Articles: outcome-assessment-health-care.
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Multicenter Study Comparative Study Clinical Trial
Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study.
Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for preventative interventions. Previous studies have used single-country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context. ⋯ Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.
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Multicenter Study
The SOAR (Stroke subtype, Oxford Community Stroke Project classification, Age, prestroke modified Rankin) score strongly predicts early outcomes in acute stroke.
Previous prognostic scoring systems in predicting stroke mortality are complex, require multiple measures that vary with time and failed to produce a simple scoring system. ⋯ A simple 8-point clinical score is highly predictive of acute stroke mortality and length of hospital stay. It could be used as prognostic tool in service planning and also to risk-stratify patients to use these outcomes as markers of stroke care quality across institutions.
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Multicenter Study
Positive and negative volume-outcome relationships in the geriatric trauma population.
In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. ⋯ Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.
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Multicenter Study Comparative Study
A brief review of recent trends in Victorian intensive care, 2000-2011.
Review of resource use and patient outcomes of intensive care unit services over time provides insights into service delivery and safety. ⋯ There was an increase in ICU resource availability and evidence of improvement in hospital survival, suggesting improved quality of care. These evaluation methods may be useful in monitoring statewide capacity, service delivery and patient safety.
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Multicenter Study Comparative Study
Improving the care of elderly adults undergoing surgery in Michigan.
To determine whether failure to rescue, as a driver of mortality, can be used to identify which hospitals attenuate the specific risks inherent to elderly adults undergoing surgery. ⋯ Although elderly adults experience higher failure-to-rescue rates, this does not account for hospitals' overall capacity to rescue individuals from complications. Comparing rates of younger and elderly adults within hospitals may identify centers where efforts toward complication rescue favor, or are customized for, elderly adults. These centers should be studied as part of the collaborative's effort to address the disparate outcomes that elderly adults in Michigan experience.