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At least 19 recordsLinked to original sources
PubMed2000

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures.

BACKGROUND: Hip fracture is a major cause of morbidity in older people and its impact, both on the individual and to society, is substantial. OBJECTIVES: To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual orthopaedic care, for older patients with hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline (up to April 1998), and reference lists of published papers and books. We also contacted colleagues and trialists. SELECTION CRITERIA: Randomised and quasi-randomised trials of postsurgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture. DATA COLLECTION AND ANALYSIS: Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling of data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors. MAIN RESULTS: In this minor update, one new trial is identified and has been placed in "studies awaiting assessment". Of another three trials previously pending assessment, one has now been excluded. The five included trials involved 1068 patients. The combined outcomes of death or requiring institutional care at final follow-up showed no significant difference between intervention and control groups (Peto odds ratio 0.92; 95% confidence interval 0.71 to 1.18). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a Peto odds ratio of 0.83 (95% confidence interval 0.64 to 1. 07). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no detrimental effect from the intervention. The review update did not result in any new data for these outcomes. REVIEWER'S CONCLUSIONS: The trials reviewed had different aims, interventions and outcomes. As a consequence, results were heterogeneous and the question of effectiveness of different types of co-ordinated inpatient rehabilitation after hip fracture cannot be answered conclusively. There is a trend to effectiveness when combined outcome variables (death and institutional care, death and deterioration in function) are considered. Future trials of postsurgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.

Aged↗
PubMed2001

How do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals?

BACKGROUND: Inpatient care in the United States accounts for one third of the health care expenditures. There exists a well-established trend towards fewer inpatient admissions and shorter lengths of stay for all inpatient care, which can be attributed to cost containment efforts through managed care and advances in treatment technologies. However, different illnesses may not necessarily share the same pattern of change in inpatient care utilization. In particular, mental health and substance abuse (MHSA) care has experienced a particularly dramatic growth of specialized managed behavioral organizations, which could have led to an even faster decline. AIMS OF THE STUDY: This study contrasts the trends of MHSA inpatient care in U.S. community hospitals with medical inpatient care over the years 1988 to 1997. It also analyzes the trends for subgroups of MHSA stays by diagnostic groups, age and primary payer. METHODS: We use the National Inpatient Sample (NIS) from the Health Care Cost and Utilization Project (HCUP) to estimate both number of inpatient discharges per 1,000 population and average length of stay over the years and relate the two indices. Inpatient MHSA stays are categorized into subgroups by age, primary payer of the care, and diagnostic group. We use the Clinical Classification Software (CCS) to distinguish between affective disorders, schizophrenia and related disorders, other psychoses, anxiety and related disorders, pre-adult disorders, and alcohol-, substance- related mental disorders and other mental disorders. Trends of population adjusted discharges and length of stay were tested using a weighted least squares method. RESULTS: Population-adjusted MHSA discharges from community hospitals increased by 8.1% over the study period, whereas discharges for all conditions decreased. Within MHSA discharges, the 20-39 and 40-64 age groups experienced significant increase relative to other age group; the increase was particularly high for affective and psychotic disorders, which are only partially offset by a decrease for other diagnostic groups. Hospitalization for both MHSA and medical conditions displayed trends towards shorter lengths of stay, but with the decline for MHSA stays steeper (40%) than for all stays (21%). The reduction in length of stay not only applied to the privately insured, for which managed behavioral health care had the highest penetration rate, but held for all other payers as well, although the rate of decline is higher for private insurance than for other insurance. Inpatient stays with pre-adult disorders displayed the greatest percentage decline for both population-adjusted discharges and average length of stay. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Different pattern of utilization emerged for MHSA inpatient care as compared to hospitalization for all medical care over the years 1988-97. The more rapid decline in length of stay for MHSA stays than for all stays may have been a result of greater incentive for cost containment and therefore more intensive care management, and advances in treatment technology, especially medication. However, the fast decline in length of stay may also have led to repeat hospitalization as a result of premature discharges for patients with affective or psychotic disorders. Some financial incentives, such as case-rates or DRG-type payments to hospitals could have contributed to such adverse effects. Increases in discharges for severe disorders could also be a consequence of shifts from long-term facilities (for which no comparable data are available) to community hospitals, although the largest absolute and relative increases were for affective disorders rather than schizophrenia or other psychoses, the two disease subgroups that make up the majority of the institutionalized patients. International comparisons, assisted by new data, may help disentangle the effect of institutional change and that of development in treatment technology or practice pattern.

