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Factors associated with death and readmission into the Intensive Care Unit; Fatores associados ao óbito e a readmissão em Unidade de Terapia Intensiva; Factores asociados a la muerte y a la readmisión en Unidad de Terapia Intensiva

SILVA, Maria Claudia Moreira da; SOUSA, Regina Marcia Cardoso de; PADILHA, Katia Grillo
Fonte: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Publicador: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
37.17%
This study identifies the factors associated with death and readmission into the Intensive Care Unit. This is a longitudinal prospective study of 600 adult patients admitted in general Intensive Care Units of four hospitals in São Paulo, Brazil. The multiple regression analysis showed that patients with a longer length of stay and higher Nursing Activities Score, Simplified Acute Physiology Score II and Logistic Organ Dysfunction Score on the last day in the unit had a higher chance of death. Nevertheless, higher Nursing Activities Score and Logistic Organ Dysfunction Score on the first day in the intensive care unit were protective factors against death. Viral hepatitis as an antecedent increased the chance of readmission. On the other hand, higher Nursing Activities Score at discharge decreased this risk. It was concluded that the nursing workload was the main variable related to the outcomes analyzed.; O objetivo deste estudo foi identificar os fatores associados ao óbito e à readmissão dos pacientes em unidade de terapia intensiva. Estudo prospectivo longitudinal, com 600 pacientes adultos, internados em unidade de terapia intensiva geral de quatro hospitais do município de São Paulo. A análise de regressão múltipla mostrou que os pacientes com maior tempo de internação...

Fatores relacionados com a alta, óbito e readmissão em unidade de terapia intensiva; Factors regarding discharge, death and readmission into the intensive care unit

Silva, Maria Cláudia Moreira da
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 22/02/2007 PT
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Ao se considerar a importância da busca de indicadores que determinam, tanto a alta dos pacientes das unidades de terapia intensiva (UTIs) como o risco de óbito e readmissão dos internados nessa unidade, este estudo teve como objetivos: caracterizar os pacientes internados em UTIs de hospitais que tenham unidades intermediárias quanto aos dados demográficos e clínicos; descrever a mortalidade e a unidade de destino após a alta da UTI e a freqüência de readmissão nessas unidades; comparar as médias do Nursing Activities Score (NAS), Simplified Acute Physiology (SAPS II) e Logistic Organ Dysfunction (LODS) no primeiro e último dia de internação na UTI; identificar os fatores associados com a alta, óbito e readmissão dos pacientes em UTI na mesma internação hospitalar. Trata-se de um estudo prospectivo longitudinal de pacientes adultos internados em UTIs gerais de dois hospitais governamentais e dois não governamentais do Município de São Paulo que possuíam unidades intermediárias. A casuística compôs-se de 500 pacientes adultos admitidos nessas UTIs. Os dados coletados foram referentes as primeiras e últimas 24 horas de permanência na UTI, porém os pacientes foram acompanhados até a alta hospitalar para identificação das readmissões. Os resultados mostraram predomínio de indivíduos idosos (55...

Readmissão por infecção de sítio cirúrgico em um hospital público de Belo Horizonte (MG); Patient readmission for surgical site infection in a governmental hospital in Belo Horizonte (MG)

Torres, Lilian Machado
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 19/05/2011 PT
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A crescente preocupação sobre as infecções relacionadas à assistência à saúde levou a Organização Mundial da Saúde a promover a criação da Aliança Mundial para a Segurança do Paciente, enfatizando ações básicas de controle de infecções. A redução de sua incidência implica em proteção para o paciente, profissionais e instituições, favorecendo a prestação da assistência livre de riscos. Dentre as mais frequentes, a infecção do sítio cirúrgico deve ser compreendida como elemento qualificador do cuidado e, os dados relacionados, o ponto de partida para as ações preventivas e de controle. Os hospitais têm dificuldades para realizar a vigilância epidemiológica pós-alta, tarefa complexa haja vista a tendência de redução do tempo de internação. Conhecer dados sobre a readmissão contribui para melhorar os dados de vigilância pós-alta. Foi realizado um estudo exploratório com o objetivo de descrever a epidemiologia das readmissões por infecções de sítio cirúrgico em pacientes em um hospital público de Belo Horizonte (MG). Foram avaliados 98 registros médicos e da Comissão de Controle de Infecção Hospitalar referentes aos indivíduos readmitidos por este motivo entre janeiro/2008 e dezembro/2009. Os resultados demonstraram que um quarto dos pacientes que desenvolveu infecção do sítio cirúrgico na instituição necessitou de nova internação. A idade média dos indivíduos foi de 57...

