Dataset Information

Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016-2017: a retrospective study.

ABSTRACT:

Objectives

To identify factors associated with length of stay (LOS) in chronic obstructive pulmonary disease (COPD) hospitalised patients, which may help shorten LOS and reduce economic burden accrued over hospital stay.

Design

A retrospective cohort study.

Setting

This study was performed in a tertiary hospital in China.

Participants

Patients with COPD who were aged ≥40 years and newly admitted between 2016 and 2017.

Primary and secondary outcome measures

LOS at initial admission was the primary outcome and health expenditures were the secondary outcome. To identify factors associated with LOS, we collected information at index hospitalisation and constructed a conceptual model using directed acyclic graph. Potential factors were classified into five groups: demographic information, disease severity, comorbidities, hospital admission and environmental factors. Negative binomial regression model was fitted for each block of factors and a parsimonious analysis was performed.

Results

In total, we analysed 565 patients with COPD. The mean age was 69±11 years old and 69.4% were men. The median LOS was 10 (interquartile range 8-14) days. LOS was significantly longer in patients with venous thromboembolism (VTE) (16 vs 10 days, p=0.0002) or with osteoporosis (15 vs 10 days, p=0.0228). VTE ((rate ratio) RR 1.38, 95% CI 1.07 to 1.76), hypoxic-hypercarbic encephalopathy (RR 1.53, 95% CI 1.06 to 2.20), respiratory infection (RR 1.12, 95% CI 1.01 to 1.24), osteoporosis (RR 1.45, 95% CI 1.07 to 1.96) and emergence admission (RR 1.08, 95% CI 1.01 to 1.16) were associated with longer LOS. In parsimonious analysis, all these factors remained significant except emergency admission, highlighting the important role of concomitant morbidities in patients' hospital stay. Total hospitalisation cost and patients' out-of-pocket cost increased monotonically with LOS (both p_trend <0.0001).

Conclusion

Patients' concomitant morbidities predicted excessive LOS in patients with COPD. Healthcare cost increased over the LOS. Quality improvement initiatives may need to identify patients at high risk for lengthy stay and implement early interventions to reduce COPD economic burden.

SUBMITTER: Dong F

PROVIDER: S-EPMC7925858 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016-2017: a retrospective study.

Dong Fen F Huang Ke K Ren Xiaoxia X Qumu Shiwei S Niu Hongtao H Wang Yanyan Y Li Yong Y Lu Minya M Lin Xinshan X Yang Ting T Jiao Jianjun J Wang Chen C

BMJ open 20210205 2

<h4>Objectives</h4>To identify factors associated with length of stay (LOS) in chronic obstructive pulmonary disease (COPD) hospitalised patients, which may help shorten LOS and reduce economic burden accrued over hospital stay.<h4>Design</h4>A retrospective cohort study.<h4>Setting</h4>This study was performed in a tertiary hospital in China.<h4>Participants</h4>Patients with COPD who were aged ≥40 years and newly admitted between 2016 and 2017.<h4>Primary and secondary outcome measures</h4>LOS ...[more]

PMID: 33550232

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Project description:BackgroundThe routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction (AMI) has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure (CPAP) use in patients hospitalised with acute cardiovascular disease and concomitant obstructive sleep apnoea (OSA) remain to be elucidated.MethodsIn this retrospective case-control analysis, using 10th International Classification of Diseases, Clinical Modification (ICD-10) codes, we searched the 2016-2019 Nationwide Inpatient Sample for patients diagnosed with unstable angina (UA), AMI, acute decompensated heart failure (ADHF) and atrial fibrillation with rapid ventricular response (AFRVR), who also carried a diagnosis of OSA. We identified in-hospital CPAP use with ICD-10-Procedure Coding System codes. In-hospital death, length of stay (LOS) and hospital charges were compared between patients with and without OSA, and between OSA patients with and without CPAP use.ResultsOur sample included 2 959 991 patients, of which 1.5% were diagnosed with UA, 30.3% with AMI, 37.5% with ADHF and 45.8% with AFRVR. OSA was present in 12.3%. Patients with OSA were more likely to be younger, male, smokers, obese and have chronic obstructive pulmonary disease, renal failure and heart failure (p<0.001 for all). Patients with OSA had significantly lower in-hospital mortality (aOR 0.71, 95% CI (0.7 to 0.73)). Among patients with OSA, CPAP use significantly increased the odds of in-hospital death (aOR 1.51, 95% CI (1.44 to 1.60)), LOS (adjusted mean difference of 1.49 days, 95% CI (1.43 to 1.55)) and hospital charges (adjusted mean difference of US$1168, 95% CI (273 to 2062)).ConclusionOur study showed that patients with recognised OSA hospitalised for AMI, ADHF and AFRVR had significantly lower mortality regardless of CPAP use, while CPAP treatment among these patients was associated with significantly higher in-hospital mortality and resource utilisation. The routine use of CPAP during acute cardiovascular encounters could neutralise the impact of chronic intermittent ischaemic preconditioning.

Project description:BackgroundThe population of persons seeking medical care is linguistically diverse in the United States. Language barriers can adversely affect a patient's ability to explain their symptoms. Among hospitalized patients, these barriers may lead to higher readmission rates and longer hospitalizations. Trained interpreters help overcome communication barriers; however, interpreter usage among patients is suboptimal.ObjectiveTo investigate differences among patients with limited English proficiency (LEP) in their length of stay (LOS) and 30-day readmission rate associated with their receiving professional interpretation at admission or discharge.DesignWe analyzed the rates of interpretation at admission and discharge of all LEP patients admitted to a tertiary care hospital over a three-year period. We calculated length of stay in days and as log of LOS. We also examined 30-day readmission. Using multivariable regression models, we explored differences among patients who received interpretation at admission, discharge, or both, controlling for patient characteristics, including age, illness severity, language, and gender.ParticipantsAll LEP patients admitted between May 1, 2004 and April 30, 2007.Main measuresLength of hospital stay as related to use of professional interpreters; readmission to the hospital within 30 days.Key resultsOf the 3071 patients included in the study, 39 % received language interpretation on both admission and discharge date. Patients who did not receive professional interpretation at admission or both admission/discharge had an increase in their LOS of between 0.75 and 1.47 days, compared to patients who had an interpreter on both day of admission and discharge (P<0.02). Patients receiving interpretation at admission and/or discharge were less likely than patients receiving no interpretation to be readmitted with 30 days.ConclusionsThe length of a hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or both admission/discharge.

Dataset Information

Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016-2017: a retrospective study.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusion

Publications

Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016-2017: a retrospective study.

Similar Datasets

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