Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study analyzed the early effects of the Medicare Prospective Payment System (PPS) on the likelihood of hospital's discharging Medicare beneficiaries to skilled nursing facilities (SNFs), intermediate care facilities (ICFs), and home health agencies. It also examined length of stay before transfer. Discharge abstract data on patients in five DRG groups were studied. Data were obtained from 501 hospitals for the third quarters of 1980, 1983, 1984, and 1985. Multinomial logit and ordinary least squares regression techniques were employed. After controlling for hospital and patient characteristics, including severity of illness, it was found that the probability of transfer increased substantially in virtually all DRGs and discharge destinations studied. This was particularly true for patients with stroke, pneumonia, and major joint and hip procedure. The analysis reveals that PPS increased the rate of discharges to subacute facilities. This effect was stronger for transfer to SNFs than to ICFs and home health agencies. Further, the impact of PPS on transfers was greater in 1985 than in 1984. Lengths of stay before transfer tended to decline in almost all DRGs and destinations examined. However, the effects of PPS on lengths of stay of transferred patients were not statistically significant at conventional levels. The results suggest that payment experiments with broader forms of bundled services are in order, as are experiments with hospital acute-subacute swing beds.
 ...
PMID:Medicare prospective payment and posthospital transfers to subacute care. 313 81

Although (diagnostic related groups) DRGs were originally devised as a research instrument for the evaluation of medical resource allocation, no studies have been reported that compare the actual physiologic status of patients with DRG classification. At the Westchester Medical Center, a University tertiary referral center, 100 consecutive high-risk elective surgical patients entered a preoperative intensive care unit for a prospective analysis of physiologic assessment, resource utilization, DRG classification, and outcome. Swan-Ganz catheters inserted 1 or 2 days before surgery were used to compute physiologic profiles and stage according to previously published criteria. Risk was determined by age, associated conditions, and magnitude of the proposed operation. There were no patients in stage 1; 55% in stage 2; 41% in stage 3; and 4% in stage 4, which accounted for three of the four total deaths. The 41% of patients over age 70 all had DRG comorbidity factors, but none died. All in stages 3 and 4 had comorbidity factors, as did 87% in stage 2. In 53% of the patients, the physiologic profile provided data necessary for preoperative "fine tuning"; in 37%, for volume expansion; in 23%, for inotropic therapy; and in 17%, for pulmonary therapy. Reoperation was required in 17% and contributed to the long average length of stay (LOS) of 24.5 days. In spite of case severity and comorbidity factors, LOS in the postoperative ICU was only 3 days. There were no significant differences in patients with cancer DRGs. Significant differences between stages 2 and 3 were found for pulmonary wedge pressure, right ventricular stroke work, pulmonary vascular resistance, and pulmonary shunt fraction. The 4% who died all had advanced liver disease. Although the DRG system as set up by the Health Care Financing Administration (HCFA) correctly predicts that age and comorbidity factors lead to increased utilization of resources, the extent to which they underestimate the increased needs of these patients will lead to financial disaster. Compensation for comorbidity factors and advanced age are not cumulative, but patients over 70 had an average of 2.5 comorbidity factors and required an average 26.5 days hospitalization. DRGs allowed only 15% extra reimbursement for these complex cases. High-risk, referred surgical patients are much sicker than they appear to the DRG system, and in all 100 cases compensation was grossly inadequate.
 ...
PMID:Physiologic assessment of surgical diagnosis-related groups. 393 95

Estimates of the total cost of stroke in the United States vary widely, ranging from annual health care expenses of $15 billion to $30 billion when the patients' lost wages are included. As a result of increasingly shorter acute hospitalizations under the DRG-based Prospective Payment System, medical costs paid by Medicare have stabilized. Data from Medicare show that people over age 64 years account for 87% of all deaths and 74% of all hospitalizations for cerebrovascular disease. Data through 1986 indicate that cost-containment measures did not appear to affect outcomes negatively or lead to more complications that would likely add to the cost of hospital care. Shorter inpatient rehabilitation stays are also a product of Medicare reimbursements and of capitated care. The mean cost across regions of the United States for inpatient rehabilitation is three to four times that of an acute hospital stay; however, only a minority of stroke survivors receive this level of care. The greater availability of nursing homes and a decline in age-adjusted death rates that might leave more patients disabled could raise some costs, whereas more widespread management of risk factors might decrease stroke rates and the severity of disability.
 ...
PMID:The economic impact of stroke. 788 89

