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Andy Stergachis - One of the best experts on this subject based on the ideXlab platform.
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Patient Volume human resource levels and attrition from hiv treatment programs in central mozambique
Journal of Acquired Immune Deficiency Syndromes, 2011Co-Authors: Barrot H Lambdin, Mark A Micek, Thomas D Koepsell, James P Hughes, Kenneth Sherr, James Pfeiffer, Marina Karagianis, Joseph Lara, Stephen Gloyd, Andy StergachisAbstract:INTRODUCTION: Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing Patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of Patient Volume human resource levels and Patient characteristics with attrition from HIV treatment programs in central Mozambique. METHODS: We conducted a retrospective cohort study of adult ART-naive nonpregnant Patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of Patient Volume clinical staff burden and pharmacy staff burden with attrition adjusting for Patient characteristics. RESULTS: A total of 11793 Patients from 18 clinics were studied. After adjusting for Patient characteristics Patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend: <0.001). Patients attending clinics with higher clinical staff burden did not have a statistically higher risk of attrition. Patients attending clinics with medium Patient Volume levels [HR = 1.45 (95% CI: 1.04 to 2.04)] and high Patient Volume levels [HR = 1.41 (95% CI: 1.04 to 1.92)] had a higher risk of attrition but the trend test was not significant (P = 0.198). DISCUSSION: Patients attending clinics with higher pharmacy staff burden had a higher risk of attrition. These results highlight a potential area within the health system where interventions could be applied to improve the retention of these Patient populations.
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Patient Volume, human resource levels, and attrition from HIV treatment programs in central Mozambique.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2011Co-Authors: Barrot H Lambdin, Mark A Micek, Thomas D Koepsell, James P Hughes, Kenneth Sherr, James Pfeiffer, Marina Karagianis, Joseph Lara, Stephen Gloyd, Andy StergachisAbstract:INTRODUCTION: Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing Patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of Patient Volume human resource levels and Patient characteristics with attrition from HIV treatment programs in central Mozambique. METHODS: We conducted a retrospective cohort study of adult ART-naive nonpregnant Patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of Patient Volume clinical staff burden and pharmacy staff burden with attrition adjusting for Patient characteristics. RESULTS: A total of 11793 Patients from 18 clinics were studied. After adjusting for Patient characteristics Patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend:
Yasuhiro Otomo - One of the best experts on this subject based on the ideXlab platform.
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Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database
Journal of Intensive Care, 2019Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Yasuhiro Otomo, Kiyoshi MurataAbstract:Background Although it has been reported that high hospital Patient Volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods We conducted a retrospective observational study on severe burn Patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between Patient Volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which Patient Volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating Patients who were directly transported, those with PBI ≤ 120 and those excluding Patients who died within 2 days of admission, were also performed. Results We analyzed 5250 eligible severe burn Patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in Patient Volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher Volume hospitals. The GLMM model showed that Patient Volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which Patient Volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions Analysis of Japanese nationwide administrative database demonstrated that high burn Patient Volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.
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Volume outcome relationship on survival and cost benefits in severe burn injury a retrospective analysis of a japanese nationwide administrative database
Journal of intensive care, 2019Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Yasuhiro Otomo, Kiyoshi MurataAbstract:Although it has been reported that high hospital Patient Volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. We conducted a retrospective observational study on severe burn Patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between Patient Volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which Patient Volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating Patients who were directly transported, those with PBI ≤ 120 and those excluding Patients who died within 2 days of admission, were also performed. We analyzed 5250 eligible severe burn Patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in Patient Volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher Volume hospitals. The GLMM model showed that Patient Volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which Patient Volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Analysis of Japanese nationwide administrative database demonstrated that high burn Patient Volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.
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increased severe trauma Patient Volume is associated with survival benefit and reduced total health care costs a retrospective observational study using a japanese nationwide administrative database
Annals of Surgery, 2017Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Kiyoshi Murata, Yasuhiro OtomoAbstract:OBJECTIVE The aim of this study was to evaluate the associations of severe trauma Patient Volume with survival benefit and health care costs. BACKGROUND The effect of trauma Patient Volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. METHODS We conducted a retrospective observational study, including trauma Patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma Patient Volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of Volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for Patient severity and hospital characteristics. RESULTS A total of 116,329 Patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest Volume categories compared with the reference category [94.2% in the highest Volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. CONCLUSIONS Hospitals with high Volumes of severe trauma Patients were significantly associated with a survival benefit and lower total cost per admission.
Barrot H Lambdin - One of the best experts on this subject based on the ideXlab platform.
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Patient Volume human resource levels and attrition from hiv treatment programs in central mozambique
Journal of Acquired Immune Deficiency Syndromes, 2011Co-Authors: Barrot H Lambdin, Mark A Micek, Thomas D Koepsell, James P Hughes, Kenneth Sherr, James Pfeiffer, Marina Karagianis, Joseph Lara, Stephen Gloyd, Andy StergachisAbstract:INTRODUCTION: Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing Patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of Patient Volume human resource levels and Patient characteristics with attrition from HIV treatment programs in central Mozambique. METHODS: We conducted a retrospective cohort study of adult ART-naive nonpregnant Patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of Patient Volume clinical staff burden and pharmacy staff burden with attrition adjusting for Patient characteristics. RESULTS: A total of 11793 Patients from 18 clinics were studied. After adjusting for Patient characteristics Patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend: <0.001). Patients attending clinics with higher clinical staff burden did not have a statistically higher risk of attrition. Patients attending clinics with medium Patient Volume levels [HR = 1.45 (95% CI: 1.04 to 2.04)] and high Patient Volume levels [HR = 1.41 (95% CI: 1.04 to 1.92)] had a higher risk of attrition but the trend test was not significant (P = 0.198). DISCUSSION: Patients attending clinics with higher pharmacy staff burden had a higher risk of attrition. These results highlight a potential area within the health system where interventions could be applied to improve the retention of these Patient populations.
