This study focused on hospital populations which account for large amounts of health care utilization at the community level in the metropolitan area of Syracuse, New York. It demonstrated that, between the two largest hospital inpatient services, adult medicine patients accounted for a larger number of excess hospital patient days than adult surgery over a two-year period. Adult medicine stays increased while adult surgery stays declined. Adult medicine also accounted for a larger number of excess inpatient days, an average daily census of 52.7 patients in 2013, although adult medicine outliers comprised only 2.4 - 2.5 percent of discharges while adult surgery patients comprised 4.4 - 4.5 percent of discharges for these services. Adult medicine readmissions accounted for 79 - 81 percent of these adverse events for the combined hospital during the two-year period. Adult medicine complications accounted for 60 - 62 percent of complications in the two hospitals for which data were available. These data clearly demonstrate the challenges that adult medicine patients carry for providers as they attempt to improve the efficiency and outcomes of care in local communities. In the United States, payer reimbursement for the care of these patients frequently does not match the resources required as funding emphasizes surgical specialties and healthier patients. In metropolitan areas such as Syracuse, where local populations are aging or declining, the expenses of caring for these patients can become a major challenge for community providers.
Lagoe, R. and Lagoe, R. (2014) Identification of At-Risk Inpatient Hospital Populations at the Community Level. Open Journal of Nursing, 4, 621-629. doi: 10.4236/ojn.2014.49065.
[1] Dentzler, S. (2011) Urgent Measures for an Old Problem. Health Affairs, 30, 1626.
http://dx.doi.org/10.1377/hlthaff.2011.0961 [2] Auerbach, D.L. and Kellerman, A.L. (2011) A Decade of Health Care Cost Growth Has Wiped out Real Income Gains for an Average U.S. Family. Health Affairs, 30, 1630-1636.
http://dx.doi.org/10.1377/hlthaff.2011.0585 [3] Fisher, E.S., Shortell, S.M., Kriendler, S.A., Van Citters, A.D. and Larson, B.K. (2012) A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations. Health Affairs, 31, 2368-2378.
http://dx.doi.org/10.1377/hlthaff.2012.0544 [4] Hartman, M., Martin, A.B., Benson, J. and Catlin, A. (2013) National Health Expenditure Accounts Team. National Health Spending in 2011: Overall Growth Remains Low, but Some Payers and Services Show Signs of Acceleration. Health Affairs, 32, 87-98.
http://dx.doi.org/10.1377/hlthaff.2012.1206 [5] Martin, A.B., Hartman, M., Whittle, L. and Catlin, A. (2014) National Health Expenditure Accounts Team. National Health Spending in 2012: Rate of Health Spending Growth Remained Low for the Fourth Consecutive Year. Health Affairs, 33, 67-77.
http://dx.doi.org/10.1377/hlthaff.2013.1254 [6] Hoonhout, L.H., de Bruijne, M.C., Wagner, C., Zegers, M., Waaijman, R., Spreeuwenberg, P., Asscherman, H., van der Wal, G. and van Tulder, M.W. (2009) Direct Medical Costs of Adverse Events in Dutch Hospitals. BMC Health Services Research, 9, 27.
http://dx.doi.org/10.1186/1472-6963-9-27 [7] 3M Health Information Systems (2009) Potentially Preventable Events. 3M Health Information Systems, Wallingford, Conn. [8] Fuller, R.L., McCullough, E.C., Bao, M.Z. and Averill, R.F. (2009) Estimating the Costs of Potentially Preventable Hospital Acquired Complications. Health Care Financing Review, 30, 17-32. [9] Hoffman, E.D., Klees, B.S. and Curtis, C.A. (2001) Overview of the Medicare and Medicaid Programs. Health Care Financing Review, Statistical Supplement, 1-102. [10] Jencks, S.F., Williams, M.V. and Coleman, E.A. (2011) Rehospitalizations among Patients in the Medicare Fee for Service Program. New England Journal of Medicine, 364, 1582.
http://dx.doi.org/10.1056/NEJMx110014 [11] Dyer, T., Zhang, J. and Udow-Phillips, M. (2014) The Cost Burden of Disease: United States and Michigan. Center for Healthcare Research & Transformation, June 2014, Ann Arbor, MI. [12] Rais, S., Nazerian, A., Ardal, S., Chechulin, Y., Bains, N. and Malikov, K. (2013) High Cost Users of Ontario’s Healthcare Services. Healthcare Policy, 9, 44-51. [13] Reid, R., Evans, R., Barer, M., Sheps, S., Kerluke, K., McGrail, K., Hertzman, C. and Pagliccia, N. (2003) Conspicuous Consumption: Characterizing High Users of Healthcare Services in one Canadian Province. Journal of Health Services Research and Policy, 8, 215-224.
http://dx.doi.org/10.1258/135581903322403281 [14] Lagoe, R., Pasinski, T., Kronenberg, P. and Schaengold, P. (2006) Linking Health Services at the Community Level. Canada Healthcare Quarterly, 9, 60-65.
http://dx.doi.org/10.12927/hcq..18229 [15] Lagoe, R.J., Westert, G.P., Kendrick, K., Morreale, G. and Mnich, S. (2005) Managing Hospital Length of Stay Reduction: A Multihospital Approach. Health Care Management Review, 30, 82-92.
http://dx.doi.org/10.1097/00004010-200504000-00002 [16] Lagoe, R.J. and Westert, G.P. (2010) Evalua-tion of Hospital Inpatient Complications: A Planning Approach. BMC Health Services Research, 10, 200.
http://dx.doi.org/10.1186/1472-6963-10-200 [17] Lagoe, R.J., Nanno, D.S. and Luziani, M.E. (2013) Clinical Identification of Patients Readmitted to Hospitals: Why Patients Return. BMC Research Notes, 6, 419.
http://dx.doi.org/10.1186/1756-0500-6-419