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Applied Research - Abstracts

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Diabetes Hospitalization at the U.S.-Mexico Border. Albertorio-Diaz JR, Notzon FC, Rodriguez-Lainz A. Prev Chronic Dis. 2007 Apr;4(2):A28.

INTRODUCTION: The diabetes hospitalization rate for the region along the U.S. side of the U.S.-Mexico border is unknown, a situation that could limit the success of the Healthy Border 2010 program. To remedy this problem, we analyzed and compared hospital discharge data for Arizona, California, and Texas for the year 2000 and calculated the diabetes hospitalization rates. METHODS: We obtained hospital-discharge public-use data files from the health departments of three U.S. border states and looked for cases of diabetes. Only when diabetes was listed as the first diagnosis on the discharge record was it considered a case of diabetes for our study. Patients with cases of diabetes were classified as border county (BC) or nonborder county (NBC) residents. Comparisons between age-adjusted diabetes discharge rates were made using the z test. RESULTS: Overall, 1.2% (86,198) of the discharge records had diabetes listed as the primary diagnosis. BC residents had a significantly higher age-adjusted diabetes discharge rate than NBC residents. BC males had higher diabetes discharge rates than BC females or NBC males. In both the BCs and the NBCs, Hispanics had higher age-adjusted diabetes discharge rates than non-Hispanics. CONCLUSION: The results of this study provide a benchmark against which the effectiveness of the Healthy Border 2010 program can be measured.

Lawsuit Activity, Defensive Medicine, and Small Area Variation: The Case of Cesarean Sections Revisited. Brown HS 3rd. Health Econ Policy Law 2007 Jul;2(Pt 3):285-96.

This paper examines whether delivery practice patterns (Cesarean sections or vaginal) are influenced by lawsuits or whether the hypothesized relationship is confounded by small area variation. The analysis uses multilevel analysis to deal with hospital- and Dartmouth Hospital Referral Region-level variation. The model includes patient clinical variables, patient socio-economic status, and hospital characteristics as control variables. The secondary data sources include hospital discharges from the 2002 Texas Health Care Information Council as well as 1988-2001 Texas Department of Insurance Closed Claim File data. After extracting the variation in delivery practice between hospitals and between Dartmouth Hospital Referral Regions in a multilevel model, the effects of lawsuits on defensive medicine are reduced but are still significant.

Gender and Age Differences in Blood Utilization and Length of Stay in Radical Cystectomy: A Population-Based Study. Cárdenas-Turanzas M, Cooksley C, Kamat AM, Pettaway CA, Elting LS. Int Urol Nephrol. 2008;40(4):893-9.

OBJECTIVE: Radical cystectomy is a major surgical procedure associated with significant blood loss and lengthy hospital stays. This surgical procedure is more challenging in women than men due to anatomical-based differences. We evaluated resource utilization and complication rates of patients undergoing radical cystectomy or exenteration using the Texas Hospital In-Patient Discharge Data Collection. METHODS: This was a retrospective study of 1,493 patients, 35 years of age or older, who underwent radical cystectomy for bladder cancer from January 2000 to December 2003. We evaluated blood product charges, length of stay, and complication rates during hospitalization. RESULTS: In this sample, 24% of the patients (n = 356) were women. Overall, women had significantly increased blood product charges and length of stay compared to men, $1,392.87 vs. $718.21(P < 0.001) and 12.72 vs. 11.64 (P = 0.03), respectively. During hospitalization, 26 of the patients died. No differences in mortality or complication rates were observed between men and women. Multivariate analysis showed that female sex (P < 0.001) and age (P = 0.003) were independent predictors of increased blood product charges. Multivariate analysis showed that female sex (P = 0.015), age (P = 0.003), and Charlson's comorbidity index >1 (P = 0.05) were predictors of longer length of stay. CONCLUSION: Women and older patients with bladder cancer are at risk of increased blood products utilization and length of hospital stay after a radical cystectomy. Appropriate postoperative care and referrals should improve postoperative outcomes for these vulnerable patients.

Specialty and Full-Service Hospitals: A Comparative Cost Analysis. Carey K, Burgess JF Jr, Young GJ. Health Serv Res. 2008 Oct;43(5 Pt 2):1869-87.

