Background: Cellulitis is a common skin and soft-tissue infection that often recurs in some patients. Patients with presenting comorbid conditions may require hospitalization which increases the cost of treatment. However, little is known about comorbid conditions as determinants for a patient’s hospital length-of-stay. Objective: 1) To profile the characteristics of patients admitted to Ontario hospitals with a diagnosis of cellulitis according to key demographic, clinical and geographic factors; 2) To examine, among patients hospitalized with cellulitis, comorbidities as possible determinants of hospital length-of-stay. Methods: A retrospective cohort of 7863 patients was identified from the Discharge Abstract Database from April 1, 2006 to March 31, 2008. The Charlson Comorbidity Index was used to measure patients’ comorbidities. Univariate analyses were performed to describe the study population. The chi-square test was used to assess the association between categorical variables. The Kaplan-Meier product-limit method and log-rank test were used to estimate and to test the difference in the distributions of hospital lengths-of-stay between patients with and without comorbidities. Cox regression modeling was used to estimate the comorbidities’ effect on hospital length-of-stay while adjusting for confounding factors. The restricted means of lengths-of-stay were given to estimate and compare the average duration of hospitalization. The effects of specific Charlson comorbidities on hospital length-of-stay were similarly investigated. Results: Forty-six percent (3588/7863) of patients were diagnosed with Charlson comorbidities. Those patients were significantly older (p<.0001), and more likely to be female (p=.006) and to have lower limb cellulitis (p<.001) and C. difficile infections (p<.0001), compared to patients without comorbidities. Patients with comorbidities stayed significantly longer in hospital (8.0 vs. 5.3 days, p<.0001). Comorbidities independently decreased the instantaneous discharge rate by 37% (95% CI, 34% to 40%, p<.001). Hospital lengths-of-stay increased with increasing index of comorbidity. The means of hospital lengths-of-stay for patients with a cumulative index of 1, 2, 3, and 4 (or more than 4) were 7.4, 7.6, 8.8, and 9.7 days, respectively. Conclusion: The Charlson Comorbidity Index is predictive of longer hospital lengths-of-stay in adult patients diagnosed with cellulitis and may be a useful tool in the decision-making process during clinical management of these patients. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-11-18 11:43:07.897

Thesis (M.H.A.)--University of Michigan, 1968.

Thesis (M.H.A.)--University of Michigan, 1968. / eContent provider-neutral record in process. Description based on print version record.

Objective: The objective of this study is to develop a national assessment of the length of stay (LOS), total costs, and in-hospital mortality among patients with chronic obstructive pulmonary disease (COPD), using retrospective data derived from Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). / Mylan School of Pharmacy and the Graduate School of Pharmaceutical Sciences; / Pharmacy Administration / MS; / Thesis;

The purpose of the study was to explore the relationship between schizophrenic patients' length of stay in a state psychiatric hospital and readily available intrapersonal, interpersonal, and sociodemographic factors. The factors selected for study were:1. Admission Legal Basis2. Relationship of Responsible Person3. Previous Episodes of Hospitalization 4. Sex5. Admission Age. 6. Marital Status7. Race8. Education9. DiagnosisThe subjects were 461 patients admitted to the Richmond, Indiana State Hospital from July 1, 1974 to June 30, 1979. All patients who met the criteria for selection were included.The design for the study was the ex post facto approach. It was essentially a Design 3 situation using only one group and holding to the assumption of random distribution of nonmanipulated variables. Two null hypotheses were tested using stepwise hierarchical multiple regression. The .05 level of significance was required.FindingsThe multiple regression analysis yielded a significant multiple correlation (R = .26, R2 = .07, P <.05) between length of stay as the dependent variable and the composite predictor variable. However, an inspection of the results showed that Admission Legal Basis was the only variable found to be individually significant. In view of the low amount (7%) of variance explained by the composite predictor variable, the analysis was terminated at that point and the results were not interpreted or considered to have a practical use.ConclusionThe only conclusion made was that the results of this study were inconclusive due to the small percentage of variance explained. Thus it was hypothesized that there were factors which remained unidentified that were in operation and greatly influenced length of stay.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (M.H.A.)--University of Michigan, 1959.

