Study objective: We sought to determine the proportion of emergency department patients who frequently use the ED and to compare their frequency of use of other health care services at non-ED sites. Methods: A compute...
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Study objective: We sought to determine the proportion of emergency department patients who frequently use the ED and to compare their frequency of use of other health care services at non-ED sites. Methods: A computerized patient database covering ail ambulatory visits and hospital admissions at all care facilities in the county of Stockholm, Sweden, was used. Frequent ED patients were defined as those making 4 or more visits in a 12-month period. Results: Frequent users comprised 4% of total ED patients, accounting for 18% of the ED visits. The ED was the only source of ambulatory care far 13% of frequent versus 27% of rare ED users (1 ED visit). Primary care visits were made by 72% of frequent ED users versus 57% by rare ED visitors. The corresponding figures for hospital admission were 80% and 36%, respectively. Frequent ED visitors were also more likely to use other care facilities repeatedly: their odds ratio (adjusted for age and sex) was 3.43 (95% confidence interval [Ct] 3.10 to 3.78) for 5 or more primary care visits and 29.98 (95% CI 26.33 to 34.15) far 5 or more hospital admissions. In addition, heavy users had an elevated mortality (standardized mortality ratio 1.55;95% CI 1.26 to 1.90). Conclusion: High ED use patients are also high users of other health care services, presumably because they are sicker than average. A further indication of serious ill health is their higher than expected mortality. This knowledge might be helpful for care providers in their endeavors to find appropriate ways of meeting the needs of this vulnerable patient category.
A recurring theme in the health economics literature is that 'excess' health insurance reduces society's welfare. This proposition is considered to be a truism by most health economists. Feldman and Morris...
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A recurring theme in the health economics literature is that 'excess' health insurance reduces society's welfare. This proposition is considered to be a truism by most health economists. Feldman and Morrisey (1990) report that two-thirds of American and Canadian health economists surveyed agree with the statement that, 'the level and type of health insurance held by most U.S. families generate substantial welfare loss due to over-consumption of medical services'. Consequently, most research in the area has attempted to identify the exact dollar value of this welfare loss. In this note, I will try to show that the traditional method of calculating welfare losses from excess health insurance is severely flawed because it is based on assumptions about consumer behavior that are not supported by the available empirical evidence. Furthermore, the methodology masks other, potentially greater societal welfare losses that are likely to exist in the health care sector, and blinds us from seeking the most effective public policy remedies. This note suggests an alternative framework for considering welfare losses based on researchers' evaluations of medical necessity.
Within the New Zealand (NZ) health care system, a number of changes have affected the way health care is accessed and delivered. Emergency Departments (EDs) are noticing increased attendance of patients with minor or ...
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Within the New Zealand (NZ) health care system, a number of changes have affected the way health care is accessed and delivered. Emergency Departments (EDs) are noticing increased attendance of patients with minor or non-urgent conditions. This increase in patient volume, together with on-going fiscal constraints and restructuring, has placed an added strain on the functioning of EDs. New Zealand nurses need to question the role currently given to EDs and identify the issues surrounding the increased use of these departments for primary health care. Is this move feasible in the NZ environment, and what are the implications for emergency nurses?
This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in ...
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This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in the area of patients' assignment to observation status. The team's primary goal was data-driven improvement. As detailed here, the team's solution to improve the use of observation status is both time-efficient and offers opportunities for financial gain.
We recorded the symptoms and disposition of every patient who visited the otorhinolaryngology emergency department at our hospital in Rome, Italy, during 1996. During that time, our ENT specialists saw 21,548 patients...
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We recorded the symptoms and disposition of every patient who visited the otorhinolaryngology emergency department at our hospital in Rome, Italy, during 1996. During that time, our ENT specialists saw 21,548 patients. Only 311 of these patients (1.4%) required immediate hospitalization, while another 2,391 patients (11.1%) received treatment and were released. The other 18,846 patients (87.5%) did not have any pathology or condition that qualified as an actual emergency, and they were examined and released, often with a prescription or instructions for home care. These patients could have easily been treated by a family physician. The fact that emergency care in Italy is rendered free of charge (unlike ambulatory care, for which fees are charged) provides patients with a strong incentive to misuse the system. Such overutilization drives up the cost of health care and stretches the capacity of the medical staff. Steps need to be taken to redirect patients who misuse emergency services to seek medical care in ambulatory care centers.
OBJECTIVE: To determine the proportion of inappropriate hospital stays, their typology and the level of nursing care in Diagnosis Related Groups(DRG). To evaluate the use of the PRN (Project Research in Nursing) regis...
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OBJECTIVE: To determine the proportion of inappropriate hospital stays, their typology and the level of nursing care in Diagnosis Related Groups(DRG). To evaluate the use of the PRN (Project Research in Nursing) register forms, when determining AEP (Appropriateness Evaluation Protocol). METHOD: A cross-sectional study was performed on 494 patients classified with one of the 10 more frequent DRG in the hospital from February to July 1997. Information from patient clinical histories, PRN register forms, sociodemographic data, and nursing care activities were used. The appropriateness of hospital stay to AEP was assessed on the day prior to discharge. Comparison of inappropriate stays with appropriate stays was performed by chi-square test for categorical variables and Student t-test for continuous variables. The independent associated factors with inappropriateness of hospital stay, were estimated using a log regression model. RESULTS: Out of 417 valid cases, hospital stay was considered appropriate in 269 (64.5%) patients and inappropriate in 148 (35.5%) patients. Mean-age of inappropriate stays was significantly higher than that of appropriate stays (70.06 +/- 13.84 vs 61.57 +/- 15.07, p < 0.05). Care intensity for inappropriate stays was larger than that of appropriate stays (median 137 [minimal value 45, maximal value 355] vs median 95 [minimal value 35, maximal value 131] p < 0.001). Care time in mobilization, elimination and hygiene activities was longer in inappropriate stays than in appropriate stays. In a log regression model, the age, feeding care intensity, therapy care intensity and DRG assigned to each process were independent predictive factors of inappropriate stays. For application of AEP, 56.9% of cases were reviewed using PRN register forms and 43.1% were reviewed using the case history. CONCLUSIONS: From the DRG examined, patients who undertook inappropriate stays consumed a large intensity of nursing basic activities;therefore, they may be candidat
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