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Identification of At-Risk Inpatient Hospital Populations at the Community Level

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Open Journal of Nursing 2014年第9期4卷 621-629页

作者： ronald lagoe Ruthie lagoe Hospital Executive Council: Syracuse New York USA

This study focused on hospital populations which account for large amounts of health care utilization at the community level in the metropolitan area of Syracuse, New York. It demonstrated that, between the two largest hospital inpatient services, adult medicine patients accounted for a larger number of excess hospital patient days than adult surgery over a two-year period. Adult medicine stays increased while adult surgery stays declined. Adult medicine also accounted for a larger number of excess inpatient days, an average daily census of 52.7 patients in 2013, although adult medicine outliers comprised only 2.4 - 2.5 percent of discharges while adult surgery patients comprised 4.4 - 4.5 percent of discharges for these services. Adult medicine readmissions accounted for 79 - 81 percent of these adverse events for the combined hospital during the two-year period. Adult medicine complications accounted for 60 - 62 percent of complications in the two hospitals for which data were available. These data clearly demonstrate the challenges that adult medicine patients carry for providers as they attempt to improve the efficiency and outcomes of care in local communities. In the United States, payer reimbursement for the care of these patients frequently does not match the resources required as funding emphasizes surgical specialties and healthier patients. In metropolitan areas such as Syracuse, where local populations are aging or declining, the expenses of caring for these patients can become a major challenge for community providers.

关键词： Hospitalization Hospital Lengths of Stay Hospital Readmissions Hospital Complications

Reducing Hospital Stays with Community Wide Programs

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Case Reports in Clinical Medicine 2020年第3期9卷 67-73页

作者： ronald lagoe Gretchen lagoe Hospital Executive Council Syracuse NY USA

This study provided an update concerning programs for reduction of inpatient lengths of stay in the three Syracuse hospitals. The study included evaluation of the impact of these programs by severity of illness. The Difficult to Place program involved the identification of patients with extended stays in the hospitals because of the need for long term care services in the community. A community wide list of Difficult to Place patients was distributed by the Hospital Executive Council each week. In addition, the Syracuse hospitals and the Hospital Executive Council implemented the Subacute and Complex Care Programs for patients with extended stays. These inpatients included those who required expensive medication or patients with infectious diseases and offsite transportation. The study data indicated that Difficult to Place patients in the combined Syracuse hospitals amounted to 20.4 - 20.5 percent of new admissions to nursing homes between 2017 and 2019. The data also demonstrated that the number of Subacute and Complex Care patients for the combined hospitals amounted to 5.7 to 6.6 percent of the Difficult to Place populations. The study data indicated that adult medicine lengths of stay declined by 0.10 patient days, from 4.91 to 4.81 days between 2017 and 2019, a reduction of 12,622 patient days or an average daily census of 34.6. The study data indicated that adult surgery lengths of stay declined by 0.22 patient days, from 5.55 to 5.33 days between 2017 and 2019, a reduction of 8681 patient days, or an average daily census of 23.8.

关键词： Hospitals Nursing Homes Long Term Care

Tracking the Sustainability of Improvements in Hospital Outcomes

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Advances in Bioscience and Biotechnology 2014年第11期5卷 895-902页

作者： ronald lagoe Ruthie lagoe Hospital Executive Council Syracuse USA

This study focused on tracking the sustainability of improvements in inpatient outcomes in the hospitals of Syracuse, New York. It involved evaluation of inpatient complications during a six-year period for two of the Syracuse hospitals and inpatient readmissions during a three-year period for three hospitals. The study employed the Potentially Preventable Complications and Potentially Preventable Readmissions software developed by 3MTM Health Information Systems. The study demonstrated that two of the Syracuse hospitals produced reductions in aggregate complication rates between 2009 and 2012. This was followed by an increase in complications during 2013 and 2014. The decline in complications and the increase that followed were supported by developments in high volume complications and some lower volume complications. Hospital readmissions for adult medicine, the largest inpatient service, both increased and declined at the aggregate level and for individual hospitals during the three-year period. Hospital readmission rates for adult surgery declined, however, individual hospital rates increased and declined. The study identified sustained reductions in readmission rates for the combined hospitals for congestive heart failure and COPD during the three-year period. The study identified the challenges related to sustaining reductions in hospital outcomes over time. In the Syracuse hospitals, these challenges involved inpatient clinical management for complications and system-wide issues for readmissions.

