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Monitoring Changes in Hospital Utilization

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

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ambulatory care Patient Safety Proactive Risk Assessment,a Necessary Fist Step 17th

Ambulatory Care Patient Safety Proactive Risk Assessment,a N...

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第十七届国际工效学大会暨中国人类工效学会成立20周年庆...

作者： James B.Battles Center for Quality Improvement and Patient Safety Agency for Healthcare Research and QualityUS Department of Health and Human Services

Much of the health care in the United States and around the world is delivered in ambulatory settings.Most medical and surgical procedures that were once provided only in hospitals are now routinely performed in ambulatory settings.However much of the focus on patient safety has been in the in patient setting.There is insufficient information on risks,hazards,and their consequences in ambulatory care.Unlike in the hospital setting there are no identified safe practices that should be implemented in the ambulatory setting.Evidence based safe practices in ambulatory care are yet to be identified.A significant starting point for improvement in the safety of care in ambulatory care is to identify the risks and hazards imbedded in the process and structure of ambulatory care.Prior to implementing interventions de jour,knowing where these risks and hazards are will inform the design,planning and development of appropriate interventions that will in fact eliminate or minimize the actual risks and hazards.Using proven proactive risk assessment/modeling methods it is possible to begin to move to risks informed design and intervention.AHRQ has funded 20 risk assessment projects using a variety of methods and approaches to identifying risk and hazards in ambulatory setting.Clearly identifying risks and hazards is an essential first step in im-proving the quality and safety of ambulatory care.Proactive risk assessment is a vital first step in the de-sign and development of interventions and safe practices.If you do not know where the risks and hazards are how one can make progress in eliminating or mitigating them.The use of established proactive risk assessment is a essential aspect of an going patient safety activities.

关键词： First Step ambulatory care Facilities Risk Assessment Security measures Patient Safety step design design scheme ambulatory care Risk Management

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Implementation of a High-Risk Outpatient Clinic for Children with Complex Congenital Heart Disease in a Reference Service in Brazil

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Congenital Heart Disease 2023年第6期18卷 649-656页

作者： Gustavo Foronda Vanessa Ferreira Amorim de Melo Claudia Regina Pinheiro de Castro Grau Ingrid Magatti Piva Glaucia Maria Penha Tavares Ana Cristina Sayuri Tanaka Nana Miura Department of Pediatric Cardiology and Adult Congenital Heart Diseases Heart Institute of the University of São PauloSão PauloBrazil Foronda Clinic São PauloBrazil Institute of Orthopedics and Traumatology University of São PauloSão PauloBrazil Department of Echocardiography Heart Institute of the University of São PauloSão PauloBrazil

Background:Children with congenital heart disease(CHD),even after surgical approaches,and especially those who undergo staged procedures in theﬁrst months of life,remain vulnerable to readmissions and complications,requiring very close monitoring and differentiated intervention strategies.Methods:Descriptive and exploratory study,of the experience report type,which presents the process of building the high-risk outpatient clinic for complex congenital heart diseases(AAR)at the Instituto do Coração(InCor).Results:Report of the path taken to structure the AAR,demonstrating the organization,interface with the multidisciplinary team,admission and discharge criteria,training,and patient proﬁle.In theseﬁve years of care,275 patients were treated,59.65%with biventricular interstage physiology,followed by univentricular interstage physiology(34.55%),residual defects after surgical procedures(3.63%),tumors with risk of mechanical obstruction(1.45%)and patients with an intrauterine approach(0.72%).The signiﬁcant number of critical patients who were successfully discharged from hospital(44.72%),the low mortality rate due to sudden deaths at home and the high adherence to follow-up cor-roborate the impact of this specialized assistance.Conclusions:Despite the limitations of the study,this experi-ence report showed that with few resources,there is the possibility of organizing an AAR with differentiated care,with the objective of early detection and treatment of residual injuries,identiﬁcation of early interventions,edu-cation of parents for follow-up of their children,resulting in individualized treatment,promoting a better quality of life for this population.

关键词： Congenital heart defects ambulatory care heart defects

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Impact of cardiologist intervention on guideline-directed use of statin therapy

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World Journal of Cardiology 2020年第8期12卷 419-426页

作者： Manouchkathe Cassagnol Ofek Hai Shaqeel A Sherali Kyla D’Angelo David Bass Roman Zeltser Amgad N Makaryus Department of Cardiology NuHealth/Nassau University Medical CenterEast MeadowNY 11554United States Department of Clinical Health Professions College of Pharmacy and Health SciencesSt.John’s UniversityQueensNY 11430United States Donald and Barbara Zucker School of Medicine at Hofstra/Northwell HempsteadNY 11549United States St.Lawrence Health System PotsdamNY 13676United States

BACKGROUND Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease(ASCVD).However,several studies have reported widespread underuse of statins in various practice settings and populations.Review of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy(GDST).AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory setting.METHODS Patients with at least one encounter at the adult Internal Medicine Clinic(IMC)and/or Cardiology Clinic(CC),who had an available serum cholesterol test performed,were evaluated.The 2 comparison groups were defined as:(1)Patients only seen by IMC;and(2)Patients seen by both IMC and CC.Patients were excluded if variables needed for calculation of ASCVD risk scores were lacking,and if demographic information lacked guideline-directed treatment recommendations.Data were analyzed using student t-tests or χ^2,as appropriate.Analysis of Variance was used to compare rates of adherence to GDST.RESULTS A total of 268 patients met the inclusion criteria for this study;211 in the IMC group and 57 in the IMC-CC group.Overall,56%of patients were female,mean age 56 years(±10.65,SD),22%Black or African American,56%Hispanic/Latino,14%had clinical ASCVD,13%current smokers,66%diabetic and 63%hypertensive.Statin use was observed in 55%(n=147/268)of the entire patient cohort.In the IMC-CC group,73.6%(n=42/57)of patients were prescribed statin therapy compared to 50.7%(n=107/211)of patients in the IMC group(P=0.002).In terms of appropriate statin use based on guidelines,there was no statistical difference between groups[IMC-CC group 61.4%(n=35/57)vs IMC group,55.5%(n=117/211),P=0.421].Patients in the IMC-CC group were older,had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group(P<0.02,all).CONCLUSION Although overall use of GDST was suboptimal,there was no statistical difference in appropriate statin use based

关键词： Statin use Guideline directed statin therapy Cardiologist ambulatory care Adherence

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Evaluating Health Planning Issues at the Community Level

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Case Reports in Clinical Medicine 2023年第11期12卷 433-438页

作者： Ronald Lagoe Mark Murphy Shelly Littau Hospital Executive Council Syracuse NY USA St. Joseph’s Hospital Health Center Syracuse NY USA

This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of services at the community level. The study suggested that the utilization of services can be associated with patient demographics. In this study, younger populations were associated with lower use of hospital inpatient care. The data have also suggested that larger numbers of younger populations are not necessarily related to opportunities for expanding local health care providers. Younger populations can be associated with lower per capita use of services. The data demonstrated that there were substantial reductions in hospital discharges for adult medicine. Total discharges declined by 3999 patients between the seven months in 2019 and 2023. The data also demonstrated that there were notable reductions in hospital discharges for adult surgery.

关键词： Hospitals Acute care ambulatory care Health Planning

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