Journal Article↗
PubMed2003

[Clinical investigation on adult inpatients contracted measles; comparing with pediatric measles inpatients].

Age distribution, history of vaccination against measles, clinical signs and symptoms were investigated among a total of 113 adult measles patients admitted in our hospital between January, 2000 and December, 2002. The maximum body temperature, duration of fever, presence of Koplik spot and exanthema among these adult inpatients were compared with those among 1-to-5-year-old inpatients having measles. Concerning age distribution, the peak was found at the age of 20-24 years. Most of adult inpatients had not contracted measles until then and had not been vaccinated against measles. The infection route was unknown except a small number of inpatients. Clinical signs and symptoms among adult inpatients were about the same of those in pediatric inpatients except a sore throat. Complications occurred in 17 cases out of 113 adult inpatients, 4 of them had encephalitis or acute disseminated encephalomyelitis and the other 4 cases contracted pneumonia. Among the 45 child inpatients, whereas, 23 had complications, 13 of them had pneumonia, 3 contracted otitis media, and an additional 3 suffered from both pneumonia and otitis media. From the results it is reasonably concluded that clinical signs and symptoms among adults impatients with measles are comparable with those of pediatric measles inpatients or slightly severer.

Adolescent↗
PubMed2006

Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service.

AIMS: To compare diabetes bed occupancy and inpatient length of stay, before and after the introduction of a dedicated diabetes inpatient specialist nurse (DISN) service in a large UK Hospital. METHODS: We analysed bed occupancy data for medical or surgical inpatients for 6 years (1998-2004 inclusive), with a DISN service in the final 2 years. Excess bed days per diabetes patient were derived from age band, specialty, and seasonally matched data for all inpatients without diabetes. We also analysed the number of inpatients with known diabetes who did not have diabetes recorded as a discharge diagnosis. RESULTS: There were 14,722 patients with diabetes (9.7% of all inpatients) who accounted for 101 564 occupied bed days (12.4% of total). Of these, 18 161 days (17.8%) were excess compared with matched patients without diabetes, and were concentrated in those < 75 years old. Mean excess bed days per diabetes inpatient under 60 years of age was estimated to be 1.9 days before the DISN appointment, and this was reduced to 1.2 bed days after the appointment (P = 0.03). This is equivalent to 700 bed days saved per year per 1000 inpatients with diabetes under 60 years old, with an identical saving for those aged 61-75 years (P = 0.008), a saving of 1330 diabetes bed days per year by one DISN. Excess diabetes bed occupancy was 167 excess bed days per year per 1000 patients with diabetes in the local population after the DISN appointment. One quarter of the known Type 2 diabetes population were admitted annually, but one quarter of patients had no diagnostic code for diabetes. CONCLUSIONS: Diabetes excess bed occupancy was concentrated in patients < 75 years old, and this was reduced notably following the introduction of a DISN service.

Adult↗
PubMed2000

The inpatient care of patients with diabetes mellitus and foot ulcers. A validation study of the correspondence between medical records and the Swedish Inpatient Registry with the consequences for cost estimations.

