Excess inpatient length of stay (LOS) varies between hospitals and is burdensome to patients and the overall healthcare system. Variation in LOS has often been associated with hospital-level factors, such as hospital efficiency and quality. Clostridium difficile infection (CDI) is an increasingly common hospital-acquired (HA) infection. This thesis explores the connection between hospital incidence of CDI and excess LOS in patients without a CDI. It is hypothesized that HA-CDI incidence may act as a "proxy variable" to capture unobserved hospital characteristics, such as hospital quality or efficiency, associated with prolonged LOS. In addition, hospitals with longer LOS may tend to observe more HA-CDI cases prior to discharge. This thesis analyzes the ability of CDI incidence to capture excess LOS variation across hospitals, while controlling for CDI cases that occur after discharge. We use data on hospital inpatient visits, spanning the years 2005-2011, from three data sources distributed by the Healthcare Cost and Utilization Project: the Nationwide Inpatient Sample (NIS), and the State Inpatient Databases (SID) for California and New York. The NIS provides discharge records from a nationwide sampling of hospitals in a given year. The SIDs are longitudinal populations of inpatient records in each state, and patient records can be linked across stays. We compute a variety of different measures of hospital CDI incidence and identify HA-CDI cases that occur after a patient is discharged. Various multivariable regression models are analyzed to predict LOS at an individual patient level. A generalized linear modeling approach is used, and different distributions and link functions are compared using the Akaike information criterion. A multilevel modeling approach is also used to estimate the amount of between-hospital variation in LOS that can be explained by HA-CDI incidence. We find CDI incidence to be a strong predictive factor for explaining a patient's LOS and is one of the strongest predictive variables we identified. Moreover, CDI incidence appears to primarily capture between-hospital variation in excess LOS. Although we find evidence that present-on-admission indicators may underreport cases of HA CDI, our findings suggest the connection between CDI incidence and excess LOS is driven primarily by CDI cases that are HA. In addition, when we account for HA-CDI cases that occur post-discharge, the relationship between CDI incidence and LOS appears even stronger. Our results suggest that CDI incidence may be a powerful tool for making comparisons of excess LOS across hospitals.

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Abstract Objective: Readmission is a big part of health care expenditure and recent studies suggested that hospital readmissions can be applied as an important indicator of quality of care within health care system. Furthermore elderly population usually costs the large amount health care expenses and is the main group in readmission. Moreover readmission is usually attributed to chronic diseases. Nevertheless, evaluations of hospital readmissions under universal health care coverage areas were not well-studied in Taiwan. Therefore this study aims to explore the associations between initial hospitalizations and probability of hospital readmissions in details. Research method: Patients aged 65 or older with primary clinical diagnosis of asthma or COPD based on ICD-9-CM for hospital admissions and readmissions in Taiwan.National claims of these two diseases were collected and analyzed from year 2000 to 2004. Population-based descriptive analyses of related health care utilizations were estimated. Multivariate logistic regressions were conducted to predict the probability of hospital readmissions. Controlled variables included patient factors, medical institutions¡¦ characteristics, urbanizations, and air quality indicators. Result: Among asthma and COPD elderly patients, more health care utilizations were observed in the hospital readmissions than initial admissions. Multivariate logistic regressions indicated that age, gender, disease severity, hospital characteristics, and air quality were significant predictors of the probability of hospital readmission. Meanwhile, age, disease severity, and hospital characteristics also significantly affected the time interval between initial admission and readmission. In addition, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission (P<0.001). Conclusion: For Asthma and COPD elderly patients, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission and have higher probability of hospital readmission. This study provides the evidence of reducing the health care expenditure by controlling readmission rate. With more understandings of factors affecting hospital readmissions, we can improve the health care delivery and reduce unplanned readmissions in the future. Key words: Asthma, COPD, hospital readmission, health care utilization, length of stay, admission fees

