Re-Justification for Reducing the Length of Hospital Stay Based on Community-Based Appraisal of Functional Recovery of Cerebrovascular Disease Patient
Notice bibliographique
Résumé
Background : Because longer length of hospital stays (LOS) have been recognized to pose a significant economic burden on society, attempts to reduce LOS in acute care hospitals have been implemented to improve the efficiency of care. However, few studies have quantitatively measured the inherent effect of LOS on patient functional recovery in acute care settings. To determine whether a reduction in LOS is justified, we tested whether a longer LOS is associated with the deterioration of functional recovery in patients with nontraumatic cerebrovascular disease (CVD). Methods : Using Japanese administrative data collected between 2004 and 2008 across 138 acute care hospitals, 19,175 CVD patients with alert consciousness at admission and at discharge were included to remove the sequence of longer LOS caused by consciousness deterioration during hospitalization. The Barthel index (BI) at admission as well as the difference between the BI at admission and discharge were examined. Patient and hospital characteristics, fiscal year, LOS, and total charges (TC; $1 = 100 yen ) were analyzed among three BI improvement categories (deterioration, no change, and improvement). The effects of longer LOS and age on change in BI were determined using mixed linear regression models where study hospitals were handled as a random intercept. To respond to the critique of handling the ordinal variable of BI as the continuous one, logistic regression was employed to assess the association of longer LOS with BI deterioration. Results : Three point five percent (3.5%), 59.7%, and 36.9% of patients experienced deterioration, no change, and improvement in BI, respectively, and 55.5%, 88.9%, and 15.6% of patients in these respective groups were nearly completely independent at admission. The mean age of deterioration, no change, and improvement in BI was 73.7, 66.5, and 69.5 years, respectively. Longer LOS was significantly associated with less BI improvement, which was more remarkable in patients ≥ 75 years of age. Rehabilitation was not observed to determine the degree of BI improvement, but delayed rehabilitation was observed to predict BI deterioration. Conclusions : Because a longer LOS was not observed to ameliorate functional recovery, stakeholders should determine the appropriate LOS in acute CVD care and monitor unnecessary hospitalization, especially in the elderly. doi:10.4021/jnr18e
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».