OBJECTIVES: To compare the correspondence of discharges and diagnoses between medical records and an administrative database in diabetic patients with foot ulcers and to calculate inpatient costs from the different sources. DESIGN: Discharge data from 117 prospectively followed patients were compared with information from the Swedish Inpatient Registry during the same treatment period for each patient. Non corresponding discharges were retrospectively reviewed in patient records. Costs of inpatient care were calculated from clinical sources and from data selected in three different ways from the database. Information in medical records was assumed to represent the 'Gold Standard'. SETTING: In-hospital treatment, multidisciplinary foot-care team. SUBJECTS: A total of 117 diabetic patients with deep foot infections. MAIN OUTCOME MEASURES: Degree of database completeness and inpatient costs. RESULTS: The degree of completeness of discharges in the database was 98%, but 8.6% of discharges had no code for diabetes and 13% were registered without any foot related diagnosis code. Less than 20% of discharges were found with selection based on primary diagnosis 250.G only. Total inpatient costs varied from 2.7 to 13.3 million SEK (Swedish Kronor) depending on selected diagnosis codes. Approximately 84% of all foot ulcer discharges could be found in the database if codes with both diabetes mellitus and foot ulcer diagnoses were selected. CONCLUSIONS: Inpatient costs for foot complications cannot be accurately estimated from the Inpatient Registry when based on primary diagnosis exclusively. Fairly good estimates at a low data acquisition cost can be made with a combination of foot related diagnoses together with codes for diabetes.

Adult↗
PubMed2002

Monitoring consumer satisfaction with inpatient service delivery: the Inpatient Evaluation of Service Questionnaire.

OBJECTIVE: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients. METHOD: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to satisfaction. Mean importance scores highlighted 20 items that were subsequently framed into neutrally worded statements. A draft questionnaire comprising these statements was introduced, on a trial basis, in a range of inpatient facilities. RESULTS: Factor analysis of 356 completed questionnaires yielded three factors comprising a staff-patient alliance; doctor/treatment issues; and an environmental component. Psychometric properties include good response variability and high internal consistency. CONCLUSIONS: The Inpatient Evaluation of Service Questionnaire addresses many of the shortcomings of existing satisfaction measures. It was developed through extensive consumer involvement, it is simply worded, easy to score and appears to perform well with acute and rehabilitation inpatients.

Consumer Behavior↗
PubMed2000

Organised inpatient (stroke unit) care for stroke.

BACKGROUND: Specially organised stroke units can be a ward or team that exclusively manages stroke patients (a dedicated stroke unit) or a ward or team that provides a generic disability service (a mixed assessment or rehabilitation unit). OBJECTIVES: The objective of this review was to assess the effect of care in a stroke unit compared with conventional care of patients following a stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register, reference lists of articles and contacted researchers in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing organised inpatient stroke unit care with conventional care. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility and trial quality. The principal reviewer conducted a structured interview with the coordinators of unpublished trials. MAIN RESULTS: Twenty trials were included. Stroke unit care showed a reduction in the odds of death recorded at final follow-up (median one year). The odds ratio was 0.83, 95% confidence interval 0.71 to 0.97. The odds of death or institutionalised care were lower (0.76, 95% confidence interval 0.65 to 0.90) as were death or dependency at final review (odds ratio 0.75, 95% confidence interval 0.65 to 0.87). Subgroup analyses showed that the observed benefits were independent of patient age, sex, stroke severity, and types of stroke unit organisation. There was no indication that organised stroke unit care resulted in increased hospital stay, although there was heterogeneity between the trials. REVIEWER'S CONCLUSIONS: Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The apparent benefits are not restricted to any particular sub-group of patients or model of stroke unit care. No systematic increase was observed in the length of inpatient stay.

Hospital Units↗
PubMed1999

Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care.

BACKGROUND: This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care. METHODS: A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt. RESULTS: Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8-6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5-0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5-0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2-30.0) in acute inpatient care; 2.1 (95% CI = 1.0-4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7-3.0) in community-based care. This effect remained after adjustment for demographics. CONCLUSION: Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings.

Acute Disease↗
PubMed2001

Inpatient utilization of medical services associated with peripheral arterial disease-related inpatient procedures in the Department of Defense.

The objective of this study was to describe the inpatient procedural medical care utilization the first 10 years after initial inpatient confirmation of peripheral arterial disease (PAD). A retrospective review was carried out of the computer records of all the army beneficiaries of the Department of Defense healthcare system since 1971. Over 8000 subjects with an initial inpatient confirmation of PAD between January 1, 1980 and December 31, 1985 were reviewed for 10 years following the initial visit. The utilization of PAD-related invasive procedures gradually increased over the first 8 years, and rose sharply in the ninth and tenth years after initial diagnosis, while the utilization of examination procedures was highest in the first, fifth to seventh, ninth and tenth years. Procedures involving bypass and amputation had the highest utilization among invasive procedures, while procedures involving arteriography and ultrasonography accounted for 88% of all examination procedures. Bypass and repair of vessel procedures gradually rose throughout the 10 years after initial diagnosis, while amputations and skin grafts remained relatively constant. Procedures involving arteriography rose until year 5 and then tapered off, while utilization of ultrasonography rose in year 7 and tapered off. These results suggest that PAD-related studies should consider the progression of the disease past the fifth year after the initial inpatient visit for PAD when measuring a change in outcomes.