Length of stay (LOS) differences were not observed between the dually entitled and other Medicare stroke patients when complexity of disease was considered. LOS for dually entitled heart failure patients was 33.2 percent longer than other Medicare heart failures and were equally likely to be in the extreme DRG subclass. Patients with extreme heart failure stayed 15.5 days longer than those with mild heart failure. LOS differences (+4.5 days) were observed between the dually entitled and other Medicare heart failures when complexity of disease was considered. Within these two DRGs, incremental health care needs for dually entitled equalled 10 percent of the hospital's total Medicare days associated with stroke and heart failure.
 ...
PMID:A length of stay study of the dually entitled Medicare and Medicaid population: challenges for managed competition. 1013 96

A chart review of acute stroke (DRG 14) discharges from a rural academic medical center in 1999 was performed because of an observed high in-hospital crude acute stroke mortality rate. An analysis of the results of this chart review demonstrated that the odds ratio of intracerebral hemorrhage in patients who had been transferred from other hospitals was 11.7 compared to intracerebral hemorrhage in nonhospital transfer patients (p < 0.00001). This finding illustrates the potential magnitude and significance of referral bias at a rural academic medical center.
 ...
PMID:In-hospital stroke mortality, hospital transfers, and referral bias at a rural academic medical center. 1213 80

We examined all the official hospital records referring to admissions for acute stroke (AS) (DRG 14) from January 1 to December 31, 1996 in Campania (Italy), a large region with 10% of the Italian population. Related healthcare burden and available resources were evaluated. During the study period, a total of 9,003 discharges were reported. We counted 11 neurological care units (NCU) committed to emergency in the region, with 230 hospital beds. The 4,890 admissions in NCU represented 54.3% of the total AS hospitalizations per year. A large number of strokes (45.7%) had no access to specialist assistance and were hospitalized mainly in general wards with a mean hospital stay of 12.7 days, compared with 9.5 days in NCU (p < 0.01). In our region, the number of hospital beds available for neurological emergencies do not meet the demand.
 ...
PMID:Burden of acute stroke and hospital resources in the Campania region of Italy. 1218 16

Inpatient mortality has increasingly been used as an hospital outcome measure. Comparing mortality rates across hospitals requires adjustment for patient risks before making inferences about quality of care based on patient outcomes. Therefore it is essential to dispose of well performing severity measures. The aim of this study is to evaluate the ability of the All Patient Refined DRG system to predict inpatient mortality for congestive heart failure, myocardial infarction, pneumonia and ischemic stroke. Administrative records were used in this analysis. We used two statistics methods to assess the ability of the APR-DRG to predict mortality: the area under the receiver operating characteristics curve (referred to as the c-statistic) and the Hosmer-Lemeshow test. The database for the study included 19,212 discharges for stroke, pneumonia, myocardial infarction and congestive heart failure from fifteen hospital participating in the Italian APR-DRG Project. A multivariate analysis was performed to predict mortality for each condition in study using age, sex and APR-DRG risk mortality subclass as independent variables. Inpatient mortality rate ranges from 9.7% (pneumonia) to 16.7% (stroke). Model discrimination, calculated using the c-statistic, was 0.91 for myocardial infarction, 0.68 for stroke, 0.78 for pneumonia and 0.71 for congestive heart failure. The model calibration assessed using the Hosmer-Leme-show test was quite good. The performance of the APR-DRG scheme when used on Italian hospital activity records is similar to that reported in literature and it seems to improve by adding age and sex to the model. The APR-DRG system does not completely capture the effects of these variables. In some cases, the better performance might be due to the inclusion of specific complications in the risk-of-mortality subclass assignment.
 ...
PMID:[Evaluation of the capacity of the APR-DRG classification system to predict hospital mortality]. 1240 5