OBJECTIVE: To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. DATA SOURCES: The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database. STUDY DESIGN: We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals. PRINCIPAL FINDINGS: Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect. CONCLUSIONS: Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.

Geographic Disparities in Diabetes-Related Amputations--Texas-Mexico Border, 2003. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2006 Nov 24;55(46):1251-3.

The risk for lower extremity amputation (LEA) is estimated at 15 to 40 times higher among persons with diabetes than among persons without diabetes. In Texas, the prevalence of diabetes is higher near the Mexico border, where persons are more likely to have lower levels of education, lower incomes, no health insurance, and other barriers to obtaining health care. To determine whether diabetes-related LEA rates are higher near the Texas-Mexico border, rates were calculated, in both the general population and among persons with diabetes, for diabetes-related LEAs in border and nonborder counties. Data used for this analysis included 2003 Texas Inpatient Hospital Discharge Data (TIHDD), 2003 Texas population estimates, and data from the 2003 Texas Behavioral Risk Factor Surveillance System (BRFSS). The results of the analysis indicated that the age- and sex-adjusted rate of diabetes-related LEAs in the general population along the border was nearly double the rate of nonborder counties. Among persons with diabetes, the rate along the border also was significantly higher than among those in nonborder counties, but the rate differences were primarily among men aged > or =45 years. Additional measures to prevent diabetes and improve education regarding diabetes care are needed to reduce the excess burden of LEAs among persons with diabetes along the border.

Public Health Use Of Inpatient Discharge Data: A Case Study Of Reducing Burdens Of Acute Respiratory Diseases In Texas With A Targeted Immunization Program. Smith DL, Elting LS, Learn PA, Raut CP, Mansfield PF. The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. lelting@mdanderson.org. TPHA Journal. 2004 Fall;56(2):3-9.

Smith DL, Elting LS, Learn PA, Raut CP, Mansfield PF. The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. lelting@mdanderson.org. 2004 Fall;56(2):3-9.

Objective: To estimate the overall human and economic burden of acute respiratory illness in Texas. Methods: We obtained estimates of in-hospital mortality, hospital days and charges during hospitalizations for acute respiratory illness from the Texas Health Care Information Council (THCIC) public use data records. We included all hospitalizations between 1999-2001 with an admitting or principal diagnosis of one of the following respiratory diseases: asthma, bronchitis, bronchiectasis, pneumonia, influenza or allergic alveolitis. Charges were adjusted to 2000 US dollars using the Consumer Price Index for Medical Care and transformed to costs using Medicare cost-to-charge ratio for Texas (0.45). Results: Annually, there were 4,486 deaths; 116,000 hospital inpatient discharges; 603,652 hospital days due to respiratory illness with total state costs over $758 million. Vaccine preventable respiratory infections of influenza and pneumococcal pneumonia in those over 50 contributed at least 800 cases to the annual death toll and over $75 million to hospitalization costs. Conclusion: The human and financial burdens of acute respiratory illnesses, severe enough to cause Texans to be hospitalized, are sizeable.

Hospitalizations for Infection in Cancer Patients: Impact of an Aging Population. Cooksley CD, Avritscher EB, Rolston KV, Elting LS. Supportive Care in Cancer. 2009 May;17(5):547-54.

GOAL OF WORK: The aim of this study was to assess the impact of an aging US population on inpatient costs and resource utilization in cancer patients admitted for infection. MATERIALS AND METHODS: From the Texas inpatient public use files (Texas Health Care Information Collection), which include all hospitals except federal institutions, we selected residents with cancer who also had a principal or admitting diagnosis of pneumonia, bacteremia/sepsis, or other documented infection in 2001. Selected admission records were directly adjusted by projected age-specific cancer prevalence totals for years 2006 and 2025 using surveillance epidemiology end results (SEER) and US census data. Charges were inflated to 2006 consumer price index for medical care then converted to costs using Texas Medicare cost-to-charge ratios. RESULTS: Over 9% of nearly 200,000 Texans admitted for infection in 2001 also had cancer. Projecting these results nationally, 318,000 discharges in cancer patients at a cost of $3.1 billion (B, 95% CI $2.8B, $3.4B) and 2.3 million (M) bed days would have been attributed to infections in 2006. By the year 2025, adjusting only for the aging population, costs could increase 45% to $4.5B (95% CI $4.1B, $4.9), with 27% more (3.4 M) hospital bed days occupied. CONCLUSIONS: Consequent to an aging population and the resulting increase in cancer prevalence, the healthcare burden of managing hospital admissions for infection in the vulnerable cancer population could be greatly magnified unless risk-based treatment and preventive strategies such as appropriate immunizations and infection control measures are implemented.

