PROJECTION OF HEALTH DEMAND IN TERMS OF HOSPITAL ADMISSIONS FOR SELECTED DIAGNOSES IN HEALTH SYSTEMS AGENCY SERVICE AREAS

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) requires that health systems agencies (HSAs) plan for their health service areas by the use of existing data to the maximum extent practicable. Health planning is based on the identificaton of health needs; however, HSAs are, at present, identifying health needs in their service areas in some approximate terms. This lack of specificity has greatly reduced the effectiveness of health planning. The intent of this study is, therefore, to explore the feasibility of predicting community levels of hospitalized morbidity by diagnosis by the use of existing data so as to allow health planners to plan for the services associated with specific diagnoses.^ The specific objectives of this study are (a) to obtain by means of multiple regression analysis a prediction equation for hospital admission by diagnosis, i.e., select the variables that are related to demand for hospital admissions; (b) to examine how pertinent the variables selected are; and (c) to see if each equation obtained predicts well for health service areas.^ The existing data on hospital admissions by diagnosis are those collected from the National Hospital Discharge Surveys, and are available in a form aggregated to the nine census divisions. When the equations established with such data are applied to local health service areas for prediction, the application is subject to the criticism of the theory of ecological fallacy. Since HSAs have to rely on the availability of existing data, it is imperative to examine whether or not the theory of ecological fallacy holds true in this case.^ The results of the study show that the equations established are highly significant and the independent variables in the equations explain the variation in the demand for hospital admission well. The predictability of these equations is good when they are applied to areas at the same ecological level but become poor, predominantly due to ecological fallacy, when they are applied to health service areas.^ It is concluded that HSAs can not predict hospital admissions by diagnosis without primary data collection as discouraged by Public Law 93-641. ^

Potential role of statins as immunomodulators in pneumococcal pneumonia

Background: Mortality in pneumococcal pneumonia remains as high as 20%, and most deaths occur within the first two weeks of hospitalization despite eradication of the causative organisms by antimicrobials in the first 24 hours. An inflammatory response rather than active infection could be responsible for this early mortality. Statins have been shown to have potent immunomodulatory activity in vitro. We investigated whether there was decreased severity or improved outcome in patients who were receiving statins at the time they were admitted for pneumococcal pneumonia. ^ Methods: Patients seen at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas from January, 2000 to June, 2010 with a diagnosis of pneumococcal pneumonia were included in this retrospective cohort study. Electronic medical records were reviewed to record demographic characteristics, comorbidities, laboratory values and statin use at the time of admission. Severity of pneumonia was determined using the Pneumonia Outcomes Research Team (PORT) classification. Uni- and multivariate Cox regression was used to evaluate survival. We adjusted for all variables in the multivariate model if they were significant in the univariate model at p<0.05. ^ Results: Of 347 patients admitted for pneumococcal pneumonia, 90 (25.9%) were taking statins at the time of presentation. Patients in the statin group were older (age: 68.0±9.7 vs. 62.5±12.3 years, p<0.001) and had higher prevalence of diabetes, coronary artery disease and kidney disease (p<0.05 for each comparison). Liver disease and alcohol consumption were less prevalent among statin users (p<0.05). The PORT scores were normally distributed in both groups with statin users having higher mean scores at admission as compared to patients not on statins (108±32 vs. 96±32, p = 0.002). The Cox proportional hazard analyses, adjusted for age, comorbidities, length of stay and PORT scores, showed a significantly reduced risk of mortality among statin users at 14 days (HR: 0.39; 0.15-0.98, p=0.045), 20 days (0.35; 0.14- 0.88, p=0.03) and 30 days(0.41; 0.17-0.95, p=0.01) after presentation. ^ Conclusion: Statin use is associated with improved clinical outcomes in patients with pneumococcal pneumonia.^

Risk factors of pneumonia in traumatic spinal-cord-injured patients

Pneumonia is a well-documented and common respiratory infection in patients with acute traumatic spinal cord injuries, and may recur during the course of acute care. Using data from the North American Clinical Trials Network (NACTN) for Spinal Cord Injury, the incidence, timing, and recurrence of pneumonia were analyzed. The two main objectives were (1) to investigate the time and potential risk factors for the first occurrence of pneumonia using the Cox Proportional Hazards model, and (2) to investigate pneumonia recurrence and its risk factors using a Counting Process model that is a generalization of the Cox Proportional Hazards model. The results from survival analysis suggested that surgery, intubation, American Spinal Injury Association (ASIA) grade, direct admission to a NACTN site and age (older than 65 or not) were significant risks for first event of pneumonia and multiple events of pneumonia. The significance of this research is that it has the potential to identify patients at the time of admission who are at high risk for the incidence and recurrence of pneumonia. Knowledge and the time of occurrence of pneumonias are important factors for the development of prevention strategies and may also provide some insights into the selection of emerging therapies that compromise the immune system. ^