Background: Substantial variation exists in rates of emergency department (ED) admission. We examine this variation after accounting for local and community characteristics.
Objectives: Elucidate the factors that contribute to admission variation that are amenable to intervention with the goal of reducing variation and health care costs.
Methods: We conducted a retrospective cross-sectional study of 1,412,340 patient encounters across 18 sites from 2012-2013. We calculated the adjusted hospital-level admission rates using multivariate logistic regression. We adjusted for patient, provider, hospital, and community factors to compare admission rate variation and determine the influence of these characteristics on admission rates.
Results: The average adjusted admission rate was 22.9%, ranging from 16.1% (95% confidence interval [CI] 11.5-22%) to 32% (95% CI 26.0-38.8). There were higher odds of hospital admission with advancing age, male sex (odds ratio [OR] 1.20, 95% CI 1.91-1.21), and patients seen by a physician vs. mid-level provider (OR 2.26, 95% CI 2.23-2.30). There were increased odds of admission with rising ED volume, at academic institutions (OR 2.23, 95% CI 2.20-2.26) and at for-profit hospitals (OR 1.15, 95% CI 1.12-1.18). Admission rates were lower in communities with a higher per capita income, a higher rate of uninsured patients, and in more urban hospitals. In communities with the most primary providers, there were lower odds of admission (OR 0.60, 95% CI 0.57-0.68).
Conclusion: Variation in hospital-level admission rates is associated with a number of local and community characteristics. However, the presence of persistent variation after adjustment suggests there are other unmeasured variables that also affect admission rates that deserve further study, particularly in an era of cost containment.
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http://dx.doi.org/10.1016/j.jemermed.2017.11.024 | DOI Listing |
J Craniofac Surg
October 2024
Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca.
Cranioplasty is a major surgical procedure typically performed in children under 1 year of age, often associated with significant complications. The scientific literature on perioperative management for children with craniosynostosis undergoing cranioplasty is limited. The authors' objective was to retrospectively evaluate the management, complication rates, and outcomes among children undergoing cranioplasty at our institution.
View Article and Find Full Text PDFJ Med Toxicol
December 2024
Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA.
Introduction: Tianeptine is an atypical tricyclic antidepressant not approved for medical use in the US but is found in dietary supplements. This study investigates single-substance tianeptine exposures reported to US poison centers.
Methods: We analyzed cases involving tianeptine reported to the National Poison Data System from 2015 to 2023.
PLoS One
December 2024
The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.
Background: Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood.
Objective: We evaluated the 10-year trend (2011-2021) in clinical factors and outcomes among children with severe wasting and/or nutritional edema at Malawi's largest nutritional rehabilitation unit (NRU).
Ann Ital Chir
December 2024
Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310019 Hangzhou, Zhejiang, China.
Aim: This study aimed to explore the application effect of comfort nursing based on evidence-based concept in radial artery puncture hemostasis of patients after coronary intervention.
Methods: This interventional study included the clinical data of 180 patients who underwent percutaneous radial coronary intervention in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from July 2024 to September 2024. All patients were treated with radial artery hemostasis device after operation.
Front Med (Lausanne)
December 2024
NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Background: The endothelial activation and stress index (EASIX) serves as a dependable and efficient surrogate marker for endothelial dysfunction, which plays an essential role in the pathophysiology of acute pancreatitis (AP). Hence, we investigated the prognostic value of EASIX in AP.
Methods: This was a retrospective study, using patient information obtained from the Medical Information Market for Intensive Care-IV (MIMIC-IV) database.
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