Kawasaki Syndrome in Texas. Coustasse A, Larry JJ III, Migala W, Arvidson C, Singh KP. HOSPITAL TOPICS: Research and Perspectives on Healthcare. Summer 2009;87(3):3-10.

The authors examined hospitalization rates of Kawasaki Syndrome (KS) among Texas children to isolate clusters, identify demographic disparities, and suggest possible causative factors. Using a retrospective cross-sectional study design, they studied 330 KS cases from 2,818,460 hospital discharges. The majority of the cases (61.5%) occurred within the 1–4-years-old category, representing the highest hospitalization rate (14.3 per 100,000 children). Almost 75% of the KS population was less than 5 years old, with hospitalization rates approximately 8 times higher than that of all other children (p < .05). KS diagnosis occurred for only 49.4% of all KS cases upon admission. Along with high-density clusters identified in major metropolitan areas, the authors found the highest rates of KS among Asian and Pacific Islander and non-Hispanic black children. Genetic predispositions and access to healthcare issues may explain the results. The authors recommend improving educational initiatives with healthcare providers and establishing KS as a reportable condition.

Correlation Between Annual Volume Of Cystectomy, Professional Staffing, And Outcomes: A Statewide, Population-Based Study. Elting LS, Pettaway C, Bekele BN, Grossman HB, Cooksley C, Avritscher EB, Saldin K, Dinney CP. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. lelting@mdanderson.org. Cancer. 2005 Sep 1;104(5):975-84.

BACKGROUND: The association between high procedure volume and lower perioperative mortality is well established among cancer patients who undergo cystectomy. However, to the authors' knowledge, the association between volume and perioperative complications has not been studied to date and hospital characteristics contributing to the volume-outcome correlation are unknown. In the current study, the authors studied these associations, emphasizing hospital factors that contribute to the volume-outcome correlation. METHODS: Multiple-variable models of inpatient mortality and complications were developed among all 1302 bladder carcinoma patients who underwent cystectomy between January 1, 1999 and December 31, 2001 in all Texas hospitals. General estimating equations were used to adjust for clustering within the 133 hospitals. Data were obtained from hospital claims, the 2000 U.S. Census, and databases from the Center for Medicare and Medicaid Services and the American Hospital Association. RESULTS: Complications were reported to occur in 12% of patients, 2.2% of whom died. Mortality was higher in low-volume hospitals compared with high-volume hospitals (3.1% vs. 0.7%; P < 0.001); mortality in moderate-volume hospitals was reported to be intermediate (2.9%). After adjustment for advanced age and comorbid conditions, treatment in high-volume hospitals was associated with lower risks of mortality (odds ratio [OR] = 0.35; P = 0.02) and complications (OR = 0.53; P = 0.01). Hospitals with a high registered nurse-to-patient ratio also had a lower mortality risk (OR = 0.43; P = 0.04). CONCLUSIONS: Mortality after cystectomy was found to be significantly lower in high-volume hospitals, regardless of patient age. Referral to a hospital performing greater than 10 cystectomies annually is indicated for all patients. However, patients with poor access to a high-volume hospital may derive similar benefit from treatment at a hospital with a high-registered nurse-to-patient ratio. This finding requires further confirmation.

Medical Resource Utilization among Community-Acquired Pneumonia Patients Initially Treated with Levofloxacin 750 Mg Daily versus Ceftriaxone 1000 Mg Plus Azithromycin 500 Mg Daily: A US-Based Study. Frei CR, Jaso TC, Mortensen EM, Restrepo MI, Raut MK, Oramasionwu CU, Ruiz AD, Makos BR, Ruiz JL, Attridge RT, Mody SH, Fisher A, Schein JR. Curr Med Res Opin. 2009 Apr;25(4):859-68.

