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PubMed2002

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder.

OBJECTIVE: Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. DESIGN: A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. SETTING: Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. SUBJECTS: Children and adolescents (2 to 18 years) presenting to an inpatient unit (n = 737). RESULTS: 10.3% (n = 76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent. CONCLUSION: PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Acute Disease↗
PubMed2003

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder.

OBJECTIVE: Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. DESIGN: A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. SETTING: Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. SUBJECTS: Children and adolescents (2 to 18 years) presenting to an inpatient unit (n = 737). RESULTS: 10.3% (n = 76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated were improved at treatment endpoint. Delays in seeking treatment and problems with the primary support group were highly prevalent. CONCLUSION: PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Adolescent↗
PubMed1991

Inpatient theophylline toxicity: preventable factors.

OBJECTIVE: To identify preventable factors contributing to inpatient theophylline toxicity. DESIGN: Case series. SETTING: Tertiary care public hospital. PATIENTS: Forty consecutive adult inpatients (mean age, 56.5 years) with theophylline levels greater than 140 mumol/L (25.0 mg/L). MEASUREMENTS AND MAIN RESULTS: A retrospective chart audit was done. Toxicity was produced in 27 of 40 patients by inpatient or emergency department theophylline administration. Management errors found included delay (greater than 10 hours) in taking action from time toxic blood levels were drawn (20 patients), inappropriately high dosing of patients with congestive heart failure (17 patients), failure to recognize obvious symptoms (16 patients), recurrent toxicity (11 patients), additional emergency department treatment of already toxic patients (7 patients), overlap of intravenous and oral therapy (6 patients), patient discharged with no physician awareness of toxicity or dosage change (5 patients). CONCLUSIONS: A set of recurring management errors was identified as contributing to inpatient theophylline toxicity. Effective preventive mechanisms could have prevented most toxicity and associated morbidity. Theophylline's overall risk-benefit ratio in the inpatient setting may be less than that measured in well-controlled studies of the drug's efficacy because of these management errors.

Adult↗
PubMed1997

How much does excess inpatient capacity really cost?

Traditional healthcare cost-accounting methods determine the cost of unused inpatient beds by calculating the fixed cost per patient-day using the number of patient days of inpatient care expected to be provided. Unfortunately, this approach can result in a misleading estimate of fixed costs per patient-day that fluctuate over time as expected levels of inpatient care fluctuate. A recommended alternative approach, practical capacity cost accounting, determines the cost of unused inpatient beds by calculating fixed costs per patient-day using the maximum feasible patient days of inpatient care that can be provided in a year. This approach yields stable fixed costs for more accurate costing of unused capacity and better long-range planning and decision making.

Accounting↗
PubMed1995

Accounting for the transition from inpatient to outpatient surgery.

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.

Ambulatory Surgical Procedures↗
PubMed1999

[Evaluation of ambulatory orthopedic-traumatologic rehabilitation by compensation insurance. A comparison with inpatient rehabilitation].

In 1994, "Ambulant Orthopaedic-Traumatologic Rehabilitation" (AOTR) was introduced by the Ersatzkassen health insurance funds. This study investigated structural, process and outcome quality. One of the study questions asked is whether AOTR is as effective for (1) patients with low back pain and clinical signs of disc problems and (2) patients with cruciate ligament injury as the routinely practised inpatient rehabilitation. In a quasi-experimental cohort study patients from five AOTR centers were compared to patients from five orthopedic rehabilitation clinics with regard to their rehabilitation outcome measured on the clinical, disability and handicap level. At the beginning (t0) and the end (t1) of the rehabilitation, data were collected from patients and therapists and 6 months later (t2) only from patients by means of questionnaires. The inclusion criteria for patients with back problems had to be broadened ("patients with low back pain") because of difficulties with patient sampling. Sample sizes were n = 166 (AOTR: 100, inpatient: 66) for t0 and t1 and n = 101 (AOTR: 47, inpatient: 54) for t0, t1 and t2. At baseline, ambulant patients with low back pain were younger (43 vs. 49 years) and better off with regard to disabilities and handicaps than patients from rehabilitation clinics. Clinical signs (e.g., neurological signs, Lasègue sign, flexibility of the spine) showed smaller differences. At t1 clinical, disability and handicaps variables had improved considerably in both groups. At t2 the improvements had stabilized or had become greater. Analyses of variance showed that improvements in the ambulant group were not much greater after accounting for the different baseline status. The sample size of patients with knee ligament injury was n = 66 (AOTR: 50, inpatient: 16). Ambulant patients considerably improved with regard to knee function and handicaps. Despite of small sample sizes this study provides some evidence that (1) AOTR and inpatient rehabilitation both are effective for treating subgroups of patients with low back pain and (2) AOTR is effective for treating patients with cruciate ligament injury.

