generic drugs usage and outpatient administration of chemotherapy should be encouraged.

Delirium in hospitalized elderly patients of Thailand; is the figure underrecognized?

BACKGROUND: Delirium is a frequent complication associated with hospitalization of older adults leading to serious complications but it is potentially preventable. The overall data regarding admission rates and its impact in Thai geriatrics are limited. OBJECTIVE: To identify admission, mortality rates of older persons with delirium and its consequences. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in delirious patients. RESULTS: Delirium occurred in 11,410 of all admissions; contributing admission and mortality rates of 155.4 and 6.4/100,000 older persons. These figures increased with age. The average length of stay in persons with and without delirium were 22.3 and 5.4 days and the average hospital charges were 53,174 and 18,230.8 Baht, respectively. CONCLUSION: The admission rate of patients with delirium was lower than prior reports; underdetection and underreport should be considered. Admission and mortality rates rose with age. There was an increase in length of stay and hospital charges.

Health insurance system and healthcare provision: nationwide hospital admission data 2010.

BACKGROUND: The three major health insurance systems are different in their medical service coverage, reimbursement process and choice of providers; leading to the question of how great are the variations in the healthcare offered and disease outcomes. OBJECTIVE: To assess whether differences exist and to analyze the effects of on healthcare provision and disease outcomes in the adult population across the three health insurance systems. MATERIAL AND METHOD: The authors analyzed the disease outcomes of the 23 major ICD-10 disease groups among the three major health insurance systems to obtain the death rates, levels of healthcare provision and the hospital charges. Factors influencing mortality rates were evaluated by multiple logistic regression analysis. RESULTS: The community, general, tertiary care and private hospitals provided hospitalization for 41.4%, 22%, 27.3% and 9.3% of hospitalized adult patients, respectively. Infectious & parasitic diseases were the most common causes of admissions. Disease of the digestive system was the most common cause of admission in general hospitals while malignancy was the most common in the tertiary care hospitals. Patients with congenital malformation, neoplasm, mental and behavioral disorder and diseases of the eye were commonly treated at tertiary care hospitals. The mean and median of hospital charges were highest in the Civil Servant Medical Benefit System (CSMBS) (26,668; 10,209 Baht), followed by the Social Security System (SSS) (21,455; 9,713 Baht) and the Universal Coverage System (UC) (13,086; 5,246 Baht). The respective overall mortality rates for the CSMBS, SSS and UC were 4.40%, 1.38% and 3.32%. After adjustment, however a significant association between UC and mortality was found with an odds ratio of 1.43 (1.40-1.45) as compared to CSMBS. In addition, other factors most influencing mortality rates were male sex, elderly age, and the levels of healthcare. CONCLUSION: The differences in charges for some groups of diseases and significantly different clinical outcomes across schemes existed. The differences in disease outcomes were not adjusted for socioeconomic status and disease severity, requiring a cautious interpretation; nevertheless, an association with a higher mortality rate under the UC scheme for inpatient services need prompt further study

Comparative effectiveness of three national healthcare schemes in Thailand: in-hospital medical expenses for diabetes and hypertension in 2010.

OBJECTIVE: To compare the health insurance schemes regarding treatment of diabetes (DM) and hypertension (HT). MATERIAL AND METHOD: In-patient expense data for all ICD-10 DM and HT for 2010 were accessed from the National Health Security Office (UC), the Social Security office (SS) and the Civil Servants Benefit System (CSMBS). Mean hospital stay charges and mortality rates were calculated and compared across schemes and types of hospital. RESULTS: Thais > or = 19 years accounted for 4,863,939 admissions (12.6% DM-All; 17.9% HT-All). Average admission per case was higher for DM-All (1.66) than HT-All (1.46). CSMBS patients trended to be older than UC and SS. Most under UC were admitted to primary care (51.9% DM-All; 50.0% HT-All) vs. tertiary under CSMBS (45.5% DM-All; 48.4% HT-All). Median of stay under CSMBS was longer (1.3-2.0x) and charges higher (1.3-1.6x) than UC for all levels for both DM and HT Mortality rate under CSMBS was higher than UC in primary care for both DM and HT while respective rates were higher under UC than CSMBS for secondary (DM-All: 9.9 vs. 8.1; HT-All: 8.2 vs. 6.6) and tertiary care (DM-All:11.7 vs.8.6; HT-All: 9.8 vs. 6.8). CONCLUSION: Inequalities among three health insurance schemes for DM and HT including hospital charge, hospital stay and mortality rate according to health care settings for DM and HT were shown, effectiveness improvement is needed.

Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis.

Corticosteroid and the combination of corticosteroid and antihelminthic drug are safe and beneficial in relieving headaches in patients with eosinophilic meningitis. However, clinical trials comparing the efficacies of these regimens have never been reported. We conducted a prospective, open, randomized, controlled study to compare the efficacy of the combination of prednisolone plus albendazole and prednisolone alone for the treatment of eosinophilic meningitis. Our study had 53 patients in the combined treatment group and 51 patients in the prednisolone alone group. There were no significant differences between the two groups with regard to the number of patients who still had headaches after 14 days (0 versus 1, respectively; P = 0.49) and the median length of time until complete disappearance of headache (3 versus 3 days, respectively; P = 0.32. Prednisolone plus albendazole is no better than prednisolone alone for treatment of patients with eosinophilic meningitis.

Initial treatment of cryptococcal meningitis in AIDS.

The comparison of initial treatment with amphotericin B (0.7 mg/kg/d) plus rifampin (600 mg/d) with amphotericin B (0.7 mg/kg/d) alone for 2 weeks, both followed by fluconazole (400 mg/ d) for 8 weeks in the acute treatment of cryptococcal meningitis in AIDS by an open- randomized, controlled, prospective clinical trial is reported. Twenty patients were enrolled in each group. There were no significant differences between the groups in regard to a negative CSF culture for Cryptococcus neoformans in the 2nd and 10th weeks of treatment, time until normal body temperature after treatment, number of patients who died, and persistence of high CSF pressure after completion of treatment. Elevated intracranial pressure was an important factor associated with the patients who died. These results indicate that the combination of amphotericin B plus rifampin is not superior to amphotericin B alone.