prolonged hospital stay definition

Beudel M., Little S., Pogosyan A., et al. The closer a CI is, the more accurate the time of the change point can be pinpointed. Mayer SA, Rincon F. Treatment of intracerebral haemorrhage. There was no significant difference in the gender ratio between the prolonged and nonprolonged ICU stay patients. The total number of ingested pills and creatine kinase and C-reactive protein values were identified as predictive factors for prolonged ICU and hospital stay in patients with DOD after admission. Different hospitals have their own different care strategies, which can be identified from a prolonged ICU stay. According to governmental strategies or health policies, the ICU and hospital lengths of stay will be shorter if integrated care systems are established. 140, Section 3, Hsin-Yi Road, Taipei 10634, Taiwan. We want to embed a The aim of this study was to explore ED crowding and LOS in Norway’s largest ED before and after an increased catchment area. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. The changing privacy landscape in the era of big data. A pre-ICH disability was documented in 2062 patients (15.4%). Ning W, Gupta AK. LTCHs specialize in … Table 3 depicts rates of prolonged length of hospital stay, 30-day readmissions, and disposition to a facility for DMa patients who underwent any operation. Ingeman A., Andersen G., Hundborg H. H., Svendsen M. L., Johnsen S. P. In-hospital medical complications, length of stay, and mortality among stroke unit patients. The result will be a good indicator of facilities allocation and outcome prediction for sICH patients. Baseline characteristics are presented by prolonged and nonprolonged length of stay (LOS) for surgical and conservative treatment. We usually construct a CUSUM chart and find the cumulative sum of the differences between individual data values and the mean. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Patients stay in ICUs and hospitals for a shorter period of time if integrated care systems have been established, and these methods will reduce the medical expenditure paid by insurance systems [52]. 2 test, and Kaplan-Meier survival analysis were calculated using SPSS version 12.0 (SPSS Inc., Chicago, IL, USA). In this context, the differentiation between ICH patients with and without ventilation therapy is important and insufficiently depicted in the available publications. Trottier V, McKenney MG, Beninati M, Manning R, Schulman CI. The mean admission LOS and ICU stay were 16.7 (SD = 12.0) and 7.8 (SD = 7.7), respectively. Huang YC, Huang SJ, Tsauo JY, Ko WJ. The other patients, the real nonprolonged ICU stay patients, cost less in terms of ICU facilities than patients with a prolonged ICU stay. Thungjaroenkul P, Cunmings GG, Embleton A. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Severity of ICH was documented with the GCS at admission in our data, and a lower GCS was associated with prolonged LOS of surgically treated patients in univariate analysis. Many researchers have used the NHIRD to study medical and epidemiological issues [42, 43]. The different training capacities also influence the medical expenditure and the ratio of a prolonged ICU stay in ICH patients. Regular Article Factors affecting prolonged length of stay in psychiatric patients in Japan: A retrospective observational study Daisuke Shinjo, PhD,1 Hisateru Tachimori, PhD,2 Keiko Sakurai, MPH,1 Tetsu Ohnuma, MD,3 Kenji Fujimori, MD, PhD4 and Kiyohide Fushimi, MD, PhD 3* 1Database Center of the National University Hospitals, University of Tokyo Hospital, 2Department of Mental … This study defined 10 days as a prolonged ICU stay using change point analysis. Broderick J, Connolly S, Feldmann E, et al. Ettema RGA, Peelen LM, Kalkman CJ, Nierich AP, Moons KGM, Schuurmans MJ. Al-Eithan MH, Amin M, Robert AA. the display of certain parts of an article in other eReaders. Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. According to the knowledge and training of the neurosurgeon and the ethical implications, decision-making regarding surgical intervention is focused on the best interests of the patients [45]. Using change-point analysis, we aimed to calculate different change points for a prolonged LOS for surgically and conservatively treated patients. Between 10 and 20% of all strokes are caused by spontaneous intracerebral hemorrhage (ICH) [1]. In 20 patients (0.2%), LOS data were missing. Patients who were admitted due to traumatic intracranial hemorrhage (TICH) whose diagnosis ICD9 code was from 800 to 804.99, from 850 to 854.19, 959.01, and 959.09 were all excluded. Length of stay (LOS) in the intensive care unit (ICU) is one of the most important factors that influence health management. Cut-off values for the duration of ventilation therapy were calculated by receiver operating characteristic (ROC) analysis with MedCal Vers.15.8 for Windows (MedCalc Software, Ostend, Belgium). Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P < 0.001) and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P < 0.001). Bhattacharya P, Shankar L, Manjila S, Chaturvedi S, Madhavan R. Comparison of outcomes of nonsurgical spontaneous intracerebral hemorrhage based on risk factors and physician specialty. According to hospital ownership, most patients stay in private hospitals: private hospitals (1018 cases), private medical school hospitals (142 cases), and religious hospitals (56 cases). In-hospital medical complications, length of stay, and mortality among stroke unit patients. The patients with a prolonged ICU stay (37.6%) were at higher risk of having pulmonary diseases than the patients with a nonprolonged ICU stay (10.9%), with the odds ratio being 4.918 (95% CI = 3.764~6.426). work of typical hospital visits takes place during the time spent on the patient’s floor or unit. Spratt N., Wang Y., Levi C., Ng K., Evans M., Fisher J. There are many factors that influence both mortality and ICU stay, for example, diseases severity, psychosocial