Class of 2008 Abstract / Objectives: This investigation was to assess the patient, hospital, or payer characteristics of inpatient cases of agranulocytosis from 1997 and 2005 with descriptive statistics. Methods: The retrospective database investigation used the U. S. Department of Health & Human Services, Agency for Healthcare Research and Quality, Healthcare Cost & Utilization Project public use database Nationwide Inpatient Sample (H-CUP NIS) for a principal diagnosis of agranulocytosis. Significance of difference between variables, including standard error (SE), was assessed with a z-test and an alpha level of 0.05. Results: alpha level of 0.05. RESULTS: The mean charges increased from 1997 at $19,670(SE $366) per patient vs. 2005 at $26,866 (SE $813) per patient (p<0.001) while inpatient mortality was not different in 1997 at 718(SE 72) vs. 2005 at 759(SE 69) (p=0.63) and the percentage of patients discharged to home declined from 84.32% [0.85%] in 1997 to 80.12% [1.29%] in 2005 (p=0.007). In 2005, inpatient mortality was lower in teaching hospitals at 1.13%( standard error 0.15%) vs. non teaching hospitals at 2.38%(SE 0.25%) (p<0.001) and for metropolitan areas hospitals at 1.42%(SE 0.14%) vs. non-metropolitan area hospitals at 3.60%(SE 0.68%) (p=0.002). Conclusions: Data from H-CUP NIS indicates higher costs per patient for the primary diagnosis of agranulocytosis in 2005 vs. 1997 while overall inpatient survival is not different and the percentage of patients discharged to home decreased. In 2005 rates of inpatient survival were higher in teaching hospitals than in non-teaching hospitals and hospitals in metropolitan areas than in non-metropolitan areas. These differences were not found in 1997.

The components of a quality assurance program for smaller hospitals in British Columbia have been defined. These components have been defined by a comparison of the normative standards as determined in the literature and by a survey of administrators. Sixteen administrators of predominantly acute-care, accredited, 20-50-bed hospitals in B.C. were surveyed. Twelve of these administrators were surveyed twice. A new requirement for accreditation was introduced by the Canadian Council on Hospital Accreditation (C.C.H.A.) called the Quality Assurance Standard (1985). This Standard required that quality assurance (QA) programs be established in every department or service in the hospital. The Standard does not give a clear description of the QA functions for each individual department in a smaller hospital. An important and relevant list of specific functions for a QA program were identified at various C.C.H.A. seminars held across Canada in late 1983 and early 1984. The literature review indicated that there were a number of controversial issues affecting the implementation of the QA Standard. In spite of many methodological problems associated with quality measurement and assurance, most hospitals will adopt a quality assurance model. The first survey asked the administrators to define the purpose, goals and objectives of a QA program. They were also asked to determine the QA functions for four areas: hospital board, dietary, nursing and pharmacy. Administrators were asked to identify who in the hospital is primarily responsible for the overall QA program and for the QA program in four areas; the problems and benefits encountered when trying to implement a QA program; and their opinion of the new QA requirements for accreditation. The second survey asked the administrators to assign a priority to those functions identified in Round I. The empirical findings were then compared with the normative standards. With some exceptions, the empirical data were consistent with the normative standards. The empirical findings shows that there are problems related to implementing a QA program but at the same time there are a number of benefits related to the program. The priority ratings of the functions indicated areas of high or low importance to the administrator. It is likely that these priority ratings are useful for planning when alternatives must be considered during this time of fiscal restraint. Government policies along with the strong voluntary support of accreditation programs make it vitally important that suitable models for implementing QA are developed. The Doll model is suggested as a basis for implementing QA. Further areas for research are presented. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This study aims to evaluate the removal efficiency of microbial contaminants from two hospitals on-site Wastewater Treatment Plants (WWTPs) in Saudi Arabia. Hospital wastewaters often go untreated in Saudi Arabia as in many devolving countries, where no specific regulations are imposed regarding hospital wastewater treatment. The current guidelines are placed to ensure a safe treated wastewater quality, however, they do not regulate for pathogenic bacteria and emerging contaminants. Results from this study have detected pathogenic bacterial genera and antibiotic resistant bacteria in the sampled hospitals wastewater. And although the treatment process of one of the hospitals was able to meet current quality guidelines, the other hospital treatment process failed to meet these guidelines and disgorge of its wastewater might be cause for concern. In order to estimate the risk to the public health and the impact of discharging the treated effluent to the public sewage, a comprehensive investigation is needed that will facilitate and guide suggestions for more detailed guidelines and monitoring.

Thesis (M.S.)--Boston University

Yes / People living with dementia (PwD) admitted in emergency to an acute hospital may be at higher risk of inappropriate care and poorer outcomes including longer hospitalisations and higher risk of emergency re-admission or death. Since 2009 numerous national and local initiatives in England have sought to improve hospital care for PwD. We compared outcomes of emergency admissions for cohorts of patients aged 65+ with and without dementia at three points in time. Methods: We analysed emergency admissions (EAs) from the Hospital Episodes Statistics datasets for England 2010/11, 2012/13 and 2016/17. Dementia upon admission was based on a diagnosis in the patient’s hospital records within the last five years. Outcomes were length of hospital stays (LoS), long stays (> = 15 days), emergency re-admissions (ERAs) and death in hospital or within 30 days post-discharge. A wide range of covariates were taken into account, including patient demographics, pre-existing health and reasons for admission. Hierarchical multivariable regression analysis, applied separately for males and females, estimated group differences adjusted for covariates. Results: We included 178 acute hospitals and 5,580,106 EAs, of which 356,992 (13.9%) were male PwD and 561,349 (18.6%) female PwD. Uncontrolled differences in outcomes between the patient groups were substantial but were considerably reduced after control for covariates. Covariate-adjusted differences in LoS were similar at all time-points and in 2016/17 were 17% (95%CI 15%-18%) and 12% (10%-14%) longer for male and female PwD respectively compared to patients without dementia. Adjusted excess risk of an ERA for PwD reduced over time to 17% (15%-18%) for males and 17% (16%-19%) for females, but principally due to increased ERA rates amongst patients without dementia. Adjusted overall mortality was 30% to 40% higher for PwD of both sexes throughout the time-period; however, adjusted in-hospital rates of mortality differed only slightly between the patient groups, whereas PwD had around double the risk of dying within 30 days of being discharged. Conclusion: Over the six-year period, covariate-adjusted hospital LoS, ERA rates and in-hospital mortality rates for PwD were only slightly elevated compared to similar patients without dementia and remaining differences potentially reflect uncontrolled confounding. PwD however, were around twice as likely to die shortly after discharge, the reasons for which require further investigation. Despite being widely used for service evaluation, LoS, ERA and mortality may lack sensitivity to changes in hospital care and support to PwD. / This study was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR). ESRC Grant reference: ES/L001772/1.

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