Frei CR, Jaso TC, Mortensen EM, Restrepo MI, Raut MK, Oramasionwu CU, Ruiz AD, Makos BR, Ruiz JL, Attridge RT, Mody SH, Fisher A, Schein JR. 2009 Apr;25(4):859-68.

OBJECTIVE: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). RESEARCH DESIGN AND METHODS: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. RESULTS: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (+/-SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 +/- 0.17 vs. 5.4 +/- 0.22 days, p < 0.01; and LOIV, 3.6 +/- 0.17 vs. 4.8 +/- 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 +/- 0.30 vs. 5.9 +/- 0.37 days, p = 0.07; and LOIV, 3.7 +/- 0.33 vs. 5.2 +/- 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. CONCLUSIONS: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

Disparities in Rates of Acute MI Hospitalization and Coronary Procedures on the US-Mexico Border. Gillum RF, Albertorio-Díaz JR, Alpert JS. Am J Med. 2010 Jul;123(7):625-30.

Gillum RF, Albertorio-Díaz JR, Alpert JS. 2010 Jul;123(7):625-30.

BACKGROUND: Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region. METHODS: Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties. RESULTS: Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery. CONCLUSIONS: Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data. Copyright 2010 Elsevier Inc. All rights reserved.

Pediatric Traumatic Brain Injury Is Inconsistently Regionalized in the United States. Hartman M, Watson RS, Linde-Zwirble W, Clermont G, Lave J, Weissfeld L, Kochanek P, Angus D. Pediatrics. 2008 Jul;122(1):e172-80.

OBJECTIVES: Traumatic brain injury is a leading cause of death in children. On the basis of evidence of better outcomes, the American College of Surgery Committee on Trauma recommends that children with severe traumatic brain injury receive care at high-level trauma centers. We assessed rates of adherence to these recommendations and factors associated with adherence. METHODS: We studied population and hospital discharge data from 2001 from all of the health care referral regions (n = 68) in 6 US states (Florida, Massachusetts, New Jersey, New York, Texas, and Virginia). We identified children with severe traumatic brain injury by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes and American College of Surgery Committee on Trauma criteria. We defined "high-level centers" as either level I or pediatric trauma centers. We considered an area to be well regionalized if >or=90% of severe traumatic brain injury hospitalizations were in high-level centers. We also explored how use of level II trauma centers affected rates of care at high-level centers. RESULTS: Of 2117 admissions for severe pediatric traumatic brain injury, 67.3% were in high-level centers, and 87.3% were in either high-level or level II centers. Among states, 56.4% to 93.6% of severe traumatic brain injury admissions were in high-level centers. Only 2 states, Massachusetts and Virginia, were well regionalized. Across health care referral regions, 0% to 100% of severe traumatic brain injury admissions were in high-level centers, and only 19.1% of health care referral regions were well regionalized. Only a weak relationship existed between the distance to the nearest high-level center and regionalization. The age of statewide trauma systems had no relationship to the extent of regionalization. CONCLUSIONS: Despite evidence for improved outcomes of severely injured children admitted to high-level trauma centers, we found that almost one third of the children with severe traumatic brain injury failed to receive care in such centers. Only 2 of 6 states and less than one fifth of 68 health care referral regions were well regionalized. This study highlights problems with current pediatric trauma care that can serve as a basis for additional research and health care policy.

An Attempt to Forecast Hospital Market Share Using Admission Data. Kash BA, Ohsfeldt RL, Gamm LD. J Healthc Manag. 2009 Jan-Feb;54(1):44-55; discussion 55-6.