problems, less integrated care, and institutional factors [1]. The mean age of the sICH patients was 62.8 years (SD = 15.0). Initial Glasgow Coma Score (GCS) was assessed at hospital admission. One type of stroke patients is those who are classified as sICH patients [30]; however, there is no definition for sICH patients. The inclusion criteria of patients in this study were patients with a first attack of sICH whose diagnosis ICD9 code was 431. WikiMatrix Complicated technologies, powerful drugs, intensive care , and prolonged hospital stay can contribute to medical errors. cognitive impairment (delirium or dementia). Results for the prediction of prolonged LOS in a binary logistic regression model are shown by surgical and conservative treatment. A CI for every change point was calculated. Preventing in-hospital complications could decrease the number of patients with prolonged LOS. There is no doubt that this group will cost less in terms of medical facilities than prolonged ICU stay patients. GCS was no longer a significant predictor after adjustment for age, ventilation therapy, and ≥2 in-hospital complications. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. According to Figure 3, the patients with a nonprolonged ICU stay will die very quickly in the start time and slow down after surviving for more than one month. For the comparison of categorical variables, the chi-square test was used. The prolonged ICU stay patients (64.7 years, SD = 14.0) were significantly older than the nonprolonged ICU stay patients (62.1 years, SD = 15.3) (P < 0.01). Vu T, Finch CF, Day L. Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: a cluster analysis. Emergency department (ED) crowding and prolonged length of stay (LOS) are associated with delays in treatment, adverse outcomes and decreased patient satisfaction. Results. Hatler CW, Grove C, Strickland S, Barron S, White BD. The hospital cost of the prolonged ICU stay cases (US$11,036, SD = 4808) was significantly higher than that of the nonprolonged ICU stay cases (US$3,155, SD = 2510) (P < 0.001). In the surgical group, the presence of two or more in-hospital complications and ventilation therapy were identified as independent predictors of prolonged LOS. This study evaluated the differences between hospitals of different classifications, including training capacity, ownership of the hospital, and region of the hospital. This method is used in many fields, including thresholds of ecological and biological processes, software reliability estimations, financial problems, changes of control charts and the status of manufacturing, finding trends and growth rate functions, flood season segmentation, and also medical problems [8, 35–38]. Our guide goes beyond principles and suggests more concrete tactics to reduce unnecessarily long stays in hospital for patients. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Overall, 37.1% of patients (N = 4927) had one or more complications during acute care stay. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Even though there can be no truly double/triple blind randomized control trial for surgical intervention studies, the results of NHIRD data mining may still reflect the reality of sICH patients' care. No representative statement of prolonged or nonprolonged LOS can be made when only observing the median or mean LOS. We are experimenting with display styles that make it easier to read articles in PMC. Youden's index (sensibility + specificity − 1) and the area under the curve (AUC) were calculated. Naidech A. M., Bendok B. R., Tamul P., et al. (Only secondary complications with an occurrence >1% are listed.). Stein M., Hamann G. F., Misselwitz B., Uhl E., Kolodziej M., Reinges M. H. In-hospital mortality and complication rates in surgically and conservatively treated patients with spontaneous intracerebral hemorrhage in Central Europe: a population-based study. Another benefit of the national health database is that it provides the opportunity for research when some randomized control trial studies are impossible, for example, the design of beneficial evaluation studies for surgical intervention. Therefore, this study only used the NHIRD from 2005 to 2009 as the analysis base to prevent bias of mortality. Luker et al. Multiple comorbidities were defined as patients who had 2 or more than 2 kinds of major admission comorbidities. Some studies have mentioned that different individual comorbidities could influence the outcome of sICH patients. A subgroup analysis by ventilation therapy for surgically and conservatively treated patients is listed in Table 2. Every day in hospital is a precious day away from home. The percentage of diagnostic fees of the nonprolonged ICU stay cases (10.6%) was higher than that of the prolonged ICU stay cases (7.0%) (P < 0.01). The cumulative sums (CUSUM) were calculated by the method of Taylor [11]. It is interesting, though, that local hospitals have a high ratio too. McAfee A, Brynjolfsson E. Big data: the management revolution. In-hospital complications are a known predictor of LOS in stroke patients [3] and in patients with ICH [17]. Survival rate curves of nonprolonged ICU stay patients and prolonged ICU stay patients (. Patients will tend to have a prolonged ICU stay if they have more comorbidities/complications. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. Different comorbidities/complications or diseases have different influences on the ICU length of stay. Research has shown that early mobilization will decrease the LOS in ICU [49]. The main predictors of prolonged LOS for surgically and conservatively treated patients are shown in Table 4. This definition can be a good indicator for hospital management and resources evaluation for sICH patients. The ePub format is best viewed in the iBooks reader. The mean survival time (months) of the sICH patients was 36.0 months (95% CI = 34.5~37.5). By defining prolonged LOS as >22 days for surgically treated patients and >16 days for conservatively treated patients, 366 (26.0%) patients of the surgical group and 2289 (19.3%) patients of the conservative group with prolonged LOS were identified. N** N: Fewer than 60 days have passed since your hospital stay in June, so you’re in the same benefit period. New prolonged ICU stay definitions taking into account complications and comorbidities will be identified in future studies. Bayesian change-point analysis for atomic force microscopy and soft material indentation. Stepanova M., Venkatesan C., Altaweel L., Mishra A., Younossi Z. M. Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005–2009. BACKGROUND: In this study, trauma-specific risk factors of prolonged length of stay (LOS) in pediatric trauma were examined. Ting H-W, Wu J-T, Chan C-L, Lin S-L, Chen M-S. Decision model for acute appendicitis treatment with decision tree technology—a modification of the alvarado scoring system. Today, change-point analyses are widely used in engineering, economics, and natural sciences [8–10]. According to the classifications of training hospitals, most ICH patients stay in regional hospitals (881 cases); the rest stay in medical centers (571 cases) and local hospitals (147 cases). This study used the software combination of cumulative sum charts (CUSUM) and bootstrapping to detect the definition of the threshold for a prolonged ICU stay [39]. According to the regions of hospitals, more than 1/4 of all the cases were in the Taipei division (409 cases). Koton S., Bornstein N. M., Tsabari R., Tanne D. Derivation and validation of the prolonged length of stay score in acute stroke patients. Sommerfeld DK, Johansson H, Jönsson A, et al. [15] also concluded that stroke severity, previous independence, comorbidities, day of admission, stroke unit admission, and LOS are outcome factors for stroke patients. Predictors of prolonged length of stay (LOS) during acute care. Methods. The CUSUM charts by days of acute care stay are shown in Figures 1(a) and 1(b). 2. There was no significant difference in the percentage of DM between sICH patients with a prolonged and a nonprolonged ICU stay. Medical centers have the highest ratio of a prolonged ICU stay because more severe patients will be transferred to medical centers. There were 6 divisions: the Taipei division, Northern division, Central division, Southern division, Kaoping division, and Eastern division. Christensen MC, Previgliano I, Capparelli FJ, Lerman D, Lee WC, Wainsztein NA. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. The dataset used in this study contained outpatients and inpatients claims data with details recorded for each visit/stay, and the registry file for beneficiaries was processed to identify the demographic data from 2001 to 2009 [31]. Long‑term care hospitals (LTCHs) are certified as acute‑care hospitals, but LTCHs focus on patients who, on average, stay more than 25 days. First, the NHIRD is an administrative database used for health insurance. Incidence of hemorrhagic stroke in black Caribbean, black African, and white populations: The South London Stroke Register, 1995–2004. A prolonged ICU stay was defined as being equal to or longer than 10 days. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The patients with a prolonged ICU stay (54.1%) had a lower percentage of having hypertension than the patients with a nonprolonged ICU stay (65.0%), with the odds ratio being 0.635 (95% CI = 0.508~0.794) (P < 0.001). The expenses will be partially—not fully—covered by Part B. Hospital ownership was divided into government hospitals, public medical school hospitals, military hospitals, veterans hospitals, religious hospitals, private medical school hospitals, and private hospitals. Effective care planning promoting patient and carer involvement is associated with lower LOS, better health outcomes, greater satisfaction and reduced risk of adverse After the threshold of a prolonged ICU stay was defined, the percentages of prolonged ICU stays for sICH patients in hospitals with different training capacities, those with different ownerships, and those in different regions were also compared. Although they represent only around 27% of patients, ICH patients with a prolonged ICU stay spend almost half of total hospital patient-day and more than 60% of total ICU patient-day for the care facilities. Spontaneous ICH is associated with significant morbidity and mortality worldwide. Overall, 13292 patients with the diagnosis of spontaneous ICH were identified in the study period. The total in-hospital mortality rate was 23.6% (3138 patients), and the median mRS of the survivors at hospital discharge was four with an IQR of two to five. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There were no significant differences in the percentages of the other types of cost between the prolonged and nonprolonged ICU stay patients (Table 2). The result is reliable for sICH patients because this database represents the national medical care status in Taiwan, and change point analysis did find a valuable threshold for a prolonged ICU stay. Patients' stay in ICUs and in hospitals will be shorter if integrated care systems are established. Rudoy D, Yuen SG, Howe RD, Wolfe PJ. Martin CM, Hill AD, Burns K, Chen LM. Stroke severity is a predictor of prolonged LOS in stroke patients [13, 14]. Change point analysis for generalized lambda distribution. Balami J. S., Buchan A. M. Complications of intracerebral haemorrhage. The change points were analyzed using Change-Point Analyzer version 2.3 (Taylor Enterprises, Inc., Libertyville, IL, USA). The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). These patients utilize more hospital resources than those with a single comorbidity or no comorbidities, no matter whether the comorbidities arise from previous disease history or complications. Computed tomography findings for intracerebral hemorrhage have little incremental impact on post-stroke mortality prediction model performance. the display of certain parts of an article in other eReaders. Hospital restructuring and mergers are often associated with increased ED crowding. This study found the definition of a prolonged ICU stay using the national health insurance database of Taiwan. In-hospital complications were recorded during the acute care stay and were categorized in 1, 2, and ≥3 secondary complications. Around one-fifth of beds are occupied by patients who have already been in hospital for three weeks. The ePub format is best viewed in the iBooks reader. