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922-080 System exam Questions

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Evaluating the efficiency of a Hospitalist equipment in Taiwan

consequences

From November 2009 to January 2010, 810 sufferers admitted from the ED to the examine wards were enrolled. amongst them, 377 had been admitted to the HW and 433 to the IWs. evaluation of admission days confirmed that eighty four (22%) and fifty three (12%) sufferers were admitted to the HW and IWs, respectively, on weekends (P < 0.001).

compared to the IW sufferers, the HW sufferers were older (age >65 years) and had poorer purposeful repute by Barthel's scores (desk 2). Admission prognosis become equivalent in each groups, aside from pneumonia and urinary tract infection, which were greater in the HW patients. There became a major care surgeon in 242 (64%) HW and 282 (65%) IW patients (P = 0.781).

The Charlson ranking, representing underlying comorbidity, turned into greater within the HW community (P = 0.002). moreover, patients with severe liver cirrhosis (newborn-Pugh class C) have been extra frequently admitted to the HW (P = 0.018). Underlying malignancy, extreme persistent kidney disease (estimated creatinine clearance <30 mL/min), and chronic respiratory failure requiring mechanical ventilator aid were greater linked to HW admission, despite the fact now not statistically greatly (P = 0.064, 0.072, and nil.104, respectively).

The standard admission cost became reduce in HW sufferers than in IW patients, no matter if paid for with the aid of NHI ($1640.2 vs $2933.8 per patient, P = 0.001) or by way of the overall admission charge ($2223.4 vs $3700.8 per affected person, P = 0.001) (desk 3). in a similar fashion, there became a shorter regular length of dwell (LOS) within the HW sufferers (9.3 vs 13.1 days, P < 0.001), who have been discharged sooner than IW patients (figure 1A). regarding cost per patient-day, the full each day charge was equivalent between the two companies (P = 0.560).

figure 1.

chance of hospitalization plotted through the Kaplan-Meier formulation and compared by means of log-rank look at various in accordance with (A) the whole number of patients in the internist-run wards (IW) and hospitalist-run ward (HW); and (B) matched-sufferers within the IW (IW-M) and HW (HW-M).

more patients in the HW group signed the do-not-resuscitate (DNR) consent (P < 0.001) and died right through the health facility path, however the change was not statistically big (P = 0.068). among those who expired all through hospitalization, DNR consent became signed by 42 (ninety%) HW and 27 (sixty eight%) IW patients (P = 0.014). amongst these discharged, fifty seven (17.2%) HW and 70 (17.6%) IW sufferers have been lost to follow-up. There was no difference within the 30-day readmission for any trigger between the two businesses (P = 0.992).

due to baseline adjustments, propensity ranking-matching changed into performed and a hundred and one pairs of patients have been chosen in line with the chance generated from components greatly different in univariate evaluation (ie, age >sixty five years, pneumonia or urinary tract infections, Charlson ranking, Barthel's rating, and blood urea nitrogen and C-reactive protein degrees on initial admission). The scientific characteristics of the 202 patients were shown in desk four.

each organizations had nearly the equal propensity scores (P = 0.970; see on-line supporting tips). patients within the HW community had vastly lower admission can charge, shorter LOS (figure 1B), and more DNR consent, however an identical in-medical institution mortality and readmission fees (desk four).


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