Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

Verma, Amol A.; Guo, Yishan; Kwan, Janice; Lapointe‐Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Razak, Fahad

doi:10.1007/s11606-018-4591-7

Cited by 41 publications

(46 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It may be difficult to organize programs around individual diseases, because no single condition accounted for more than 6.0% of short stays, consistent with the heterogeneity of this population. 32 However, certain conditions were more common among patients with short stays: chest pain, syncope, hypertension, intestinal infection and vertigo. Several of these represent conditions in which patients have a brief stay for clinical monitoring.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study

Verma

Guo²,

Kwan

et al. 2019

cmajo

Self Cite

View full text Add to dashboard Cite

H ospital care accounts for nearly 30% of health care costs in Canada. 1 Given the high costs of hospital care, there is substantial interest in averting unnecessary hospital admissions and reducing length of stay. Interventions designed to avoid admission 2 or reduce the length of stay have included hospital-at-home, 3 short-stay or observation units, 4-8 and rapid-access clinics. 9 Patients with short stays may be candidates for these models of expedited and streamlined care. Patient age, illness severity, level of comorbidity and functional status have all been associated with longer hospital stays. 10-16 However, less is known about the situational and phys ician factors and resource use associated with short medical stays. The proportion of medical admissions associated with a short stay and the conditions that account for these short stays are also not well described. This information may highlight opportunities to improve care. To inform the design of interventions that target patients with potentially avoidable hospital admissions or brief stays, we examined the patient, physician and situational characteristics associated with short stays among patients admitted to general internal medicine wards. In addition, we describe the use of hospital resources by these patients. Methods Design, setting and participants This was a multicentre cross-sectional study involving 5 academic hospitals in Toronto that were participating in the General Medicine Inpatient Initiative (GEMINI). 17 The participating sites included St.

show abstract

Section: Discussionmentioning

confidence: 99%

Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study

Verma

Guo²,

Kwan

et al. 2019

cmajo

Self Cite

View full text Add to dashboard Cite

show abstract

“…Therefore, we excluded 579 PICC placements from the institution during that time (representing 12% of all PICC placements). General medicine patients in participating hospitals have previously been described in detail 10–12. They represent nearly 40% of emergency department admissions and 25% of hospital bed days and are broadly similar to other general medicine inpatient populations in Canada, Europe and the USA 10…”

Section: Methodsmentioning

confidence: 99%

Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundPeripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).MethodsThis was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.ResultsAmong 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.ConclusionsClinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

show abstract

“…Of the 11 (0.9%) patients who had a cardiac thrombus, 5 already had an indication for anticoagulation (most often atrial fibrillation). For the remaining 6 patients, 5 were Prior stroke or TIA 243 (19) 139 24Diabetes mellitus 340 (27) 149 (25) Coronary artery disease 128 (10) 60 (10) Heart failure 73 626 4Antiplatelet use 396 (31) 215 (36) Anticoagulant use 141 (11) 75 (13) Note: SD = standard deviation, TIA = transient ischemic attack. *Unless stated otherwise.…”

Section: Echocardiographic Findingsmentioning

confidence: 99%

“…35 Second, our study included only patients admitted to hospital with stroke or TIA, and thus we may have overestimated the prevalence of echocardiographic abnormalities because patients in hospital might have a higher burden of comorbid conditions or more severe stroke compared with patients managed as outpatients. 36 Third, we identified patients with stroke or TIA by their most responsible discharge diagnosis. Although the diagnostic codes we used have been validated in other Canadian hospitals, 19,37 we may have missed patients who presented with stroke-like symptoms but were subsequently given a different diagnosis.…”

Section: Limitationsmentioning

confidence: 99%

Health Services

Fralick

Goldberg

Rohailla

et al. 2019

CMAJ

Self Cite

View full text Add to dashboard Cite

S troke is the third leading cause of death in high-income countries, and accounts for substantial morbidity in those who survive. 1 Ischemic stroke is primarily due to a thrombotic or embolic event, and emboli frequently originate in the heart. 2 Transthoracic echocardiography can sometimes diagnose cardiac sources of embolism, such as atrial or ventricular thrombus, 3-5 and these generally require anticoagulation. Transthoracic echocardiography can also identify other causes of stroke that may require intervention, such as atrial abnormalities (e.g., patent foramen ovale, atrial myxoma) 6-8 or infective endocarditis. Transthoracic echocardiography is often recommended to plan secondary stroke management, but it is unclear how often this test provides clinically actionable findings. 4,9 Previous studies provide a range of conflicting estimates for how often transthoracic echocardiography might affect patient management because of changing opinions on what pathology is considered clinically relevant. 10,11 For example, dilated cardiomyopathy is no longer an indication for anticoagulation among patients with stroke. 12 Other findings previously considered to be incidental, such as patent foramen ovale, are now clinically actionable among patients with cryptogenic stroke. 6-8 Current stroke clinical practice guidelines do not reflect these nuanced data, making it challenging for physicians to know which patients should have transthoracic echocardiography after an ischemic stroke. 9,13,14 Furthermore, data that are both comprehensive and recent are lacking to further understanding of how often patients in routine care with stroke will have echocardiographic findings that are clinically actionable. Choosing Wisely 15 advocates against routine low-value care that is unlikely to improve patient care or is likely to cause harm. Transthoracic echocardiography is unlikely to cause direct patient harm but may cause indirect harm; for example, where incidental findings lead to invasive testing (i.e., transesophageal echocardiography) and expose patients to additional risks. Awaiting transthoracic echocardiography can also RESEARCH HEALTH SERVICES

show abstract

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

Cited by 41 publications

References 18 publications

Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study

Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study

Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data

Health Services

Contact Info

Product

Resources

About