Reinternação psiquiátrica no campo da atenção psicossocial: a perspectiva dos pacientes reinternantes; Psychiatric readmission in the field of Psychosocial Care: the perspective of readmitted patients.

Machado, Vanessa Cristina
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 13/12/2012 PT
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As concepções sobre a loucura, bem como as formas de tratá-la, vêm sofrendo consideráveis transformações de acordo com a cultura e as épocas. A partir da década de 1990, foi oficializada a Reforma Psiquiátrica no Brasil, dando início à política de desinstitucionalização e reinserção social. Todavia, ainda são verificados alguns desafios, entre estes, as reinternações no setor de internação breve em um hospital psiquiátrico, o que traz sérias consequências, como a propensão a uma nova modalidade de institucionalização. Este estudo teve como objetivos: analisar o fenômeno da reinternação psiquiátrica no contexto da Atenção Psicossocial, a partir da visão dos pacientes reinternantes em um hospital psiquiátrico público; compreender o processo de reinternação psiquiátrica ao qual o paciente está sujeito; investigar o cenário assistencial e sociofamiliar e suas interferências no fenômeno da reinternação psiquiátrica; explorar, junto aos pacientes, a existência de perspectivas que vislumbrem saídas às repetidas internações psiquiátricas. Inicialmente, com vistas a sintetizar e analisar a produção científica nacional e internacional acerca do fenômeno da reinternação psiquiátrica...

Factors associated with readmission to a general hospital in Brazil

Castro,Mônica Silva Monteiro de; Carvalho,Marilia Sá; Travassos,Cláudia
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2005 EN
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37.17%
The objective of this study was to compare different modeling strategies to identify individual and admissions characteristics associated with readmission to a general hospital. Routine data recorded in the Hospital Information System on all admissions to the Regional Public Hospital of Betim, Minas Gerais State, Brazil, from July 1996 to June 2000 were analyzed. Cox proportional hazards model and variants designed to deal with multiple-events data, like Andersen-Gill (AG), Prentice, Williams and Peterson (PWP), and random effects models were fitted to time between hospital admissions or censoring. For comparison purposes, a Poisson model was fitted to the total number of readmissions, using the same covariates. We analyzed 31,648 admissions of 26,198 patients, including 17,096 adults and 9,102 children. Estimates for the PWP and frailty models were very similar, and both approaches should be fitted and compared. If clinical characteristics are available, the PWP model should be used. Otherwise the random effects model can account for unmeasured differences, particularly some related to severity of the disease. These methodologies can help focus on various related readmission aspects such as diagnostic groups or medical specialties.

Factors associated with death and readmission into the Intensive Care Unit

Silva,Maria Claudia Moreira da; Sousa,Regina Marcia Cardoso de; Padilha,Katia Grillo
Fonte: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Publicador: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2011 EN
Relevância na Pesquisa
37.17%
This study identifies the factors associated with death and readmission into the Intensive Care Unit. This is a longitudinal prospective study of 600 adult patients admitted in general Intensive Care Units of four hospitals in São Paulo, Brazil. The multiple regression analysis showed that patients with a longer length of stay and higher Nursing Activities Score, Simplified Acute Physiology Score II and Logistic Organ Dysfunction Score on the last day in the unit had a higher chance of death. Nevertheless, higher Nursing Activities Score and Logistic Organ Dysfunction Score on the first day in the intensive care unit were protective factors against death. Viral hepatitis as an antecedent increased the chance of readmission. On the other hand, higher Nursing Activities Score at discharge decreased this risk. It was concluded that the nursing workload was the main variable related to the outcomes analyzed.

Assessment of ICU readmission risk with the Stability and Workload Index for Transfer score

Oakes,Daiane Ferreira; Borges,Ingrid Nemitz Kras; Forgiarini Junior,Luiz Alberto; Rieder,Marcelo de Mello
Fonte: Sociedade Brasileira de Pneumologia e Tisiologia Publicador: Sociedade Brasileira de Pneumologia e Tisiologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2014 EN
Relevância na Pesquisa
37.17%
Patient discharge from the ICU is indicated on the basis of clinical evidence and the result of strategies aimed at improving health care. Nevertheless, some patients might be discharged too early. We attempted to identify risk factors for unplanned ICU readmission, using a score for risk assessment, designated the Stability and Workload Index for Transfer (SWIFT) score. We evaluated 100 patients discharged from an ICU and found that the SWIFT score can be used as a tool for improving the assessment of ICU patients and the appropriateness of ICU discharge, thus preventing readmission.