Adult↗
PubMed2000

A national inpatient cost estimate of percutaneous endoscopic gastrostomy (PEG)-associated aspiration pneumonia.

OBJECTIVE: To present national estimates of the prevalence and costs of inpatient admissions for aspiration pneumonia (AP) associated with percutaneous endoscopic gastrostomies (PEGs) inserted before or during an admission. STUDY DESIGN: Retrospective analysis using medical claims. PATIENTS AND METHODS: National estimates of the prevalence of inpatient admissions associated with AP and mortality rates were developed, using data from the Nationwide Inpatient Sample of the Hospital Cost and Utilization Project (HCUP-3) Database. The MEDSTAT Group's MarketScan Private Pay Fee-for-Service (FFS) and Medicare FFS databases were used to calculate the percentage of admissions for AP that were preceded by a PEG or that entailed a PEG placement. Associated statistics, such as average length of stay and mean payments for these admissions, also were estimated. RESULTS: Approximately 300,000 inpatient admissions for AP took place in the United States in 1995, of which roughly 70,000 (23.9%) resulted in death. Approximately 10% of all AP admissions occurred after or entailed a PEG placement. After adjusting for differences in patients' age, gender, and health status, the total mean payments were estimated to be $26,618 per patient. This per-patient estimate translates into a national estimate of the cost of PEG-associated AP of approximately $808.2 million. CONCLUSION: The cost of PEG-associated AP is relatively high, as estimated in this study. The high inpatient mortality rates of AP imply that future efforts should be directed toward preventing AP.

Adolescent↗
PubMed2000

Preconditions and outcome of inpatient treatment in child and adolescent psychiatry.

Inpatient care is expensive and should ideally be provided for children and adolescents with the most serious psychiatric disorders. However, only little is known about inpatient treatment, e.g. the factors influencing hospital admission, the content of care in the hospital, the appropriate norms for the duration of inpatient stays, the inpatient arrangements that result in the best outcomes, or connection with necessary aftercare services. There are many methodological problems with existing research. However, it can cautiously be concluded that psychiatric hospitalisation of children and adolescents is often beneficial, particularly if special aspects of treatment are fulfilled (e.g. good therapeutic alliance, treatment with a cognitive-based problem-solving skills training package, or planned discharge) and aftercare services are available. The continuum-of-care model is promising because it provides opportunities to achieve better integration between inpatient interventions and aftercare services.

Adolescent↗
PubMed2000

Maximizing services along the continuum of care from inpatient to home.

The nurse managers of the inpatient pediatric units and home care division of Robert Wood Johnson University Hospital met to restructure and optimize the quality of care delivered to children and their families in the home setting. A program was developed using inpatient pediatric staff nurses to perform home visits to children requiring follow-up after an inpatient hospital stay. The nurse managers found home visits could comfortably be delivered by pediatric inpatient nurses if they were appropriately oriented and precepted by experienced home care nurses. When home visits were performed by the nurses who cared for the patient in the hospital, both the child and the family appeared to have an increase in comfort and self-confidence in caring for their child. The program also was successful in reducing the costs associated with pediatric home care. This was achieved by facilitating the downsizing of the inpatient units in periods of low census, as well as in cost avoidance associated with not paying benefits to additional employees that otherwise would have been hired by the home care department. This program could be implemented successfully in institutions that support communication, coordination, and continuous improvement of the programs provided to children and families.

Aftercare↗
PubMed2001

[Epidemiologic survey on mental health of maxillofacial traumatic inpatients].

OBJECTIVE: To Analyze the mental health level of maxillofacial traumatic inpatients. METHODS: The mental test was carried out in 126 maxillofacial traumatic inpatients of Department of Oral and Maxillofacial Surgery of the Fourth Military Medical University from 10/1998 to 09/1999 with the SCL-90 (symptom check list-90). RESULTS: The total mark of SCL-90 was 153.76 +/- 62.44. The number of symptomatic items was 31.52 +/- 24.55, which was higher than that of domestic norm (P < 0.01). The inpatient constitutes at different level of SCL-90 total mark showed normal distribution. The every factor mark of SCL-90 was also higher than that of domestic norm (P < 0.01). The former four factors were melancholy, anxiety, horror and psychosis. The SCL-90 factors mark had an increased trend along with injury severity score (RISS). The age and sex had not notable influence on the mental health level (P > 0.05), but the educational level had notable influence on the mental hralth level (P < 0.05). CONCLUSIONS: The mental health level of maxillofacial traumatic inpatients is lower than normal people and has a decreasing trend along with the RISS. The inpatient that has lower educational level also has lower mental health level. The mental handicap is caused by traumatic event and nosocomial stress.