关键词： Hospital Outcomes Hospital Complications Hospital Readmissions

Resident Hospital Discharges by Severity of Illness at the Regional Level

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Case Reports in Clinical Medicine 2019年第5期8卷 140-146页

作者： ronald lagoe Gretchen lagoe Hospital Executive Council Syracuse NY USA

In the twentieth century, government sponsored health planning focused on the use of services by population in the United States. This case study evaluated the impact of severity of illness for resident hospital discharges for 2017, the latest time period for which this information was available. It focused on the Central New York Health Service Area, one of the original health planning populations. The study demonstrated that patients at Extreme severity of illness constituted similar percentages of adult medicine and adult surgery populations in the Central New York Region. The sizes of Moderate severity of illness populations were also similar. The study identified considerable differences in the sizes of Minor and Major severity of illness populations for adult medicine and adult surgery in the Central New York Region. These differences resulted from large numbers of healthy patients in the adult surgery population. They were admitted for orthopedic procedures and procedures to address obesity.

关键词： Hospitalization Hospital Discharges Severity of Illness

Improving Health Care Efficiency with Lower Cost Services

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Case Reports in Clinical Medicine 2019年第8期8卷 231-238页

作者： ronald lagoe Emmi lagoe Hospital Executive Council Syracuse NY USA

This study described Subacute and Complex Care Programs developed by the Syracuse hospitals to reduce the expenses of extended hospital stays. They focused on the movement of patients for services such as dialysis and complex care. These programs involved costs of approximately $7100 to $10,600 per patient compared with $12,600 to $25,000 per patient for extended stays in hospitals. The study also suggested that substantial savings were generated in the service area of the Syracuse hospitals by reducing inpatient adult medicine and adult surgery hospital rates. The annual savings for these services were substantial, $4,600,000 for 2017 when compared with 2011.

关键词： Hospitals Nursing Homes Health Care Expenses

Hospital Utilization after the Epidemic

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Case Reports in Clinical Medicine 2021年第4期10卷 92-98页

作者： ronald lagoe Bella lagoe Shelly Littau Hospital Executive Council Syracuse NY USA

This study focused on hospital utilization for adult medical-surgical patients in Syracuse, New York as the census peaked then declined between December 2020 and February 2021. The initial analysis demonstrated that the adult medical-surgical census including Coronavirus patients declined by 8.1 percent during January and February 2021. The study data also demonstrated that the adult medical-surgical census of the combined hospitals increased as the numbers of virus patients declined. The inpatient census at the end of February 2021 was 3.6 percent below the level for February 2019 and 15.0 percent below the level for February 2020. This suggested a range between 3.6 and 15.0 percent below those in previous years for medical-surgical planning after the epidemic.

关键词： Hospitals Coronavirus Inpatient Hospital Beds

Changes in Hospital Utilization at the Community Level

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Case Reports in Clinical Medicine 2023年第8期12卷 285-291页

作者： ronald lagoe Shelly Littau Hospital Executive Council Syracuse USA

This study evaluated developments in adult medicine and adult surgery inpatient discharges of the Syracuse, New York metropolitan area during a five-year period. The study demonstrated that adult medicine discharges declined by 19.1 percent and adult surgery discharges declined by 25.1 percent between January-April 2019 and 2023. The study also indicated that discharges for both services increased slightly, 2.8 - 6.2 percent, between January-April 2022 and 2023. The study data suggested that some of the reduction in adult medicine discharges resulted from less use of health care services related to the coronavirus epidemic. It also demonstrated that reduced use of adult surgery services was associated with greater utilization of ambulatory surgery and other outpatient services in the community. The results of the study suggested that hospitals in the United States may experience less utilization of inpatient services in the future.

关键词： Hospitals Hospital Discharges Hospital Utilization

Evaluating Hospital Utilization Late in the Epidemic

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Case Reports in Clinical Medicine 2022年第7期11卷 261-267页

作者： ronald lagoe Shelly Littau Hospital Executive Council Syracuse NY USA

This study evaluated present and future impact of the coronavirus on hospitalization as the virus winds down in the metropolitan area of Syracuse, New York. The study compared adult medicine and adult surgery discharges between January-May 2019 and 2022. The data indicated that 69 percent of the reduction in medical-surgical discharges that occurred since 2019 was offset during 2022. The remaining 31 percent remained at levels experienced in 2020 and 2021. The study clearly demonstrated that medical and surgical discharges increased significantly since 2019. An important question is whether these will continue or if they will level off.

关键词： Hospitals Infectious Diseases Hospitalization

Monitoring Changes in Hospital Utilization

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Case Reports in Clinical Medicine 2024年第4期13卷 115-121页

作者： ronald lagoe Shelly Littau Hospital Executive Council Syracuse NY USA

This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.

关键词： Hospitals Hospital Utilization Long Term Care Ambulatory Care