Utility of the combination of serum highly-sensitive C-reactive protein level at discharge and a risk index in predicting readmission for acute exacerbation of COPD,

Chang,Chun; Zhu,Hong; Shen,Ning; Han,Xiang; Chen,Yahong; He,Bei
Fonte: Sociedade Brasileira de Pneumologia e Tisiologia Publicador: Sociedade Brasileira de Pneumologia e Tisiologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2014 EN
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OBJECTIVE: Frequent readmissions for acute exacerbations of COPD (AECOPD) are an independent risk factor for increased mortality and use of health-care resources. Disease severity and C-reactive protein (CRP) level are validated predictors of long-term prognosis in such patients. This study investigated the utility of combining serum CRP level with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) exacerbation risk classification for predicting readmission for AECOPD. METHODS: This was a prospective observational study of consecutive patients hospitalized for AECOPD at Peking University Third Hospital, in Beijing, China. We assessed patient age; gender; smoking status and history (pack-years); lung function; AECOPD frequency during the last year; quality of life; GOLD risk category (A-D; D indicating the greatest risk); and serum level of high-sensitivity CRP at discharge (hsCRP-D). RESULTS: The final sample comprised 135 patients. Of those, 71 (52.6%) were readmitted at least once during the 12-month follow-up period. The median (interquartile) time to readmission was 78 days (42-178 days). Multivariate analysis revealed that serum hsCRP-D ≥ 3 mg/L and GOLD category D were independent predictors of readmission (hazard ratio = 3.486; 95% CI: 1.968-6.175; p < 0.001 and hazard ratio = 2.201; 95% CI: 1.342-3.610; p = 0.002...

What are the risk factors for readmission in patients with an ileostomy?

Campos-Lobato,Luiz Felipe de; Alves-Ferreira,Patricia Cristina; Oliveira,Paulo Goncalves de; Sousa,Joao Batista de; Vogel,Jon D.
Fonte: Sociedade Brasileira de Coloproctologia Publicador: Sociedade Brasileira de Coloproctologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2013 EN
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PURPOSE: the aim of this study was to identify the risk factors for readmission among patients submitted to colorectal surgery. METHODS: a single-center colorectal quality-assessment database was queried for patients undergoing colorectal procedures with ileostomy during 2009. The sample was divided into readmitted vs. non-readmitted. Readmission was defined as admission within the first 30 days after the index procedure. Groups were compared by pre, intra and postoperative characteristics. A multivariate analysis was performed to identify the risk factors for readmission. RESULTS: the query returned 496 patients, [267 (54%) males, median age 48 years (IQR: 34-60)]. Eighty-three (17%) were readmitted; 296 patients (60%), were operated due to inflammatory bowel disease, 89 (18%) for cancer, 16 (3%) for diverticular disease and 95 (19%) for other diagnosis. The three most common procedures were total proctocolectomy with ileal pouch-anal anastomosis (IPAA) in 103 patients (21%), total colectomy with end ileostomy in 117 (24%) and small bowel resections (including enterocutaneous fistula takedown and J-pouch excision) in 149 (30%). The following variables were significantly more common in readmitted patients: current smoking (24% vs. 14%...

Hospital Readmission in General Medicine Patients: A Prediction Model

Meltzer, David O.; Shaykevich, Shimon A.; Bell, Chaim M.; Kaboli, Peter J.; Wetterneck, Tosha B.; Arora, Vineet M.; Zhang, James; Hasan, Omar; Auerbach, Andrew; Schnipper, Jeffrey Lawrence
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN_US
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Background: Previous studies of hospital readmission have focused on specific conditions or populations and generated complex prediction models. Objective: To identify predictors of early hospital readmission in a diverse patient population and derive and validate a simple model for identifying patients at high readmission risk. Design: Prospective observational cohort study. Patients: Participants encompassed 10,946 patients discharged home from general medicine services at six academic medical centers and were randomly divided into derivation (n = 7,287) and validation (n = 3,659) cohorts. Measurements: We identified readmissions from administrative data and 30-day post-discharge telephone follow-up. Patient-level factors were grouped into four categories: sociodemographic factors, social support, health condition, and healthcare utilization. We performed logistic regression analysis to identify significant predictors of unplanned readmission within 30 days of discharge and developed a scoring system for estimating readmission risk. Results: Approximately 17.5% of patients were readmitted in each cohort. Among patients in the derivation cohort, seven factors emerged as significant predictors of early readmission: insurance status...

