Visualising linked health data to explore health events around preventable hospitalisations in NSW Australia

Objective: To explore patterns of health service use in the lead-up to, and following, admission for a ‘preventable’ hospitalisation. Setting: 266 950 participants in the 45 and Up Study, New South Wales (NSW) Australia Methods: Linked data on hospital admissions, general practitioner (GP) visits and other health events were used to create visual representations of health service use. For each participant, health events were plotted against time, with different events juxtaposed using different markers and panels of data. Various visualisations were explored by patient characteristics, and compared with a cohort of non-admitted participants matched on sociodemographic and health characteristics. Health events were displayed over calendar year and in the 90 days surrounding first preventable hospitalisation. Results: The visualisations revealed patterns of clustering of GP consultations in the lead-up to, and following, preventable hospitalisation, with 14% of patients having a consultation on the day of admission and 27% in the prior week. There was a clustering of deaths and other hospitalisations following discharge, particularly for patients with a long length of stay, suggesting patients may have been in a state of health deterioration. Specialist consultations were primarily clustered during the period of hospitalisation. Rates of all health events were higher in patients admitted for a preventable hospitalisation than the matched non-admitted cohort. Conclusions: We did not find evidence of limited use of primary care services in the lead-up to a preventable hospitalisation, rather people with preventable hospitalisations tended to have high levels of engagement with multiple elements of the healthcare system. As such, preventable hospitalisations might be better used as a tool for identifying sicker patients for managed care programmes. Visualising longitudinal health data was found to be a powerful strategy for uncovering patterns of health service use, and such visualisations have potential to be more widely adopted in health services research

Some Reflections on Liberty : Bruce Winick’s ‘Civil Commitment: A Therapeutic Jurisprudence Model’

In the United States, involuntary hospitalisation of the mentally ill through the civil commitment process results in a curtailment of the fundamental liberty interest of freedom from external restraint; part of the constitutional guarantee. Apart from the loss of freedom through physical confinement, the labelling that inevitably accompanies commitment can give rise to significant social stigma and restricted life chances. In the last fifty-years, the power of doctors to commit on a best interests basis has been replaced by a legal process in which the grounds for involuntary hospitalisation have been restricted and the rights of patients prioritised. The problems inherent to both models have led to the development of therapeutic jurisprudence in which the therapeutic possibilities of law and the legal process are studied with the aim of optimising the therapeutic outcomes of commitment. Any model of involuntary hospitalisation necessarily gives rise to basic philosophical and political questions about the nature of individual liberty, of freedom and of the relationship between the individual and the state. As historically contingent concepts, what meaning can be attached to them and the goal of striving for a better balance in the context of the mentally ill between freedom and coercion

New Zealand regions, 1986 – 2001: Hospitalisation and some related health facts

Once age and gender composition is controlled for, regional health differentials are a function of problems of health service delivery, of socio-economic variance, and overall Māori Pakeha health differences. They indicate relative levels of exclusion and of inequality. This paper shows that these differentials follow in general the patterns seen in other papers in this series

Systemic hypertension in cats with acute kidney injury

Retrospective study of cats presenting to the Queen Mother Hospital for Animals, Royal Veterinary College with acute kidney injury between 2007 and 2015. Systolic blood pressure was measured using Doppler sphygmomanometry and systemic hypertension was defined pressures ê150 mmHg. Median systolic blood pressure measurement, grade of acute kidney injury (as defined by the International Renal Interest Society), serum creatinine on admission, anuria or oliguria, length of hospitalisation, survival to discharge and six‐month survival were all recorded

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Assessing preventable hospitalisation indicators (APHID): protocol for a data-linkage study using cohort study and administrative data

Introduction Potentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID) study will validate PPH as a measure of health system performance in Australia and Scotland. APHID will be the first large-scale study internationally to explore longitudinal relationships between primary care and PPH using detailed person-level information about health risk factors, health status and health service use. Methods and analysis APHID will create a new longitudinal data resource by linking together data from a large-scale cohort study (the 45 and Up Study) and prospective administrative data relating to use of general practitioner (GP) services, dispensing of pharmaceuticals, emergency department presentations, hospital admissions and deaths. We will use these linked person-level data to explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-level, geographic-level and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of GP and other services, and hospital characteristics. Ethics and dissemination Participants have consented to use of their questionnaire data and to data linkage. Ethical approval has been obtained for the study. Dissemination mechanisms include engagement of policy stakeholders through a reference group and policy forum, and production of summary reports for policy audiences in parallel with the scientific papers from the study.</p

The great lockdown: was it worth it? CEPS Policy Insights No 2020-11 / May 2020

What the IMF calls the ‘great lockdown’ has thrown Europe and the global economy into a deep recession. When putting their countries into lockdown, governments essentially pushed the panic button, mostly in the face of rising fatalities. Was this the right choice? The answer to this question is usually framed in terms of the lives saved versus jobs lost. However, a closer look at the actual expenses for medical care that the pandemic has engendered so far and a bottomup calculation for hospitalisation costs suggests that the economic costs of the great lockdown, while very large, might still be lower than the medical costs that an unchecked spread of the virus would have caused. There might thus be no need to assign an economic value to the lives saved to come to the conclusion that a

Health care and hospitalisation costs of cardiovascular disease (CVD) in Thailand

Background: Cardiovascular disease (CVD) has become a leading cause of death and disability in Thailand due to the unhealthy lifestyle of the populace; triggering high risk of exposure to CVD, increase in the number of hospital admissions year on year. Objectives: The concerns generated by the inflation in the health care expenditure among service providers motivated this study to examine the costs of hospitalisation of inpatients with (CVD) conditions in Thailand, 2009. Methods: Anonymised secondary data of 327,435 CVD inpatients under “Universal Coverage” (UC) health care scheme were obtained from the National Health Security Office (NHSO), Thailand. The data(51.69%- women and 48.31% - men) were classified using International Classification of Diseases, Tenth Revision (ICD-10) code, of which I20-I25 are Ischemic heart disease (IHD), I60-I69 are stroke and I00- I99areallCVD conditions. Results: Average costs of treatments for all CVD conditions, IHD and stroke were ฿21,921 (£1 = ฿50), ฿32,884 (highest) and ฿25,617.67per patient respectively. Absolute total cost increased with age and the cost of admission of male patients is higher than female. The average (three months) length of stay for stroke patients was found to be the highest. Conclusion: Providers generally spent a total of ฿7,177 million on the treatment of CVD with IHD and stroke taking ฿2,544 million and ฿1,920 million respectivel