Adult↗
PubMed1998

[Evaluation of gerontopsychiatric treatment. II: On the effectiveness of clinical ambulatory, partial inpatient and inpatient treatment of elderly psychiatric patients].

Based on data of a quantitative prospective longitudinal study (one year) with mentally disordered elderly aged 60 years and older in two geronto-psychiatric catchment areas in Northrhine-Westfalia (FRG, the City of Bielefeld and the district of Gütersloh) we compare in this second part of our investigation the effects of clinical outpatient-, day hospital- and inpatient treatment settings. Criteria of comparison are the outcome variables: (re-)admission rates within one year, development of severity of psychiatric symptoms and that of need of care in a gerontopsychiatric population (t1: N = 124, t2: N = 90). Important results of this study are: home based outpatient and day hospital treatment reduce the risk of (re-)admission into hospital significantly in contrast to inpatient treatment for all diagnostical groups of mental disorders within one year. Clinical gerontopsychiatric outpatient treatment for elderly with functional psychic disorders is more effective (in terms of development of need of care) than inpatient and--surprisingly--also than day hospital treatment. For older people with organic psychoses (mostly dementia), however, the development of severity of psychiatric symptoms as well as that of their need of care doesn't show any differences between the three groups of patients (in-/outpatient and day hospital). But outpatient and day hospital treatment also don't have worse effects on the patients than inpatient treatment.

Aged↗
PubMed1986

The effect of waiting for inpatient alcoholism treatment after detoxification. An experimental comparison between inpatient treatment and advice only.

Seventeen detoxified alcoholics were randomly assigned to a waiting list group or an inpatient treatment group. The waiting list group members were informed that they had to wait some time until there was a vacant place. By their discharge from the Detoxification Unit they were told to complete a self-report form every day with regards to drinking, working, sleeping home and use of disulfiram orally. Two weeks later they had an outpatient appointment in which the self-reports were collected and reviewed. This was repeated once for everybody so that they all had to wait 4 weeks. By discharge from further inpatient treatment, the inpatient treatment group was instructed to record the same four behaviors daily as the waiting list group did, and they, too, got an outpatient appointment with a 2 week interval. No significant differences between the groups were observed in the three main variables of drinking, working and sleeping home, but the waiting list group used significantly more disulfiram than the inpatient treatment group.

Adult↗
PubMed1989

Completed suicide in psychiatric inpatients and former inpatients. A comparative study.

A total of 49 psychiatric inpatient suicides were compared with 53 former psychiatric inpatients who had committed suicide within one year after their discharge. Significant differences were found in the diagnostic distribution of both groups, especially the predominance of schizophrenics among inpatient suicides, and of alcoholics and drug abusers among suicides of former inpatients. Furthermore, some other important differences between the groups emerged that bore practical implications. In different diagnostic groups suicide occurs for different reasons and based on different psychosocial backgrounds. In the investigation of suicide in psychiatric patients, homogeneity of the population studied in terms of patient status should be strived for.

Adolescent↗
PubMed2005

Where schizophrenic patients commit suicide: a review of suicide among inpatients and former inpatients.

OBJECTIVE: To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies for future interventions. METHOD: A computerized MedLine, Excerpta Medica and PsycLit search supplemented by an examination of cross-references and reviews. RESULTS: Up to half the suicides among patients with schizophrenia occur during inpatient admission. Inpatient suicides were found among those of a young age group who were predominantly single, childless and socially isolated. The vast majority experienced an illness characterized by long duration and prolonged psychiatric hospitalizations or multiple admissions and discharges. Up to 50% of the suicides occurred in the first few weeks and months following discharge from the hospital. The paranoid subtype of schizophrenia, where positive symptoms prevail and negative symptoms are few, is associated with a suicide risk that is three times greater than that associated with nonparanoid subtypes and eight times greater than the risk associated with the deficit subtype. CONCLUSIONS: Treatment of suicide is a major problem among inpatients with schizophrenia. Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital. Strategies aimed at preventing this phenomenon have been introduced to the medical personnel, but suicide in these patients does not seem to have been reduced. We emphasize the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia.