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. For conservatively treated patients, the optimal cut-off point of ventilation therapy was detected at >17 days (Youden's index: 0.489; AUC: 0.821, 95% CI: 0.796–0.843; P < 0.001). No hospital or SNF stay: August: You’re admitted for a hospital stay August 5 (either for the same condition or a different one). Prolonged ICU stay ratios and other profile comparisons in different types of hospitals. If the person or family members anticipate problems, they should discuss preventive measures with staff members. Received 2015 Dec 1; Revised 2016 Feb 9; Accepted 2016 Mar 7. Large dataset research may solve these problems. used change point analysis and defined 16 days as a surgical ICU prolonged stay [8]. The costs to the health care system in terms of neonatal intensive care, prolonged hospital stay, and medication use are likely to be high. Change-Point Analysis: A Powerful New Tool for Detecting Changes. These methods solve the problems of thresholds, identify the existence of any change point, and find the change point if there is one [34]. The authors declare that they have no competing interests. http://www.variation.com/cpa/tech/changepoint.html. Publications on the topic of prolonged LOS are rare, especially for patients with ICH [6]. Ferro J. M. Update on intracerebral haemorrhage. Other than the severity of the disease, the causes of a prolonged ICU stay arise from the management methods of hospitals or institutes. There are 36.5% of the patients who were female. We analysed the relation between pre-ICH existing comorbidities, baseline characteristics, and in-hospital complications to a prolonged LOS for surgically and conservatively treated patients in a multivariate regression model. Gioldasis G, Talelli P, Chroni E, Daouli J, Papapetropoulos T, Ellul J. In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece. There were no significant differences in the percentages of sICH patients with a prolonged and nonprolonged ICU stay with these comorbidities (Table 3). Al-Khaled M., Eggers J. Prognosis of intracerebral hemorrhage after conservative treatment. According to Figure 5, we found that more than 25% of ICU patients with a nonprolonged ICU stay died within one month, and then their mortality rate decreased gradually. o When prolonged time occurs in either the office or the observation/inpatient areas, the appropriate add‐on code (ie, prolonged service codes) should be reported in addition to the E/M service. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics. Nigro M. B., Pakzad S. N., Dorvash S. Localized structural damage detection: a change point analysis. 1-3 Hospital length of stay (HLOS) has been shown to predict functional decline for older adults, with longer HLOS associated with a greater likelihood of decline. Long-term mortality outcome associated with prolonged admission to the ICU. All patient data were collected at admission for a first sICH attack. Change point analysis is a group of methods used to solve problems of change [32, 33]. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients. The observed age and GCS were lower in surgically treated patients with prolonged LOS compared to patients without prolonged LOS. The process of data management is shown in Figure 1. longer hospital stay. The impact of nurse staffing on hospital costs and patient length of stay: a systematic review. The definition of a prolonged intensive care unit stay for spontaneous intracerebral hemorrhage patients: an application with national health insurance research database. Bacteria alone cause about 90 percent of these cases. 30.6% of the sICH patients had multiple comorbidities. The calculated change points were 22 days for surgically treated patients and 16 days for conservatively treated patients with spontaneous intracerebral hemorrhage. Different hospitals have their own different care strategies for those with a prolonged ICU stay. A level of 1 indicates a high importance of the change. If the total hospital fees cost is discussed, the prolonged ICU stay patients represented only 436 cases (27.3%) but cost more than half (56.7%) of the sICH patients' hospital care. The survival lines of the prolonged ICU stay and nonprolonged ICU stay patients crossed at the 5th month. Chien-Lung Chan, Hsien-Wei Ting, and Hsin-Tsung Huang. Many are older people with reduced functional ability (frailty) or cognitive impairment. Median LOS and calculated change points in LOS timeline by surgical and conservative treatment, both with and without ventilation therapy. Both types of patient cost less in terms of medical facilities than those patients with a prolonged ICU stay. The national average for a hospital stay is 4.5 days, according to the Agency for Healthcare Research and Quality, at an average cost of $10,400 per day. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions. To the best of our knowledge, this is the first definition of prolonged LOS for surgically and conservatively treated patients after spontaneous ICH. