Analyzing hospital readmissions using statewide discharge databases

Electroconvulsive therapy clinical database: a standardized approach in tertiary care psychiatry

Across health care disciplines research reflects the usefulness of integrating computer technology into administrative and clinical practices. Electroconvulsive therapy (ECT) researchers are often interested in examining 3 primary areas: patient characteristics, treatment characteristics, and treatment outcomes. Generating reports and conducting research analysis via the traditional patient chart review are a time-consuming and costly method. At Riverview Hospital, a tertiary care psychiatric hospital, the active use of a clinical database for patients receiving ECT allows for detailed treatment tracking and evaluation of pretreatment and posttreatment patient outcome measures. Initially, designed as part of a quality improvement process to readily access patient information and generate periodic reports, the ECT clinical database is now a central resource for ECT-specific patient, treatment, and outcome tracking. The relevance, design, content variables, and subsequent functions of the entry and storage of ECT-related administrative, treatment, outcome, and patient factors are clearly outlined and discussed. Strengths and limitations to the existing database are shared. Recommendations to other ECT services to implement this valuable documentation strategy are addressed. This approach can be an invaluable tool in providing the field of psychiatry with further contributions to ECT clinical outcomes.

Readmission data for outcomes measurement: identifying and strengthening the empirical base

Hospital readmission is an important indicator of patient care outcomes and is widely used in evaluating the quality of health care provided. However, few definitions of the term "readmission" are listed in the literature, and exact measurement parameters regarding readmission are seldom stated. The term readmission is indiscriminately used and defined, making accurate comparisons of results difficult across studies if not impossible. This article analyzes the concept readmission, creates a criteria-based definition for the term, and proposes a measurement instrument on the basis of these criteria to consistently quantify readmission in quality management programs and research studies. Multiple databases were searched using various key terms to locate literature covering adult and pediatric populations and all clinical conditions or diagnoses. Articles were selected on the basis of the specified inclusion/exclusion criteria.

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

OBJECTIVE

To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration.

DATA SOURCES

Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state.

STUDY DESIGN

Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999, 2000, and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals.

PRINCIPAL FINDINGS

There is significantly (p<.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals.

CONCLUSION

Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.