Adolescent↗
PubMed2003

[Retrospective analysis for first-visiting case data of 272 SARS inpatients in Peking University Third Hospital].

OBJECTIVE: The first-visiting cases of total 272 SARS inpatients admitted in SARS wards in Third Hospital from April 10, 2003 to May 12 were analyzed retrospectively. The clinical characteristics and diagnostic decision for these patients were described. METHODS: The enrollment of inpatients was ruled with two official standards, i.e., 'Clinical Standards for Diagnosis of SARS, Trial Edition' from Health Ministry, and 'Diagnostic Standards for SARS' from Joint Force of Prevention and Therapy for SARS in Beijing, PRC. The present work was based on the first-visiting case records of these SARS inpatients. RESULTS: The characteristics of gender, age, occupation, contagious history and previous therapy were described in SARS inpatients when they visited the outpatient department for SARS in the first time; the clinical symptoms, physical signs, blood WBC counts and X-ray in lungs were also analyzed. In 272 inpatients who were admitted into SARS wards at their first visiting, 145 patients (53.5%) were finally diagnosed as SARS, well as 97 patients (35.7%) were eliminated. CONCLUSION: In the first visiting of the suspectable SARS patients, the contagious history, clinical symptoms, laboratory results and lung X-ray should be studied comprehensively and thoroughly to avoid omitted or mistaken diagnosis. Most final diagnosis came from the revising of the original decision. The advances in SARS virology and immunology may provide more accurate evidences in SARS diagnosis.

Adult↗
PubMed2003

Establishing minimal clinically important differences for scores on the pediatric evaluation of disability inventory for inpatient rehabilitation.

BACKGROUND AND PURPOSE: Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. SUBJECTS AND METHODS: A retrospective review was done of the medical charts of 53 children and youth (1-19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. RESULTS: The MCIDs ranged from 6 to 15 points (X=11.5, 95% confidence interval= +/- 2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (tau =.73-.80). DISCUSSION AND CONCLUSION: Across all scales, PEDI change scores on the order of about 11% (0-100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Activities of Daily Living↗
PubMedDate not supplied

Population based study of the cost of inpatient care for HIV-lnfected individuals in an Irish teaching hospital.

A microcosting evaluation of the cost of inpatient care of 69 HIV-infected patients in an Irish teaching hospital was conducted from the hospital perspective. The median cost per admission was 6220 Euros and median cost per inpatient day was 557 Euros. HIV related admissions were associated with a greater cost per admission than non-HIV related admissions. There was an inverse relationship between inpatient costs and CD4 count. Ward costs accounted for the majority of inpatient expenditure. This is the first detailed study of the cost of inpatient care for HIV-infected individuals in Ireland. This study provides the data necessary to estimate the burden of HIV disease in Ireland and to evaluate the cost-effectiveness of antiretroviral and other strategies to manage HIV infection in the Irish context.

Female↗
PubMed2005

Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: a randomized clinical trial.

OBJECTIVE: To compare satisfaction levels after reconstruction of the anterior cruciate ligament (ACL) between inpatients and outpatients by means of a valid and comprehensive outcome tool. METHODS: Fifty patients examined at a tertiary clinic who met the study's inclusion criteria (15-50 yr old, no previous ACL reconstruction, > 6 h after injury, living < 1 h from hospital, assigned a caregiver for outpatient management within 48 h of injury, no serious health condition, no known hypersensitivity to ASA/NSAIDs, bleeding disorder or gastric ulcer, ability to cope at home after operation) were recruited and randomized into either the inpatient or outpatient groups. Inpatients stayed overnight in hospital after their ACL reconstruction and were discharged home the next day. Outpatients were discharged home on the day of the procedure. All patients attended a preoperative educational session and were required to meet the same discharge criteria (able to bear weight using crutches and to void, to be reasonably pain free, no nausea or vomiting, no excess bleeding or drainage, be alert, be given take-home medications and be in the company of a caregiver). Standardized anesthetic and postoperative analgesic protocols were used. One week after ACL reconstruction, patient satisfaction was quantified with a previously validated visual analogue questionnaire (maximum score of 100). RESULTS: We collected data on 21 inpatients and 19 outpatients. The mean overall-satisfaction score of the outpatient group was higher than that of the inpatient group (85.1 v. 78.2, p = 0.015). Between-group differences in postoperative pain, nausea, rate of readmission and complications were not significant. CONCLUSION: As determined by a comprehensive, population-specific, validated outcome, patient satisfaction is higher when ACL reconstruction is done on an outpatient basis.