The Debrecen Stroke Unit covers a catchment area of 210,000 inhabitants in eastern Hungary. The unit was established at the Department of Neurology of the University Hospital in 1974 and has 23 beds, 7 of which have monitoring facilities. The unit treats about 600 patients with acute cerebrovascular diseases annually - about 60% of all hospitalised stroke cases in the region. Overall, 18 registered nurses and 4 nurse helpers work for the unit. Computer tomography is performed in over 90% of cases. Carotid duplex ultrasound and echocardiography are part of the routine examinations in ischaemic strokes. Delay from onset of stroke to hospital arrival is the main barrier against the use of rt-PA. Average length of stay is 12 days; a lack of rehabilitation and nursing capacities sometimes delays discharge of dependent patients. The hospital is reimbursed the costs of stroke care based on DRG.
 ...
PMID:Stroke units in Hungary - the Debrecen experience. 1264 11

Many prospective, randomized clinical trials evaluating the safety and efficacy of carotid endarterectomy (CEA) versus medical management in the prevention of ischemic stroke were performed in the 1990s. Clinical trials are underway that will compare CEA outcomes to carotid stenting; however, relatively few studies have examined the outcomes of modern CEA. The purpose of this report is to examine current outcomes of CEA and evaluate hospital costs and length of stay. Statewide results were collected for all hospitals, except Veterans Administration hospitals, by Virginia Health Information (VHI). Data for the years 1997-2001 were evaluated, and data were based on the All Patient Refined Diagnostic Related Group (APR-DRG; 3M Company). A total of 14,095 CEAs were performed in a 5-year period. The mortality of patients undergoing CEA was 0.5 per cent. The stroke rate was 1 per cent overall and decreased each year of the study. Mean and median lengths of hospital stay were 3 and 2 days, respectively. Length of stay decreased over the course of this study. Mean and median hospital costs were 14,331 dollars and 11,268 dollars. Higher rates of mortality and stroke and higher costs were observed at low-volume hospitals. The need for CEA is substantial. CEA is safe and inexpensive. The data presented here demonstrates continued refinement in CEA, leading to a very low rate of perioperative adverse events, declining lengths of stay, and low hospital costs.
 ...
PMID:Carotid endarterectomy: update on the gold standard treatment for carotid stenosis. 1621 46

It is well known that stroke is associated with high morbidity and mortality. Previous studies and metaanalysis provide evidence favouring care of stroke patients in Stroke Units (SU). We published data on SU coverage for seven Italian regions during 2000-2001. The aim of this study is to conduct a new recent survey of SUs in the entire national territory and to evaluate changes in number of SUs and in organisation of in-hospital care in the seven Italian regions evaluated in our previous survey. Hospital services were identified through the diagnosis-related groups (DRG 14) from national hospital discharge registers. We selected services recording at least 50 acute stroke discharges per year. The characteristics of hospital services were obtained from a structured questionnaire submitted by phone by trained researchers to the doctors in charge of services. A SU was defined as a ward that admits acute stroke patients cared for in dedicated beds and by dedicated staff. Out of 676 hospital services evaluated during 2003-2004, 68 were SUs. The national coverage for SU services was 10%, ranging from 0% to 50% in different regions. In 2003-2004 SUs admitted 10% of the total national acute stroke cases. SUs have a more facilitated access to diagnostic evaluations and also seem to be better organised than general wards. Between 2000 and 2004 the number of SUs increased from 7% to 11% in the seven regions evaluated in our first survey. Notwithstanding we found an increase of 30% in the number of SUs, at least in the regions previously evaluated, there is still a shortage of SU beds and high regional heterogeneity.
 ...
PMID:Stroke units in Italy. 1675 52


1 2 Next >>