Institution specific risk factors for 30 day readmission at a community hospital: a retrospective observational study

Park, Lee; Andrade, Danielle; Mastey, Andrew; Sun, James; Hicks, LeRoi
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Background: As of October 1, 2012, hospitals in the United States with excess readmissions based on the Centers for Medicare and Medicaid Services (CMS) risk-adjusted ratio began being penalized. Given the impact of high readmission rates to hospitals nationally, it is important for individual hospitals to identify which patients may be at highest risk of readmission. The objective of this study was to assess the association of institution specific factors with 30-day readmission. Methods: The study is a retrospective observational study using administrative data from January 1, 2009 through December 31, 2010 conducted at a 257 bed community hospital in Massachusetts. The patients included inpatient medical discharges from the hospitalist service with the primary diagnoses of congestive heart failure, pneumonia or chronic obstructive pulmonary disease. The outcome was 30-day readmission rates. After adjusting for known factors that impact readmission, provider associated factors (i.e. hours worked and census on the day of discharge) and hospital associated factors (i.e. floor of discharge, season) were compared. Results: Over the study time period, there were 3774 discharges by hospitalists, with 637 30-day readmissions (17% readmission rate). By condition...

Predicting readmission of heart failure patients using automated follow-up calls

Inouye, Shelby; Bouras, Vasileios; Shouldis, Eric; Johnstone, Adam; Silverzweig, Zachary; Kosuri, Pallav
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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37.49%
Background: Readmission rates for patients with heart failure (HF) remain high. Many efforts to identify patients at high risk for readmission focus on patient demographics or on measures taken in the hospital. We evaluated a method for risk assessment that depends on patient self-report following discharge from the hospital. Methods: In this study, we investigated whether automated calls could be used to identify patients who are at a higher risk of readmission within 30 days. An automated multi-call follow-up program was deployed with 1095 discharged HF patients. During each call, the patient reported his or her general health status. Patients were grouped by the trend of their responses over the two calls, and their unadjusted 30-day readmission rates were compared. Pearson’s chi-square test was used to evaluate whether readmission risk was independent of response trend. Results: Of the 1095 patients participating in the program, 837 (76%) responded to the general status question in at least one of the calls and 515 (47%) patients responded to the general status question in both calls. Out of the 89 patients exhibiting a negative response trend, 37% were readmitted. By contrast, the 97 patients showing a positive trend and the 329 patients showing a neutral trend were readmitted at rates of 16% and 14% respectively. The dependence of readmission on trend group was statistically significant (P < 0.0001). Conclusions: Patients at an elevated risk of readmission can be identified based on the trend of their responses to automated follow-up calls. This presents a simple method for risk stratification based on patient self-assessment.

Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

McCaul, K.; Wakefield, M.; Roder, D.; Ruffin, R.; Heard, A.; Alpers, J.; Staugas, R.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2000 EN
Relevância na Pesquisa
37.52%
OBJECTIVES: To describe patterns of hospital readmission for asthma in South Australia from 1989 to 1996, in relation to implementation of the National Asthma Campaign. DESIGN AND SETTING: A comparison of hospital admissions in South Australia of patients aged between one year and 49 years for three conditions: asthma (or respiratory failure with asthma as an underlying condition) and two control conditions--diabetes and epilepsy. Individuals were identified by Medicare number and date of birth. OUTCOME MEASURES: Hospital readmission within 28 days and within one year. RESULTS: Overall, by 1996, there was a statistically significant decline in the risk of readmission for asthma within 28 days of 18% and within one year of 17% compared with 1989 readmission rates. There were no reductions in the risk of readmission for diabetes or epilepsy, suggesting that the decline in risk of readmission for asthma was greater than the underlying effects of general changes in hospital casemix. CONCLUSIONS: The decline in risk of readmission may reflect changes in asthma severity or improved management practices. However, hospital readmission rates still remain high, and to further reduce readmissions for asthma there is a need to identify factors related to presentation for asthma at accident and emergency departments.; http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=10738474&cmd=showdetailview&indexed=google; Mccaul...

Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men

Mnatzaganian, G.; Ryan, P.; Norman, P.; Davidson, D.; Hiller, J.
Fonte: Dove Medical Press Ltd Publicador: Dove Medical Press Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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Background: We retrospectively assessed the independent effects of patient and clinical factors on length of stay and all-cause 90-day, one-year, and two-year readmission following elective total joint replacement. We also evaluated the independent association between length of stay and readmission with postoperative five-year mortality. Methods: Longitudinal data from 819 men who had had total joint replacement were integrated with validated hospital morbidity data and mortality records. Length of stay, readmission, and mortality following total joint replacement were each modeled using multivariable proportional hazards regression. Results: Mean age at surgery was 76.3 ± 4.3 years. Median length of stay following total joint replacement decreased by 25% from 12 days in 1997–1998 to nine days in 2005–2007. Age, inhospital complications, total knee replacement, private hospital, and increased body weight were significantly associated with longer stay. A dose-response relationship between weight and length of stay was observed (P = 0.003). Crude 90-day, one-year, and two-year readmission rates were 17.3%, 47.4%, and 65.0%, respectively. Ninety-day readmission was associated with comorbidity, inhospital complications, and treatment in public hospitals. Age...

Modelo de hospitalización y frecuencia de reingreso en pacientes con exacerbación de EPOC.; Hospitalization model and the readmission frequency in patients with copd exacerbation

Maciá Soler, Loreto; Latour Pérez, J.; Moncho Vasallo, J.; Mariscal Crespo, M.I.; Orts Cortés, Mª Isabel.
Fonte: Murcia : Servicio de Publicaciones de la Universidad de Murcia Publicador: Murcia : Servicio de Publicaciones de la Universidad de Murcia
Tipo: Artigo de Revista Científica Formato: application/pdf
SPA
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Objetivo. Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad. Método. Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox. Resultados. De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p < 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p <0,07) que los pacientes de HC. La estancia media fue de 3,2 días en UCE frente a 8,9 días en HC (p <0,001). En el análisis univariante, los pacientes ingresados en UCE mostraron una mayor incidencia de muerte o reingreso (Riesgo Relativo [RR] 1,31; p<0,001), a expensas de los reingresos (RR 1,53; p= 0,013), no hubo diferencias de mortalidad (RR 0,82; p=0,34). Al ajustar para las covariables del modelo de hospitalización mediante regresión de Cox, estas estimaciones no cambiaron El análisis de las curvas de supervivencia demostró que las diferencias no se debieron a un aumento de los reingresos precoces. Conclusiones. En el estudio...

Elderly readmission and death after discharge from treatment of hip fracture, occurred in public hospitals from 2008 to 2010, Rio de Janeiro

Paula,Fátima de Lima; Cunha,Geraldo Marcelo da; Leite,Iúri da Costa; Pinheiro,Rejane Sobrino; Valente,Joaquim Gonçalves
Fonte: Associação Brasileira de Saúde Coletiva Publicador: Associação Brasileira de Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 EN
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OBJECTIVES: To estimate the risk of death and readmission of a cohort of elderly patients discharged after hip fracture treatment from hospitals of the public health system; to describe the causes of these events; and to compare the rates of readmission and death observed with those of the elderly population hospitalized in public hospitals of Rio de Janeiro city. METHODS: Data on deaths and readmissions were obtained through the linkage of these two data sources: the Hospital Information System of the Sistema Único de Saúde and the Mortality Information System from the city of Rio de Janeiro. The time frame for the study was 2008 to 2011. The population consisted of 2,612 individuals aged 60 years or older with nonelective hospitalization for hip fracture who were followed for a year after discharge. RESULTS: The readmission rate in one year, excluding the deaths in this period, was 17.8%, and the death rate was 18.6%. The most common causes of death were circulatory system diseases (29.5%). Approximately 15% of the causes of readmissions were surgical complications. The state hospitals showed lower readmission risks and higher death risks compared with the federal and municipal hospitals. It was observed that there is an excess risk of readmission and hospitalization of the study population compared with the elderly population hospitalized in the public hospitals of the city. CONCLUSION: Hospitalization of elderly individuals for hip fracture causes adverse outcomes such as readmissions and deaths. Many of these outcomes can be prevented from actions recommended in the National Policy for the Elderly Health.

Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

Santos,Marcelo Rodrigues dos; Sayegh,Ana Luiza Carrari; Groehs,Raphaela Vilar Ramalho; Fonseca,Guilherme; Trombetta,Ivani Credidio; Barretto,Antônio Carlos Pereira; Arap,Marco Antônio; Negrão,Carlos Eduardo; Middlekauff,Holly R.; Alves,Maria-Janieire d
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2015 EN
Relevância na Pesquisa
37.46%
Background:Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.Objective:We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.Methods:Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.Results:Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR]...

