Predictors and reasons for inappropriate hospitalization days for surgical patients in a tertiary hospital in Wuhan, China: a retrospective study.

BACKGROUND: Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization. METHODS: A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs. RESULTS: The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60-69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor's conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs. CONCLUSIONS: Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.

Analysis of clinical features and related factors of coronavirus disease 2019 in Shanghai / 上海交通大学学报（医学版）

Objective • To explore the common clinical features of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-infected local patients in Shanghai and their related influencing factors. Methods • A total of 320 patients admitted to Shanghai Public Health Clinical Center from January to March 2020 and diagnosed as having coronavirus disease 2019(COVID-19) were selected. Clinical data of the patients were collected to analyze their characteristics. Using the statistical operation formula of R language, the correlation analysis of hospitalization days, days of increased hypersensitive C-reactive protein concentration (allergic days), days of lung CT improvement (CT days), and days required for nucleic acid turning negative with the main clinical manifestations and laboratory data was carried out. The correlation factors affecting the above four variables were analyzed. Results • Among the 320 patients, the proportions of mild type, moderate type, serious type and critical type were 6.25%, 83.44%, 6.88% and 3.44%, respectively; 91.25% of them had a history of exposure to Hubei. The proportions of fever, cough, sputum and fatigue were 79.06%, 46.56%, 21.56% and 15.31%, respectively. Spearman correlation analysis showed that the concentrations of lactate dehydrogenase, interleukin-2(IL-2) and IL-6 were positively correlated with the above four variables, respectively (all P<0.05), albumin concentration was negatively correlated with allergic days (P=0.018), and CD4+ cell count was negatively correlated with CT days and days required for nucleic acid turning negative (both P<0.05). Stepwise multiple linear regression analysis showed that procalcitonin (PCT) concentration was negatively correlated with hospitalization days, CT days and allergic days (both P<0.05), and disease type was positively correlated with hospitalization days, allergic days, CT days and days required for nucleic acid turning negative (all P<0.05). Conclusion • Moderate type is common in the local patients in Shanghai; fever, cough and fatigue are common symptoms, and most of the patients are accompanied by lung CT abnormalities. The therapeutic effect and prognosis of these patients are closely related to disease type, concentrations of PCT and IL-6, as well as CD4+ cell count.

Is There A Non-Essential Hospitalization Day In Inpatients With Diabetes Under Medical Insurance? Evidence From An Observational Study In China.

PURPOSE: Non-essential hospitalization day of inpatient diabetes threatens health seriously and contributes to great economic burden on individuals and the society. Studying the essential utilization of hospitalization services is conducive to the reduction in the burden of diabetes. The purpose of this study is to identify the existence of non-essential hospitalization days during hospitalization in diabetic patients through exploring the use of health care in different types of insured patients. PATIENTS AND METHODS: A sample of 6731 admission records from 5929 hospitalized patients was studied. Binary logistic regression was performed to estimate the adjusted effects of health insurance status on readmission. Multiple stepwise linear regression was performed to estimate the adjusted effects of health insurance status on length of stay (LOS), direct medical expenses (DME), out-of-pocket (OOP) expenditures, and percentage of individual payment after reimbursement (PIPAR). Adjusted odds ratios (with 95% CI) were reported as the results of logistic regression models and linear regression models, respectively. RESULTS: Adjusted 7-day readmission rate and 30-day readmission rate were not significantly different between urban and rural resident basic medical insurance (URRBMI) and urban employee basic medical insurance (UEBMI). Compared with inpatients under URRBMI, the adjusted LOS and DME were significantly higher for UEBMI inpatients (adjusted OR of 2.6, 95% CI=1.9-3.2, adjusted OR of 1870.85, 95% CI=1370.97-2370.73, respectively). Adjusted OOP and PIPAR were significantly lower for UEBMI inpatients (adjusted OR of－970.86, 95% CI =-1111.63--830.10, adjusted OR of -0.19, 95% CI=-0.20--0.18, respectively). CONCLUSION: There was a non-essential hospitalization day existing in the treatment of diabetes. Moral hazard has been found in UEBMI which would trigger overtreatment in hospitalization of diabetics, and the lower PIPAR of UEBMI was one of the main causes of moral hazard.

Effects of Community-Based Primary Care Management on Patients With Hypertension and Diabetes.

As the prevalence of chronic diseases is continuously increasing, the socioeconomic cost of those conditions in Korea is also rising. In order to effectively manage chronic diseases, the "Community-Based Primary Care Project" was implemented from 2014 to 2016 and focused on primary medical care and physician-led chronic disease management. The purpose of this study is evaluating the effects of the project through the DID (difference in difference) model. The project's database and the National Health Insurance claims database were both used to compare the project and control groups (n = 6092 vs 24 368). Results of the analysis show that medication adherence was increased more in the project group compared with the control group. Hospitalization days, outpatient days, and number of primary medical clinic visits increased more in the participant group than the control group. As the project showed an improvement in treatment persistence, it will be necessary to monitor for a longer period of time.

[Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor].

Objective: To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor. Methods: The tumor patients treated in neurosurgery ward from July 1, 2015 to June 30, 2017 were included in the study. The patients with and without postoperative infections were divided into a case group and a control group, respectively (1 ∶ 1 ratio), matched by admission time (±3 months), age (±5 years) and surgical site. Average hospitalization days and medical costs between the two groups were analyzed. Results: The incidence of postoperative infection was 5.66%, the surgical site infection and lower respiratory tract infection accounted for 54.72% and 31.32% of the total, respectively. The median of hospitalization days in the case group was 20.5, 8.5 days longer than that in the control group (Z=-10.618, P<0.001). The median of total medical costs in the case group was 91 573.42 yuan, higher than that of the control group by 30 518.17 yuan (Z=-9.988, P<0.001). The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan, respectively. Among them, surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627, P<0.001) and 43 631.36 yuan (Z=-4.954, P<0.001), respectively. Conclusions: Postoperative infection greatly increased the patient's financial burden, prolonged the hospitalization duration and resulted in unnecessary use of health resources. It is necessary to pay close attention to postoperative infection.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.