INTRODUCTION: Preoperative pulmonary rehabilitation (PPR) is an emerging therapy for transplant candidates who are awaiting surgery. Research indicates that PPR training has benefits for improving exercise tolerance, but little researcher exists on the association between PPR on post-transplant hospital outcomes. METHODS: The study was a non-probability cross-sectional analysis performed on data for post-transplant recipients who received either a single or bilateral lung transplant from February 8, 2007 to July 8, 2014. The study sample consisted of 207 transplant recipients. Analyses of the associations between independent variables: preoperative pulmonary rehabilitation and six-minute walk distance (6MWD) and covariates were performed by logistic regression analysis to examine the following outcomes: length of stay, hospital readmissions in the first 90 days post- transplant, and the number of hospital readmissions in the first 90 days. RESULTS: Transplant recipients who participated in preoperative pulmonary rehabilitation had 1.77 times greater odds of being readmitted in the first 90 days post-transplant compared to recipients who did not participated in preoperative pulmonary rehabilitation. Transplant recipients whose 6MWD was greater than 207 meters and who participated in preoperative pulmonary rehabilitation had 4.99 times greater odds of length of staying 12 days or less post- transplant surgery compared to transplant recipients whose walk distance was less than 207 meters and who did not participate in preoperative pulmonary rehabilitation. CONCLUSION: Pulmonary rehabilitation is an important part of the lung transplant. The results of this study indicate the importance of preoperative lung transplant on post-transplant outcomes for transplant recipients.

The vast majority of child maltreatment in the United States is perpetrated by parents and over half of maltreated children placed in out-of-home care are reunified with the parents from which they were removed. Additional victimization of these children sometimes necessitates their reentry into out-of-home care. These realities emphasize the need to engage parents in assessment, planning, and services throughout the life of a child welfare case. Engagement is a key ingredient in social work practice and is widely accepted in the child protection arena as critical to successful service planning and participation. However, little research has focused on the relationship between engaging parents and child welfare case outcomes. Utilizing data systematically collected by the Florida Department of Children and Families as part of its quality assurance program, this study examined the relationship between case worker efforts to engage parents in case planning, decisions impacting the child, and services; and the length of a child's stay in out-of-home care related to being discharged within 12 months of entering out-of-home care, and a child's reentry into out-of-home care within 12 months of being reunified with his or her parents. Cox regression analyses revealed that Hispanic children were less likely to be discharged from out-of-home care within 12 months of entry and younger children were more likely to reenter out-of-home care within 12 months of being reunified with their parents. Multivariate models revealed that case worker efforts to engage fathers in case planning and decisions impacting the child were significant predictors of children being discharged from out-of-home care within 12 months of entry, though this did not hold true for efforts to engage mothers. No case worker efforts to engage parents were significant predictors of children reentering out-of-home care within 12 months of being reunified with their parents. Although this study took an important step in more fully understanding how engaging parents may influence case outcomes, the findings suggest considerations for social work practice and research. Additional training to enhance cultural awareness and cultural competency skills could aid case workers in tailoring their engagement efforts to the race/ethnicity of children and families with whom they work. Further research into the lack of association between engaging mothers and length of stay, and between engaging parents and reentry into out-of-home care is also warranted. Quantitatively measuring engagement from the parents' perspective should also advance the line of inquiry into the relationship between engagement and child welfare case outcomes.

This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Purpose: To examine the relationship between social engagement (SE) and health care use (HCU) in baby-boomers (age 45-64) and older adults (65+). Methods: Data from the Wellness Institute Services Evaluation Research III was used. SE was assessed using measures of formal, informal, and civic activities. HCU was assessed using administrative health care records (hospital use and length of stay, overall general and family physician use). Results: Higher formal SE indicated higher contact with physicians in general, higher hospital visits, and longer lengths of stay in hospital. Higher informal SE indicated shorter lengths of stay. Results were found while controlling for demographic variables, chronic conditions, and self-rated health. Older adults had higher HCU overall, compared to baby-boomers. Conclusion: While further research is necessary, this study has implications in determining the impact that certain types of SE can have on the health care system for different age groups.

Purpose: To examine the relationship between social engagement (SE) and health care use (HCU) in baby-boomers (age 45-64) and older adults (65+). Methods: Data from the Wellness Institute Services Evaluation Research III was used. SE was assessed using measures of formal, informal, and civic activities. HCU was assessed using administrative health care records (hospital use and length of stay, overall general and family physician use). Results: Higher formal SE indicated higher contact with physicians in general, higher hospital visits, and longer lengths of stay in hospital. Higher informal SE indicated shorter lengths of stay. Results were found while controlling for demographic variables, chronic conditions, and self-rated health. Older adults had higher HCU overall, compared to baby-boomers. Conclusion: While further research is necessary, this study has implications in determining the impact that certain types of SE can have on the health care system for different age groups.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.