Data mining models to predict patient's readmission in intensive care units

Braga, Pedro; Portela, Filipe; Santos, Manuel Filipe; Rua, Fernando
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Conferência ou Objeto de Conferência
Publicado em //2014 ENG
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37.28%
Decision making is one of the most critical activities in Intensive Care Units (ICU). Moreover, it is extremely difficult for health professionals to interpret in real time all the available data. In order to improve the decision process, classification models have been developed to predict patient’s readmission in ICU. Knowing the probability of readmission in advance will allow for a more efficient planning of discharge. Consequently, the use of these models results in a lower rates of readmission and a cost reduction, usually associated with premature discharges and unplanned readmissions. In this work was followed a numerical index, called Stability and Workload Index for Transfer (SWIFT). The data used to induce the classification models are from ICU of Centro Hospitalar do Porto, Portugal. The results obtained so far, in terms of accuracy, were very satisfactory (98.91%). Those results were achieved through the use of Naïve Bayes technique. The models will allow health professionals to have a better perception on patient’s future condition in the moment of the hospital discharge. Therefore it will be possible to know the probability of a patient being readmitted into the ICU.

Hospital Readmission for Heart Failure in a Teaching Hospital in the State of São Paulo-SP; Readmissão Hospitalar por Insuficiência Cardíaca em um Hospital de Ensino do Interior do Estado de São Paulo-SP*

Reis, Marcio B.; Dias, Marina G.; Bibanco, Mariana S.; Lopes, Camila T.; Gea, Gisela N.
Fonte: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto Publicador: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 26/04/2015 POR
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Estudo descritivo retrospectivo de pacientes readmitidos por insuficiência cardíaca crônica, com o objetivo de quantificar as taxas de readmissão hospitalar não planejada em até 30 dias e fatores possivelmente associados à readmissão. As taxas de readmissão hospitalar em 2010 e 2011 foram de 3,91% e 2,41%, respectivamente, sendo a média de tempo até a readmissão de 14,5±7,1 dias. A etiologia mais frequente da insuficiência cardíaca foi a doença valvar, seguida da hipertensão arterial. As mulheres foram mais acometidas e 96% dos pacientes foram readmitidos em decorrência da persistência ou recorrência do episódio que motivou a admissão inicial. Não foram obtidos dados satisfatórios quanto às possíveis causas que teriam levado à persistência ou recorrência do episódio de doença.; Retrospective descriptive study of patients readmitted for chronic heart failure, aiming to quantify the rates of unplanned hospital readmission within 30 days and factors possibly associated with readmission. Hospital readmission rates in 2010 and 2011 were 3.91% and 2.41%, respectively, the average time until readmission being 14.5±7.1 days. The most frequent heart failure etiology was valve disease, followed by hypertension. Most were women and 96% were readmitted as a result of the persistence or recurrence of the episode that prompted the initial admission. No satisfactory data regarding the possible causes of persistence or recurrence of the disease were found.

Occupational performance factors perceived to influence the readmission of mental health care users diagnosed with schizophrenia

Smith,Rulaine; De Witt,Patricia; Franzsen,Denise; Pillay,Michelle; Wolfe,Nadine; Davies,Carrie
Fonte: South African Journal of Occupational Therapy Publicador: South African Journal of Occupational Therapy
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2014 EN
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Schizophrenia is a complex disorder due to the range of deficits with which mental health care users (MHCUs) present. In addition, the high rate of relapse and readmission in clients diagnosed with schizophrenia complicates the effective management of the condition. Medical factors have been evidenced to affect relapse and readmission rates however limited data exists regarding the influence of occupational performance factors. The aim of this study was therefore, to determine which occupational performance factors are perceived to affect the readmission of MHCUs diagnosed with schizophrenia. A descriptive, cross-sectional quantitative design with qualitative elements was conducted. Card sorting was implemented in two phases to a conveniently sampled population of occupational therapists and MHCUs diagnosed with schizophrenia. Data were analysed by means of descriptive statistics. It was found that social participation was perceived to be the most influential factor in the readmission of MHCUs diagnosed with schizophrenia. In conclusion, both medical and occupational performance factors affect readmission rates of MHCUs diagnosed with schizophrenia. Therefore to implement a client centred approach in occupational therapy, therapists may need to reconsider the priorities they address in treatment.