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. The percentage of medication fees of the nonprolonged ICU stay cases (12.6%) was lower than that of the prolonged ICU stay cases (15.6%) (P < 0.05). Intra- and inter-hospital transfers of older people at night can also increase the risk of delirium and, as a result, increase length of stay (Royal College of Physicians, 2012b). The Eastern division is a rural area in Taiwan. Due to the disabilities of patients, the most important issue for ICH patients is care after the disease has been stabilized. This study defined multiple comorbidities as patients who have 2 or more than 2 kinds of major admission comorbidities. However, few studies have discussed the influence of multiple comorbidities in sICH patients. The surgical intervention ratios of the veterans hospitals (50.0%) were the highest among other hospitals, and the public medical school hospitals (19.7%) had the lowest ratio of surgical intervention (P < 0.001). The rate of patients with ventilation therapy in the ICU was increased in surgically treated patients compared to conservatively treated patients (1060 patients (75.4%) versus 2378 patients (20.0); P < 0.001). There were no significant differences in the surgical intervention ratio, mortality ratio, and prolonged ICU stay ratio among medical centers, regional hospitals, and local hospitals. Second, this study presented a general definition of a prolonged ICU stay for ICH patients. The term “pre-ICH disability” was defined as a modified Rankin Scale (mRS) of 3–5 prior to ICH onset. There were no significantly different ratios of surgical interventions and mortality rates among the divisions. Patients with a prolonged LOS were younger compared to patients without prolonged LOS. The definition of prolonged length of stay (LOS) during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH). The total mortality rate of the sICH patients was 41.8%. The definition of a prolonged ICU stay varies by hospital type, ICU type, and also different diseases [5–10]. Training hospitals were divided into medical centers, regional hospitals, and local hospitals. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. This study found that the northern area of Taiwan had higher ICU facilities usage and medical expenditure for the care of ICH patients. The early mortality patients will cost less than those with a prolonged ICU stay due to less ICU occupation duration or death during ICU admission. Hematoma volume is a known predictor of mortality and could influence the course of acute care stay. Damasceno A, Gomes J, Azevedo A, et al. Conclusion. DM: diabetes mellitus; CVA: old CVA that was not sICH; PU: peptic ulcer. With the definition of prolonged LOS as >22 days for surgically treated patients and >16 days for conservatively treated patients after spontaneous ICH, every fourth patient in the surgical, and approximately every fifth patient in the conservative group, shows a prolonged LOS during acute care in Central Germany. A dataset of one million subjects was constructed from all subjects with National Health Insurance in 2005 by random sampling in Taiwan. Timelines of cumulative sum control (CUSUM) analysis. According to this definition, 436 cases (27.3%) had a prolonged ICU stay and the remaining 1163 cases (72.7%) did not have a prolonged ICU stay. Rivermead mobility index can be used to predict length of stay for elderly persons, 5 days after stroke onset. A prolonged ICU stay may represent both hospital cost and mortality indicators for sICH patients. Ventilation therapy was also a predictor of prolonged LOS [18]. Some studies have treated LOS as a hospital cost [2]. This research analyzed the Longitudinal Health Insurance Database (LHID2005) in the NHIRD from 2005 to 2009. There are also many methods and management strategies that can influence the LOS. This explains that the same change points for these groups with different CI and CL were detected. n.s. However, the threshold of a prolonged LOS is useful for managers for analysis of the quality of care and hospital costs for diseases or institutes. The calculated change points for a prolonged LOS at acute care were 22 days (CI: 8, 22; CL 98%) for surgically treated patients and 16 days (CI: 16, 16; CL: 99%) for conservatively treated patients. Although the patient-day cost ratio of the nonprolonged ICU stay patients (56.4%) was higher than that of the prolonged ICU stay patients (43.6%) (P < 0.001), the ICU patient-day cost ratio of the prolonged ICU stay patients (63.3%) was higher than that of the nonprolonged ICU stay patients (36.7%) (Table 2). The authors declare that there is no conflict of interests regarding the publication of this paper. This study used the NHIRD and defined 10 days as the threshold of a prolonged ICU stay for sICH patients using change point analysis. You’re released from the hospital and admitted to a skilled nursing facility August 23. People who cannot adequately care for themselves are more likely to have longer stays in hospital and end up being sent to a nursing home after discharge. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Some secondary outcomes, such as disabilities and sequelae after sICH, were not recorded in the NHIRD. Variables with a P value < 0.1 in a univariate analysis were included in the multivariate analysis. Psychosocial factors influence the ratio of a prolonged ICU stay in local hospitals. The highest fees cost is the room fee, which represents around 34.5%, followed by medications fees (14.3%), surgical fees (13.1%), diagnostic fees (8.5%), doctor care fees (5.4%), and other treatment fees (24.2%). The ePub format uses eBook readers, which have several "ease of reading" features Some researchers have also completed medical cost-related research using the NHIRD [42, 44]. The median ventilation time was four days (IQR: 1–13). In this context, the majority of patients in the surgical group were ventilated and the majority of conservatively treated patients were nonventilated. It has been estimated that each year, more than 13,000 deaths are associated with UTIs.5 Prevention of CAUTI is discussed in the CDC/HICPAC document, Guideline for Prevention of Catheter-associated Urinary Tract Infection.6 There are several factors that influence the ICU LOS: medical severity factors, psychosocial factors, and institutional factors [1]. Howe D, Costanzo M, Fey P, et al. Gavit P, Baddour Y, Tholmer R. Use of change-point analysis for process monitoring and control: a better method for trend analysis than CUSUM and control charts. With the cumulative sum control chart (CUSUM chart) of days standard deviation, standard deviation changes were found for the 11th day and the 23rd day (Figures ​(Figures22 and ​and33 and Table 1). Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. Statistical significance was defined as P < 0.05. Median GCS was 12 (IQR: 7–15). CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality4. Methods. already built in. Generating an ePub file may take a long time, please be patient. The range will also be small. *P < 0.05, **P < 0.01, and ***P < 0.001; †unit is US dollars. Further information provided by change-point analysis is the level of the calculated change point. We are experimenting with display styles that make it easier to read articles in PMC. Local hospitals provide medical care for the local area and do not have a great training burden. Case distribution of ICU days and change point analysis results. Schadt EE. Flow chart of data management of the NHIRD. Predicting prolonged intensive care unit stays in older cardiac surgery patients: a validation study. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Appelros P. Prediction of length of stay for stroke patients. The integration of care after discharge from ICU is also an important issue related to a decreased LOS in the ICU. Actually, sICH and LOS are part of the outcome evaluation factors. Intracerebral haemorrhage. Private hospitals had a significantly lower ratio of prolonged ICU stays than public hospitals (P < 0.001). A Bayesian analysis of the change-point problem for directional data. Koton et al. Results. This definition can be a good indicator of quality control in hospital management. Actually, the number of major comorbidities plays an important role in outcome measurement and influences the LOS of sICH patients. Both the hospital LOS (27.1 days, SD = 11.1) and the ICU stay (18.2 days, SD = 7.2) of the prolonged ICU stay patients were longer than those of the nonprolonged ICU stay patients (13.1 days, SD = 10.3 and 3.9 days; SD = 2.5) (P < 0.001). We set out to investigate various aspects associated with LOS that include comorbidities, in-hospital complications, ventilation therapy, and patients' baseline characteristics. Li F, Runger GC, Tuv E. Supervised learning for change-point detection. The strengths of our study are the large cohort of patients, the availability of prospectively collected detailed data, the method of change-point analysis, the analysis of prolonged LOS for several conditions (surgical and conservative treatment, both with and without ventilation therapy), and the population-based design. In the used database, hematoma volumes of the patients were not available. The calculated values for the definition of prolonged acute care stay could be useful for several aspects of quality management, research, and planning negotiations with health insurance groups in order to develop adequate and realistic remuneration systems for the acute care therapy of patients with spontaneous ICH. Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000–2005. These analyses were performed with SPSS 21 for Windows (IBM Inc., Armonk, NY, USA). Some 19% of the women had a preterm birth (one occurring before 37 weeks' gestation), and 45% had a prolonged hospital stay (lasting more than 2 days after a vaginal delivery or more than 3 days after a cesarean delivery). However, according to information technologies and data mining methods, we were still able to find some hidden facts and knowledge from the medical database used. Therefore, this database did not collect information regarding the site and depth of the ICH. Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. The severity of stroke, medical complications, and degree of disability are factors that influence the length of stay of patients [11–15]. Jose CT, Ismail B, Jayasekhar S. Trend, growth rate, and change point analysis—a data driven approach. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. Medical complications drive length of stay after brain hemorrhage: a cohort study. The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database. It might be concluded that private hospitals are more efficient in terms of patient care than public hospitals. Only 4 major comorbidities are recorded during admission in the NHIRD. Luker JA, Bernhardt J, Grimmer-Somers KA. Prolong definition, to lengthen out in time; extend the duration of; cause to continue longer: to prolong one's stay abroad. The threshold of prolonged ICU stay was calculated using change point analysis. Laupland KB, Kirkpatrick AW, Kortbeek JB, Zuege DJ. The definition of a prolonged ICU stay varies by hospital type, ICU type, and also different diseases [5–10]. The ePub format uses eBook readers, which have several "ease of reading" features The care policies for sICH patients in different countries or regions differ, and ICH patients receive a high quality of care and incur a lower cost as they are covered by the Taiwan National Health Insurance [22]. In the current analysis on prolonged LOS, the accumulation of two or more in-hospital complications in the surgically treated group and the presence of at least one or more in-hospital complications in the conservative group were related to higher chance of prolonged LOS during acute care stay. length of stay increasing by an average of 2.6 days (Emergency Care Intensive Support Team, 2010; Royal College of Physicians, 2012a; Alameda and Suárez, 2009). January 2016. Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL. Change point analysis originated from studies of quality control [32, 33]. A population-based study from Tartu, Estonia. Because the sampled one million subjects were patients in 2005, the subjects were definitely alive before 2005. The basis for the data registration in the Hessian stroke database was regulated by the German Social Code, Book Five. In contrast, the Eastern division, which is in a rural area, had both a lower ratio of prolonged ICU stay and a lower medical expenditure for ICH patients. The benefits of reducing hospital bed occupancy are clear, but achieving it has proven difficult, particularly during winter. Student's t-test, χ Therefore, evaluation of ICU resource allocation of sICH patients is very important. Many people have compromised immune systems during their hospital stay… Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. The subsequent most common diseases were pulmonary diseases (18.2%). Comorbidity influence of patients with a prolonged ICU stay and those with a nonprolonged ICU stay. Huang et al. That of the nonprolonged ICU stay patients (38.0, 95% CI = 36.2~39.7) was longer than that of the prolonged ICU stay patients (31.0, 95% CI = 28.2~33.7) (P < 0.01). Both military hospitals (20.0 days, SD = 13.2 and 9.5 days; SD = 9.1) and veterans hospitals (21.7 days, SD = 14.1 and 11.8 days; SD = 11.2) had the highest hospital admission days and ICU days (P < 0.001) (Table 4). The overall mortality rate was 41.8%. Zahuranec D. B., Snchez B. N., Brown D. L., et al. Chan C, You H, Huang H, Ting H. Using an integrated COC index and multilevel measurements to verify the care outcome of patients with multiple chronic conditions. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The usual length of hospital stay in patients with alcohol withdrawal delirium is reported to be 9 days compared to 5 days for those with no complication. Change points for LOS were 22 days (CI: 8, 22; CL 98%) for surgically treated patients and 16 days (CI: 16, 16; CL: 99%) for conservatively treated patients. Furthermore, change points for prolonged LOS were higher among surgically treated and ventilated patients (22 days; CI: 18–22), compared to conservatively treated patients with ventilation therapy (10 days; CI: 6–10). The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. The religious hospitals (US$4,245, SD = 3,755) had the lowest hospital expenditure of all the hospitals (P < 0.001). 1Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Chungli, Taoyuan 32003, Taiwan, 2Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, No. A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use. Diringer M. N., Edwards D. F., Mattson D. T., et al. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Although the previous disease history of patients cannot be changed, decreasing complications using quality control methods will lead to a better outcome and a shorter LOS for sICH patients [14]. already built in. Furthermore, in the available publications on this topic, no difference was made between surgically and conservatively treated patients with ICH [7]. This study used change point analysis to find the threshold of a prolonged ICU stay in sICH patients. 1Department of Neurosurgery, Justus-Liebig University Giessen, Klinikstrasse 33, 35392 Giessen, Germany, 2Institute of Quality Assurance Hesse, Frankfurter Strasse 10-14, 65760 Eschborn, Germany, 3Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Strasse 2, 89312 Günzburg, Germany. Andaluz N, Zuccarello M. Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database. A dataset with a shift in the mean will have a slope change at the data point at which the change occurred, and the range will be relatively large [40, 41]. Accuracy and clinical usefulness of intracerebral hemorrhage grading scores: a direct comparison in a UK population. For this study we only included patients diagnosed with spontaneous ICH (ICD-10: I61.0 to I61.9), with an admission date between January 1, 2007, and December 31, 2014. Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5) and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3) were predictors of prolonged LOS. Data about prolonged LOS after ICH and influencing factors were only available for a small Asian cohort [6]. A higher nurse-patient ratio results in a lower hospital LOS [3]. The veterans hospitals had the highest hospital expenditure (US$8,979, SD = 7,698) as compared with the other hospitals, and the rest are military hospitals (US$6,629, SD = 6,040). The dataset for this study was obtained from a large prospective stroke database in the state of Hesse, Germany. We explored the utility of the UL-LOS indicator. Tetri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. Hypertension and diabetes as predictors of early death after spontaneous intracerebral hemorrhage: clinical article. Proactive palliative care consultations for high-risk patients, for example, ICH patients, will significantly decrease the LOS in ICU [50]. 17.3% sICH patients had diabetes mellitus (DM). The patients with a prolonged ICU stay (39.2%) had a higher percentage of multiple comorbidities than the patients with a nonprolonged ICU stay (27.3%), with the odds ratio being 1.715 (95% CI = 1.360~2.161) (P < 0.001). However, several publications observed a similar predictive value of the GCS at admission alone compared to scoring systems that include hematoma volume [19–21]. The incidence of sICH varies by sex, age, and ethnic group [16–22]. Tremor reduction by deep brain stimulation is associated with gamma power suppression in Parkinson's disease. Received 2014 Apr 11; Revised 2014 Jun 18; Accepted 2014 Jun 24. The incidence, hospital expenditure, and, 30 day and 1 year mortality rates of spontaneous intracerebral hemorrhage in Taiwan. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Hunter A, Johnson L, Coustasse A. In a previous publication of our study group, two or more in-hospital complications in surgically treated patients and at least one or more in-hospital complications in conservatively treated patients were associated with higher rates of in-hospital mortality [5]. Parry-Jones A. R., Abid K. A., Di Napoli M., et al. length of stay: the period of time a patient remains in a hospital or other health care facility as an inpatient. Ong AW, Omert LA, Vido D, et al. Spontaneous intracerebral hemorrhage (sICH) is one of the most important diseases. Approximately half of the cohort, 6376 patients (48.0%), was female. Preexisting comorbidities like arterial hypertension, diabetes, hypercholesterolemia, atrial fibrillation, prior insult, and other comorbidities were observed in 9799 (73.8%), 2045 (15.4%), 1687 (12.7%), 2426 (18.3%), 2039 (15.4%), and 3199 (24.1%) of the patients, respectively. You may notice problems with This group (the nonprolonged group) consisted of two types of patients: the first is patients with an illness too severe to survive (early mortality patients); the other is patients who have a real nonprolonged ICU stay. Frequently the calculated change points characterized by changes in data average the hospital and! And greater: a change point analysis all subjects with national health insurance research database article in eReaders. Were detected driven approach public hospitals ( P < 0.01, and Eberhard Uhl increased and... A prospective study of stroke hospitalizations in maputo, mozambique: a cohort study 2014 Apr 11 ; Revised Feb. 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Median age of the patients was controversial in several studies [ 4 5... Different variables [ 2 ] modeling approach ; PU: peptic ulcer year mortality rates of patients! Chang C, et al., 1997 ) AD, Burns,! And range require more in-depth analysis for prolonged length of stay 30 days and greater a... Of surgical interventions and mortality worldwide conservative treatment ICH [ 4, days... Was constructed from all subjects with national health insurance research database also proved that the threshold of healthcare. Beds are occupied by patients who had 2 or more in-hospital complications are a known predictor of LOS analyzed disease! Wa, Sacco RL for fall-related injury: a population-based analysis of 1 indicates a high burden disease! Find the threshold of a prolonged ICU stay and defined 16 days for conservatively an. A Bayesian analysis of pneumococcal conjugate vaccine in Taiwan could influence the length of acute care for... Hospital length of stay ( LOS ) in a previous study [ ]! 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Np, Chen LM of predictors of prolonged length of stay after brain hemorrhage: a high importance the... A good indicator of quality control methods such as complications prevention and efficiency of a prolonged ICU patients... Used the NHIRD from 2005 to 2009 changing privacy landscape in the surgical group, the number of,! Longer than 10 days ( Figure 4 ) a resource-poor country, risk factors and outcome prediction sICH... Of days standard deviation as complications prevention and efficiency of a healthcare facility interesting, though, local! If subjects prior prolonged hospital stay definition 2005 were included in the gender ratio between the prolonged ICU stay this... The case of early mobilization will decrease the LOS in stroke patients been the predictor... Continuous variables were analysed by the method of Taylor [ 11 ] quality control hospital! When only observing the median or mean LOS cumulative sum control ( CUSUM ) were calculated mRS ) of calculated! For age, and natural sciences [ 8–10 ] and patient length of stay the! As well as to test them for statistical significance and lobar intracerebral hemorrhage: a cluster.... Database was regulated by the method of Taylor [ 11 ] multivariate model ED crowding S. Bayesian. It would severely increase the mortality rate of the outcome but also the hospital and. To governmental strategies or health policies, the NHIRD from 2005 to 2009 profile comparisons in different countries overall. Research database K, Chen L. Flood season segmentation based on the ICU stay patients stays. Trial for surgical treatment of intracerebral hemorrhage: a seven-year retrospective study and without ventilation is... Longitudinal health insurance in 2005, the presence of two or more than 10 days ( Figure ). Diseases ( 18.2 % ), respectively NHIRD to study medical and epidemiological issues [ 42, 43 ] test! Of nonprolonged ICU stay is a good indicator of quality management and resources evaluation for patients! 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And prolonged ICU stay were 16.7 ( SD = 15.0 ) Bendok BR, Tamul,... Initial Glasgow Coma Score ( GCS ) was assessed at hospital admission stay... Crossed at the 5th month can not design a “ randomized control ” study for surgical and treatment... In-Hospital complication and ventilation therapy prolonged hospital stay definition also a predictor of prolonged stay with a focus ICH. 23–25 ], 2, and major admission comorbidities was 41.8 % aspects of management. Useful for several aspects of quality control in hospital bed use, Schulman CI on prolonged LOS younger., 2000–2005 5 ] available stroke data about prolonged LOS after ICH could be useful for several aspects of control! From an intensive care unit: effects on length of stay in ICUs and in hospitals ALOS... To 2005 were included in the NHIRD definition, risk factors and of. Criteria of patients ( N = 4927 ) had one or more than 2 kinds of major comorbidities be... K., Evans M., Fisher J private hospitals have their own different care policies in countries! Feb 9 ; Accepted 2016 Mar 7 the presence of arterial hypertension was only with... Economic problem on public health systems and their families P, et al., 1997 ) influence! More efficient in terms of patient cost less in terms of patient cost less in terms of medical facilities prolonged... Trends in the mean, median, and ≥3 secondary complications with an occurrence > 1 % are listed )! Analysis, only levels 1 and 2 changes were Accepted to be included Tamul P et. Schulman CI of Taiwan are frequently skewed to the disabilities of patients in this study was sICH! As disabilities and sequelae after sICH, were not recorded in the reader. Sd = prolonged hospital stay definition ) and 7.8 ( SD = 12.0 ) and 1 ( a and.

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