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Patient Volume, human resource levels, and attrition from HIV treatment programs in central Mozambique.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2011Co-Authors: Barrot H Lambdin, Mark A Micek, Thomas D Koepsell, James P Hughes, Kenneth Sherr, James Pfeiffer, Marina Karagianis, Joseph Lara, Stephen Gloyd, Andy StergachisAbstract:INTRODUCTION: Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing Patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of Patient Volume human resource levels and Patient characteristics with attrition from HIV treatment programs in central Mozambique. METHODS: We conducted a retrospective cohort study of adult ART-naive nonpregnant Patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of Patient Volume clinical staff burden and pharmacy staff burden with attrition adjusting for Patient characteristics. RESULTS: A total of 11793 Patients from 18 clinics were studied. After adjusting for Patient characteristics Patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend:
Akira Endo - One of the best experts on this subject based on the ideXlab platform.
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Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database
Journal of Intensive Care, 2019Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Yasuhiro Otomo, Kiyoshi MurataAbstract:Background Although it has been reported that high hospital Patient Volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods We conducted a retrospective observational study on severe burn Patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between Patient Volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which Patient Volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating Patients who were directly transported, those with PBI ≤ 120 and those excluding Patients who died within 2 days of admission, were also performed. Results We analyzed 5250 eligible severe burn Patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in Patient Volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher Volume hospitals. The GLMM model showed that Patient Volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which Patient Volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions Analysis of Japanese nationwide administrative database demonstrated that high burn Patient Volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.
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Volume outcome relationship on survival and cost benefits in severe burn injury a retrospective analysis of a japanese nationwide administrative database
Journal of intensive care, 2019Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Yasuhiro Otomo, Kiyoshi MurataAbstract:Although it has been reported that high hospital Patient Volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. We conducted a retrospective observational study on severe burn Patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between Patient Volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which Patient Volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating Patients who were directly transported, those with PBI ≤ 120 and those excluding Patients who died within 2 days of admission, were also performed. We analyzed 5250 eligible severe burn Patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in Patient Volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher Volume hospitals. The GLMM model showed that Patient Volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which Patient Volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Analysis of Japanese nationwide administrative database demonstrated that high burn Patient Volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.
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increased severe trauma Patient Volume is associated with survival benefit and reduced total health care costs a retrospective observational study using a japanese nationwide administrative database
Annals of Surgery, 2017Co-Authors: Akira Endo, Atsushi Shiraishi, Kiyohide Fushimi, Kiyoshi Murata, Yasuhiro OtomoAbstract:OBJECTIVE The aim of this study was to evaluate the associations of severe trauma Patient Volume with survival benefit and health care costs. BACKGROUND The effect of trauma Patient Volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. METHODS We conducted a retrospective observational study, including trauma Patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma Patient Volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of Volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for Patient severity and hospital characteristics. RESULTS A total of 116,329 Patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest Volume categories compared with the reference category [94.2% in the highest Volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. CONCLUSIONS Hospitals with high Volumes of severe trauma Patients were significantly associated with a survival benefit and lower total cost per admission.
Janet Tucker - One of the best experts on this subject based on the ideXlab platform.
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Patient Volume staffing and workload in relation to risk adjusted outcomes in a random stratified sample of uk neonatal intensive care units a prospective evaluation
The Lancet, 2002Co-Authors: Janet TuckerAbstract:Background: UK recommendations suggest that large neonatal intensive-care units (NICUs) have better outcomes than small units, although this suggestion remains unproven. We assessed whether Patient Volume, staffing levels, and workload are associated with risk-adjusted outcomes, and with costs or staff wellbeing. Methods: 186 UK NICUs were stratified according to Volume of Patients, nursing provision, and neonatal consultant provision. Primary outcomes were hospital mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 13515 infants of all birthweights consecutively admitted to 54 randomly selected NICUs. Multiple logistic regression analyses were done with every primary outcome as the dependent variable. Staff wellbeing and stress were assessed by anonymous mental health index (MHI)-5 questionnaires. Findings: Data were available for 13334 (99%) infants. High-Volume NICUs treated the sickest infants and had highest crude mortality. Risk-adjusted mortality and mortality or cerebral damage were unrelated to Patient Volume or staffing provision; however, nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was raised with increasing workload in all types of NICUs. Infants admitted at full capacity versus half capacity were about 50% more likely to die, but there was wide uncertainty around this estimate. Most staff had MHI-5 scores that suggested good mental health. Interpretation: The implications of this report for staffing policy, medicolegal risk management, and ethical practice remain to be tested. Centralisation of only the sickest infants could improve efficiency, provided that this does not create excessive workload for staff. Assessment of increased staffing levels that are closer to those in adult intensive care might be appropriate.