Hospitalization↗
PubMed2001

Validity of the pediatric inpatient behavior scale in an inpatient psychiatric setting.

Standardized assessment of children's behavior during psychiatric hospitalization is increasingly important for evaluation, chart documentation, treatment planning, and outcome monitoring, yet little research has been done to validate the use of behavior checklists developed specifically to assess in-hospital behavior. The Pediatric Inpatient Behavior Scale (PIBS) was evaluated for its validity as a measure of behavior of children hospitalized on a psychiatric unit. Nurses completed the PIBS for 41 children, based on behavior observed during the first week of hospitalization. DSM-IV diagnoses and major symptoms were coded based on chart review, and children completed self-report measures of depression and anxiety. The Pediatric Inpatient Behavior Scale subscale scores were related significantly to diagnosis, as well as to major symptoms, correctly classifying 75 to 85% of cases. The Pediatric Inpatient Behavior Scale subscale scores also significantly correlated with self-reported symptoms of depression, but not symptoms of state anxiety. Results support the use of the PIBS as a behavioral instrument for hospitalized children with severe psychopathology.

Adolescent↗
PubMed1983

Inpatient violence and the schizophrenic patient. A study of Brief Psychiatric Rating Scale scores and inpatient behavior.

A correlational analysis of Brief Psychiatric Rating Scale (BPRS) ratings and measures of inpatient violence in 207 schizophrenic patients is presented. Significant correlations were found between BPRS measures of schizophrenic symptomatology and several measures of inpatient violence including assault. BPRS subscales which related to paranoid symptoms were also significantly correlated with inpatient danger-related measures; however, to a lesser degree.

Adult↗
PubMed1999

Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians.

The number of hospital-based physicians, or hospitalists, in the United States has grown rapidly, yet no published data have characterized hospitalists or their practices. A self-administered questionnaire was used to describe 1) the features of hospitalists, 2) the hospitals in which they practice, and 3) the practice of inpatient medicine. The questionnaire contained 48 questions that covered four domains: demographic information about the respondent, the clinical and nonclinical workload and responsibilities of the respondent, organizational and financial aspects of the respondent's practice, and the respondent's satisfaction and his or her perception of the reaction of other physicians and nurses to the hospitalist system. The overall response rate was 57%. Data are reported on 372 surveys. Respondents were young and most were men, and only 48% had practiced hospital-based medicine for more than 2 years. Eighty-nine percent of respondents were internists; of these, 51% were generalists and 38% were subspecialists. Most hospitalists limited their practices to the inpatient setting, but 37% practiced outpatient general internal medicine or subspecialty medicine in a limited capacity. In addition to providing care for inpatients, 90% of hospitalists were engaged in cohsultative medicine. Quality assurance and practice guideline development were the most frequently reported nonclinical activities (53% and 46%; respectively). Small group practices (31%) and staff-model health maintenance organizations (25%) were the most common practice settings, and 78% of participants were reimbursed through salary. Financial incentives were common (43%) but modest. Accurate information about hospitalists and their practices will be important to clinicians, educators, researchers, and policymakers as the hospitalist movement continues to grow.

Adult↗
PubMed1990

[Inpatient therapy in child and adolescent psychiatry--analyses of a inpatient population].

The study deals with 207 inpatients' medical histories at a university clinic for child and adolescent psychiatry. Antisocial behavior, emotional and neurotic as well as psychosomatic disorders were the most frequent disorders to be treated. The inpatients were characterized through a remarkable high rate of psychosocial stress factors in their natural environment. The choice of special interventions and the length of treatment was not related to the diagnosis. The function of an inpatient treatment unit is discussed.

Adolescent↗