Medical care
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The use of hospitalists is increasing. Hospitalists have been associated with reductions in length of stay and associated costs while not negatively impacting outcomes. We examine care for stroke patients because it requires complex care in the hospital and has high post discharge complications. We assessed the association of care provided by a hospitalist with length of stay, discharge destination, 30-day mortality, 30-day readmission, and 30-day emergency department visits. ⋯ Hospitalists are associated with reduced length of stay and higher rates of discharge to inpatient rehabilitation. The higher readmission rates should be further explored.
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As electronic patient data from automated hospital databases become increasingly available, it is important to explore the ways in which these data could be used for the purposes other than patient care, such as quality assurance and improvement. ⋯ We found that information from our hospital's automated patient databases could be used to accurately predict patients' daily risk of death in hospital. The predictions from this model could be used in quality of care analyses to more accurately risk-adjust hospital mortality rates and by hospitals to improve triage processes and patient flow.
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Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. ⋯ Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.
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Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be justified equally among patients of varying health needs. This study evaluated whether nursing hours per patient day (HPPD) and skill mix are associated with higher inpatient care costs within acute medical/surgical inpatient units using data from the Veterans Health Administration. ⋯ The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.
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Heart failure patient mortality rates are a focus of hospital quality assessment. This study examines whether comprehensive use of diagnoses identified as present on admission improves methods for comparing hospital mortality rates. ⋯ More comprehensive use of diagnoses identified as present on admission improves the performance of mortality risk adjustment methods, and these improvements meaningfully change the results of hospital mortality rate comparisons.