TY - JOUR
T1 - Preventable complications in epilepsy admissions
T2 - The “July effect”
AU - Pierson, Natalie S.
AU - Kramer, Daniel R.
AU - Wen, Timothy
AU - Ho, Lianne
AU - Patel, Arati
AU - Donoho, Daniel
AU - Mehta, Vivek
AU - Heck, Christianne
AU - Lee, Brian
AU - Mack, William J.
AU - Liu, Charles Y.
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/11
Y1 - 2017/11
N2 - Background Inpatient hospital stays for patients with epilepsy represent a significant burden on patients and society. Identifying factors that contribute to such costs aides in developing effective strategies to address this burden. July admissions have been associated with higher rates of complications and worse outcomes, attributed to the presence of new physicians. This study aims to evaluate whether epilepsy patients admitted in July have higher preventable complication rates and mortality than during the rest of the year. Methods Data was derived from the Nationwide Inpatient Sample (NIS) for epilepsy admissions for the years 2000–2010. Multivariable analyses assessed the effect of July against non-July admission on “hospital acquired complications” (HAC), which are complications identified as owing to preventable causes and mortality. Additionally, the total adjusted charges and prolonged length of stay (pLOS) for July admissions were compared to the 50th percentile. Results A total of 12,997,181 admissions for epilepsy were identified with 993,619 (8%) occurring in July, 10,810,900 (83%) were non-July months, and 1,192,662 (9%) were missing data. Patients admitted in July showed an increased association for HAC events (RR = 1.02, [1.01,1.03], p < 0.01), but a decrease in mortality (RR = 0.96, [0.95,0.97], p < 0.01). There was no difference in rates of higher total adjusted charges for July admissions (RR = 1.00, [1.00,1.00], p < 0.01) and a decrease in rates of pLOS (RR = 0.99, [0.98,0.99], p < 0.01). Conclusion In the epilepsy population, although July admissions were associated with a slight increase in HAC events, there was a non-significant or decreased rate of mortality, LOS, and total charge. Our results suggest that although complications were increased in July, possibly due to new staff, supervision is sufficient to prevent significant burden on patients and hospitals.
AB - Background Inpatient hospital stays for patients with epilepsy represent a significant burden on patients and society. Identifying factors that contribute to such costs aides in developing effective strategies to address this burden. July admissions have been associated with higher rates of complications and worse outcomes, attributed to the presence of new physicians. This study aims to evaluate whether epilepsy patients admitted in July have higher preventable complication rates and mortality than during the rest of the year. Methods Data was derived from the Nationwide Inpatient Sample (NIS) for epilepsy admissions for the years 2000–2010. Multivariable analyses assessed the effect of July against non-July admission on “hospital acquired complications” (HAC), which are complications identified as owing to preventable causes and mortality. Additionally, the total adjusted charges and prolonged length of stay (pLOS) for July admissions were compared to the 50th percentile. Results A total of 12,997,181 admissions for epilepsy were identified with 993,619 (8%) occurring in July, 10,810,900 (83%) were non-July months, and 1,192,662 (9%) were missing data. Patients admitted in July showed an increased association for HAC events (RR = 1.02, [1.01,1.03], p < 0.01), but a decrease in mortality (RR = 0.96, [0.95,0.97], p < 0.01). There was no difference in rates of higher total adjusted charges for July admissions (RR = 1.00, [1.00,1.00], p < 0.01) and a decrease in rates of pLOS (RR = 0.99, [0.98,0.99], p < 0.01). Conclusion In the epilepsy population, although July admissions were associated with a slight increase in HAC events, there was a non-significant or decreased rate of mortality, LOS, and total charge. Our results suggest that although complications were increased in July, possibly due to new staff, supervision is sufficient to prevent significant burden on patients and hospitals.
KW - Epilepsy
KW - Hospital acquired conditions
KW - Inpatient admission
KW - July effect
KW - Mortality
KW - National discharges
KW - Never events
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U2 - 10.1016/j.eplepsyres.2017.09.009
DO - 10.1016/j.eplepsyres.2017.09.009
M3 - Article
C2 - 28985613
AN - SCOPUS:85030715725
SN - 0920-1211
VL - 137
SP - 101
EP - 106
JO - Epilepsy Research
JF - Epilepsy Research
ER -