The purpose of this study was to develop a model to forecast market share before actual market share data become available to a hospital system. The typical data lag is about six to nine months, and market share information is often based on incomplete admissions data. Therefore, this exploratory analysis of admissions for all hospitals in a Texas hospital system was performed as an attempt to improve the accuracy and timeliness of market share data. We used four data sources: (1) Texas Health Care Information Council Public Use Data File, (2) Solucient, (3) internal data on admissions for three small nearby hospitals not reporting to the state, and (4) population growth data based on the U.S. census. Data analysis was performed using STATA 9 and SAS statistical software. Six prediction models were chosen and evaluated that best predicted present and future market share using historical market share data, historical and current admissions data, and population growth data. These included models for the total market area; the core cluster; and the eastern, western, northern, and southern market clusters. Only two of the six forecasting equations were useful, with a relatively high prediction value. Overall, the attempt to predict market share based on historical and current admissions data while controlling for demographic factors and seasonality was of limited success. Future research should consider additional factors associated with market share; these factors could include changes in physician referral patterns and third-party-payer contracts. The value of this type of research for management is explored here as well.

Uncontrolled Diabetes in Southeast Texas Communities: Use of Hospital Discharge Data to Assess a Health People 2010 Goal. FC Lemus, DH Freeman, M Bajaj, JL Freeman. Texas Public Health Association Journal. Spring 2007; 58(4):7-11.

This study assessed the baseline status of three southeast Texas communities toward being at the target of Healthy People 2010 Objective 1-9b: Reduce hospitalization rates for uncontrolled diabetes- persons 18-64 years to 5.4 admissions per 10,000 persons, using 3 years of Texas Health Care Information Collection's hospital discharge data and 2000 U.S. Census population counts. Only one community (League City) was the the Healthy People goal. There were also disparities between non-Hispanic Whites and Blacks and lower than anticipated hospitalization rates in Hispanics/Latinos. The study's methodology demonstrates how publicly available hospital discharge data can be used by communities to better assess, measure and make decisions about the quality of health care provided to its residents. A systematic approach to provide information about rates of hospitalizations at the county and community level could lead to improved outcomes as a result of effective primary care interventions.

Correlates of Bacterial Pneumonia Hospitalizations in Elders, Texas Border. Lemus FC, Tan A, Eschbach K, Freeman DH Jr, Freeman JL. J Immigr Minor Health. 2009 Mar 18. [Epub ahead of print]

Background: Immunization preventable bacterial pneumonia is an Agency for Healthcare Research and Quality (AHRQ) prevention quality indicator of health care. This study explored associations of individual and county correlates with bacterial pneumonia hospitalization rates for elders residing in 32 Texas counties bordering Mexico. Methods: We estimated baseline rates from Texas Health Care Information Collection's hospital discharge data for 1999-2001, and population counts from the 2000 U.S. Census. Results: The rate among the total Texas border population was 500/10,000, three times the national rate. Elders 75+, males, and Latinos had the highest rates. An increase of 1 primary care physician per 1000 population is associated with a decrease in pneumonia-related hospitalization rates by 33%, while each 10% increase in Latinos is associated with a 0.1% rate increase. Discussion: This baseline bacterial pneumonia hospitalization study demonstrates a systematic approach to estimate county rates, a process that could lead to improved outcomes through effective community interventions. Methodology demonstrates how publicly available hospital discharge data can be used by communities to better measure and improve quality of health care.

Anaphylaxis in the Obstetric Patient: Analysis of a Statewide Hospital Discharge Database. Mulla ZD, Ebrahim MS, Gonzalez JL. Ann Allergy Asthma Immunol. 2010 Jan;104(1):55-9.

BACKGROUND: Previous reports of anaphylaxis during pregnancy typically have involved single institutions and a few cases. OBJECTIVE: To describe the epidemiologic features of anaphylaxis in women who gave birth in Texas. METHODS: Statewide public use hospital discharge data for 2004 and 2005 provided by the Texas Department of State Health Services were accessed. Diagnoses and procedures in this data set were recorded using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The records of women who delivered a neonate and simultaneously had a diagnosis of anaphylaxis were selected for study. The prevalence of maternal anaphylaxis noted at the time of delivery of the neonate and the 95% Wilson's confidence interval were calculated. The International Classification of Diseases, Ninth Revision, Clinical Modification E codes were examined to determine the possible anaphylactic trigger. Finally, the impact of 4 selected maternal comorbidities and complications on length of stay was assessed. RESULTS: A total of 19 maternal anaphylaxis cases were identified. The prevalence was 2.7 cases per 100,000 deliveries (95% confidence interval, 1.7-4.2 cases per 100,000 deliveries). Penicillins and cephalosporins were the anaphylactic trigger in 11 of the patients. Five patients were emergent admissions. There were no maternal deaths. Most of the patients (14 [74%]) delivered by cesarean section. Patients who had 1 or more of 4 selected comorbidities or complications had a median length of stay of 5 days, whereas those patients free of these conditions had a median length of stay of 3 days (P = .07, exact Wilcoxon rank sum test). CONCLUSIONS: Anaphylaxis during pregnancy is a rare event. In this large case series, we found that beta-lactam antibiotics were the most common triggers of anaphylaxis.

