Clinical identification of patients readmitted to hospitals: why patients return.

Background: Increased interest in hospital outcomes has supported the need for clear and useful identification of patients who are readmitted. These patients have frequently been identified by the principal diagnosis of the initial admission.

Findings: In order to evaluate the effectiveness of identifying patients who were subsequently readmitted, those with two frequently encountered conditions, principal diagnoses of congestive heart failure and pneumonia, in the hospitals of Syracuse New York were evaluated.

Quantitative tools for addressing hospital readmissions.

Background: Increased interest in health care cost containment is focusing attention on reduction of hospital readmissions. Major payors have already developed financial penalties for providers that generate excess readmissions. This subject has benefitted from the development of resources such as the Potentially Preventable Readmissions software.

Healthcare cost containment and integration of care in the United States: implications at the local level.

As the urgency of healthcare cost containment in the United States increases, this study concerns the impact of this process at the community level in the metropolitan area of Syracuse, New York. It suggests that the responses of the Syracuse hospitals to cost containment have resulted in greater numbers of adult medicine patients. This development has been paralleled by a reduced integration of services with long-term care and ambulatory care providers.

Fifty ways to reduce length of stay: an inventory of how hospital staff would reduce the length of stay in their hospital.

Purpose And Setting: In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions.

Reducing potentially preventable complications at the multi hospital level.

Background: This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes.

Findings: This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems.

Inpatient hospital complications and lengths of stay: a short report.

Background: Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area.

Findings: This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York.

Evaluation of hospital inpatient complications: a planning approach.

Background: Hospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of the health care reform efforts in the United States.An objective of this study was to describe the Potentially Preventable Complications software developed as a tool for evaluating hospital inpatient outcomes.

Benchmarking and reducing length of stay in Dutch hospitals.

Background: To assess the development of and variation in lengths of stay in Dutch hospitals and to determine the potential reduction in hospital days if all Dutch hospitals would have an average length of stay equal to that of benchmark hospitals.

Methods: The potential reduction was calculated using data obtained from 69 hospitals that participated in the National Medical Registration (LMR). For each hospital, the average length of stay was adjusted for differences in type of admission (clinical or day-care admission) and case mix (age, diagnosis and procedure).

Integrating hospital competition and co-operation at the community level.

During the past few decades, relations among healthcare providers at the community level have been characterized by competition and co-operation. Opinions concerning the merits of these approaches vary.

Electronic daily reporting of community-wide healthcare information.

The development of electronic healthcare data systems has proceeded rapidly; concerns regarding the impact and costs of electronic healthcare data have also been raised. This study describes the development and implementation of a community-wide program for daily electronic exchange of aggregate healthcare data in Syracuse, NY, addressing major concerns and producing important lessons learned.

Linking health services at the Community level.

This study describes a series of interventions linking hospitals, medical staff physicians, long-term care providers and mental health services in the metropolitan area of Syracuse, New York. The objectives of these interventions were to improve patient outcomes and system-wide efficiency. The study demonstrated that these linkages, including system-wide data feedback, contributed to limitation of emergency department overcrowding, reduction of physician lengths of stay, elimination of duplication of medical staff credentialing, as well as access to and efficiency of long-term care and mental health services.

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

Objective: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration.

Data Sources: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state.

Community wide electronic distribution of summary health care utilization data.

Background: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data.

Development and implementation of a community-wide infusion therapy program by hospitals and nursing homes in Syracuse, New York.

The development and implementation of an infusion therapy program in the metropolitan area of Syracuse, New York is described. The program was implemented in a number of nursing homes with training and financial support from area hospitals. It resulted in a reduced number of hospital patient days and related savings for the healthcare system.

Managing hospital length of stay reduction: a multihospital approach.

Major financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions with physicians and nursing homes to reduce inpatient lengths of stay by four hospitals in Syracuse, New York. These initiatives saved over 28,000 patient days and an average daily census of 96.

Current and future developments in managed care in the United States and implications for Europe.

The paper reviews and evaluates current and future approaches to cost containment in the United States. Managed care was once seen as an effective approach to supporting health care quality while containing costs in the USA. In recent years payors started to look in other directions, since prospects for limiting expenses faded.

Improving outcomes with community-wide distribution of health care data.

This study describes the impact of the exchange of daily, weekly, and quarterly information among a full range of health care administrators and practitioners on the accessibility and efficiency of care. These efforts produced increased accessibility of hospital emergency departments and greater efficiency of acute and long-term care.

Reducing ambulance diversion: a multihospital approach.

Objective: To evaluate the impact of procedures for reducing ambulance diversion in the metropolitan area of Syracuse, New York.

Methods: This was a retrospective review of procedures for reducing ambulance diversion at the system-wide and hospital-specific levels between January 1, 2001, and June 30, 2002. System-wide procedures involved exchange of information concerning diversion.

An international study of hospital readmissions and related utilization in Europe and the USA.

This study concerns a comparative analysis of hospital readmission rates and related utilization in six areas, including three European countries (Finland, Scotland and the Netherlands) and three states in the USA (New York, California, Washington State). It includes a data analysis on six major causes of hospitalization across these areas. Its main focus is on two questions.

Utilization and impact of ambulance diversion at the community level.

Objective: To evaluate the utilization and impact of ambulance diversion in the metropolitan area of Syracuse, New York.

Methods: This was a retrospective review of the ambulance diversion system operated by the hospitals of Syracuse, New York. This system allows each emergency department to divert incoming ambulances during periods of extreme overcrowding.