In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use. To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed. An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management. One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action. Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Background: Hospitalizations including the diagnosis of an eating disorder (ED) have increased significantly in the pediatric population over the past few decades. Patients who are male, who areage, who receive an nasogastric (NG) tube, or who require admission to a residential treatment program often remain in the hospital for longer periods of time. Few studies examining LOS exist for children and adolescents with an ED. Longer lengths of stay have previously been associated with factors such as having Medicaid, a reduced body mass index (BMI) upon admission, and a diagnosis of anorexia nervosa (AN). Objective: The purpose of this study is to examine risk factors related to a longer LOS in children and adolescents admitted to a large urban pediatric hospital with AN or bulimia nervosa (BN). Participants/setting: A retrospective cohort study was conducted in 65 patients 9-20 years of age who were admitted to Children’s Healthcare of Atlanta (CHOA) between January 1, 2014 and December 31, 2015. Statistical Analysis: Frequency statistics were used to describe the demographic, anthropometric, and clinical characteristics of the population. A Mann Whitney U test or Kruskal-Walllis test was used to examine differences in LOS by demographic characteristics, mode of nutrition therapy, discharge treatment program location, and admission BMI category. The association between LOS category by demographic and clinical characteristics was determined using a Chi-square statistic. Results: A total of 65 patients (94% female, 89% Caucasian) with a mean age of 14.6 ± 2.4 years were admitted during the study period. The median LOS was 9 days (IQR; 6, 13) and was significantly longer in those who had an NG tube placed vs. oral diet (11 days (IQR; 7, 21) vs. 8 days (IQR; 5, 9.3), respectively; p Conclusion: The characteristics of hospitalized pediatric patients with an ED were consistent with those of other studies. Longer lengths of stay in those who had an NG tube placed may have been due to the patient’s lack of compliance, failure to gain weight, and severity of malnutrition since more time is needed for medical recovery. More treatment centers for children and adolescents with an ED are needed in the state of Georgia to potentially reduce LOS. Future studies should include a greater percentage of males and larger population of children and adolescents.

This study was undertaken to assess factors contributing to difference in nutritional status of patients at high risk for malnutrition. Twenty-five patients hospitalized for treatment of cancer and other disorders and for surgery were assessed using anthropometric, biochemical and dietary measures.Significant malnutrition was found. Males, as compared with females, had lower percent triceps skinfold, percent weight-for-height, percent hemoglobin, decreased appetites and total iron binding capacity. Mean total iron binding capacity for males was 62 percent of normal suggesting acute malnutrition similar to kwashiorkor. Cancer patients had lower total lymphocyte counts than those with other diagnosis. Patients hospitalized more than 23 days showed evidence of marasmus, with lower percent mid-arm muscle circumference, percent hematocrit, percent hemoglobin and a tendency for decreased weight/height than those hospitalized for a short time. Compared with patients with good appetites, those experiencing poor appetites had increased caloric and protein needs but lower protein intake compared to needs and lower creatinine-height-index.Five subjects with decreased weight/height had lower total iron binding capacity. The mean was 61 percent of normal indication severe depletion. The mid-arm muscle circumference was 82 percent of normal suggesting acute malnutrition imposed upon compromised somatic protein stores. Nine subjects showed evidence of frank kwashiorkor, three other subjects experienced marasmic-kwashiokor indication acute malnutrition imposed upon chronic malnutrition.In conclusion, this study suggests several characteristic features of hospitalized patients at risk for malnutrition: hospitalization for over three weeks, inadequate caloric and protein intake relation to need and anorexia. These patients are candidates for nutritional assessment and support.