Factors Influencing The Volume-Outcome Relationship In Gastrectomies: A Population-Based Study. Smith DL, Elting LS, Learn PA, Raut CP, Mansfield PF. Department of Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive/Ste 1, Lackland AFB, Texas 78236, USA. Ann Surg Oncol. 2007 Jun;14(6):1846-52. Epub 2007 Apr 4.

BACKGROUND: A relationship between hospital procedural volume and patient outcomes has been observed in gastrectomies for primary gastric cancer, but modifiable factors influencing this relationship are not well elaborated. METHODS: We performed a population-based study of 1864 patients undergoing gastrectomy for primary gastric cancers at 214 hospitals. Hospitals were stratified as high-, intermediate-, or low-volume centers. Multivariate models were constructed to evaluate the effect of institutional procedural volume and other hospital- and patient-specific factors on the risk of in-hospital mortality, adverse events, and failure to rescue, defined as mortality after an adverse event. RESULTS: High-volume centers attained an in-hospital mortality rate of 1.0% and failure-to-rescue rate of .7%, both less than one-fifth of that seen at intermediate- and low-volume centers, although adverse event rates were similar across the three volume tiers. In multivariate modeling, treatment at a high-volume hospital decreased the odds of mortality (odds ratio [OR], .22; 95% confidence interval [95% CI], .05-.89), whereas treatment at an institution with a high ratio of licensed vocational nurses per bed increased the odds of mortality (OR, 1.96; 95% CI, 1.04-3.75). Being treated at a hospital with a greater than median number of critical care beds decreased odds of mortality (OR, .46; 95% CI, .25-.81) and failure to rescue (OR, .53; 95% CI, .29-.97). CONCLUSIONS: Undergoing gastrectomy at a high-volume center is associated with lower in-hospital mortality. However, improving the rates of mortality after adverse events and reevaluating nurse staffing ratios may provide avenues by which lower-volume centers can improve mortality rates.

Falls among Older Adults in Texas: Profile from 2007 Hospital Discharge Data. Smith ML, Ory MG, Beasley C, Johnson KN, Wernicke MM, Parrish R. Texas Public Health Journal. 2010 Winter;62(1):7-13.

ABSTRACT: In 2006, approximately 1.8 million American seniors sustained a non-fatal injury fall and over 16,600 died from fall-related trauma. The purposes of this study are to utilize the most currently available Texas data to: (1) document the prevalence of fall-related hospitalizations and event characteristics and (2) examine differences based on geographic dispersion and age. Population estimates and hospital discharge data from the year 2007 were obtained and analyzed for all counties and places in Texas to generate counts and prevalence rates of fall-related hospitalizations, associated injuries, and causes of fall-related events. Statewide, results showed high fall-related hospitalization prevalence rates among females (313 per 100,000), non-Hispanic Whites (369 per 100,000), and those age 85 years and older (5,937 per 100,000). Slips, trips, and stumbles were the most common specified cause of falls resulting in hospitalization (33%). Among those admitted to the hospital, the oldest old sustained more fractures from fall-related events (49%) of which 66% were hip fractures. Fall-related hospital charges exceeded $1.8 billion statewide for adults age 50 and older with an average hospitalization lasting approximately 6 days. Falls among the senior population in Texas are a large and important public health issue and require constant surveillance from state and local health authorities. To combat fall events and offset the associated health sequelae, there is a need to build the capacity to create and deliver evidence-based fall prevention programs statewide.


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Last updated March 16, 2011