Adolescent↗
PubMed2001

Measuring population health risks using inpatient diagnoses and outpatient pharmacy data.

OBJECTIVE: To examine and evaluate models that use inpatient encounter data and outpatient pharmacy claims data to predict future health care expenditures. DATA SOURCES/STUDY DESIGN: The study group was the privately insured under-65 population in the 1997 and 1998 MEDSTAT Market Scan (R) Research Database. Pharmacy and disease profiles, created from pharmacy claims and inpatient encounter data, respectively, were used separately and in combination to predict each individual's subsequent-year health care expenditures. PRINCIPAL FINDINGS: The inpatient-diagnosis model predicts well for the low-hospitalization under-65 populations, explaining 8.4 percent of future individual total cost variation. The pharmacy-based and in patient-diagnosis models perform comparably overall, with pharmacy data better able to split off a group of truly low-cost people and inpatient diagnoses better able to find a small group with extremely high future costs. The model th at uses both kinds of data performed significantly better than either model alone, with an R2 value of 11.8 percent . CONCLUSIONS: Comprehensive pharmacy and inpatient diagnosis classification systems are each helpful for discriminating among people according to their expected costs. Properly organized and in combination these data are promising predictors of future costs.

Adolescent↗
PubMed2005

[Does improvement of symptoms four weeks after the begin of psychodynamic inpatient psychotherapy correspond to long term outcome?].

OBJECTIVES: This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. METHODS: Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). RESULTS: The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. DISCUSSION: In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Adaptation, Psychological↗
PubMed1989

A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Part I. Pain, disability, compliance, and reported treatment benefits three months after treatment.

Outcome of inpatient and outpatient treatment of low back pain was studied in 459 patients (aged 35-54 years, 63% men); 156 inpatients, 150 outpatients and 153 controls. Changes in low back pain and in disability caused by it, and adherence and accomplishment of back exercises were used as short-term outcome criteria. The overall results showed a significant decrease in pain and disability and better compliance in the two treated groups when compared to the controls. There was also a significant difference in treatment gains between the inpatients and outpatients; i.e. the decrease in pain was greater and the frequency of back exercises higher in the inpatients. The inpatients also estimated their treatment benefits more positively than the outpatients.

Adult↗
PubMed1994

[Cost/benefit relations: evaluation of inpatient and ambulatory rehabilitation].

Three different forms of rehabilitation in patients after myocardial infarction are discussed on the basis of cost-effectiveness: 1) outpatient rehabilitation as performed in North America and other developed countries, 2) inpatient rehabilitation in Germany, and 3) outpatient rehabilitation in Germany. Parameters compared are mortality, coronary risk factor profile, and return to work. A metaanalysis of international studies on outpatient rehabilitation demonstrated a significant reduction of total and cardiovascular mortality. Similar data are not available for inpatient rehabilitation in Germany. However, data of 6 years of outpatient rehabilitation as performed in the "Heidelberg Study" demonstrate a continuous significant improvement in coronary risk factor profile and cardiopulmonary fitness. On the other hand, 4 weeks of inpatient rehabilitation exhibited only short-term and no long-lasting effects (4 years) on coronary risk factor profile. The economic benefit can be based on return to work, which is only marginally affected by rehabilitation in the USA, where more than 80% of the patients are back to work 6 months after myocardial infarction. In Germany, about 5 months after myocardial infarction 50% of the patients are retired, despite 4-6 weeks inpatient rehabilitation; i.e., the patients which are back to work can be assumed to be less than 50%. The costs of 8 weeks outpatient rehabilitation in North America has been calculated to be 804 DM per patient, 4 weeks of inpatient rehabilitation amounts to about 5320-5600 DM, and 1 year ambulatory treatment in the "Heidelberg Study" accounts for 2270 DM per patient. It can be concluded: outpatient rehabilitation as performed in North America has been shown to significantly reduce total and cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