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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Trang Nguyen, MD, MPH1, Akerke Baibergenova, MD2, Louise-Anne McNutt, PhD3, Michael Zdeb, MS3, and Jean-Paul Hafner, MD, MPH4. (1) School of Public Health, University at Albany, SUNY, 1 University Place, Rensselaer, NY 12144, 5185252668, tn0469@albany.edu, (2) Department of Epidemiology, University at Albany, SUNY, School of Public Health, One University Place, Rensselaer, NY 12144, (3) Department of Epidemiology, University at Albany, School of Public Health, One University Place, Rensselaer, NY 12144, (4) Stratton VA Medical Center, New Scotland Avenue, Albany, NY 12203
Objective: To assess the association between weekend admission and in-hospital mortality in elderly patients with acute infectious diseases. Methods: A retrospective cohort study was conducted among patients, 65 years and older, with intestinal, upper respiratory infections or pneumonia primary diagnoses. Data was obtained from New York State’s hospital discharge database from 1995 to 1998. Stratified analysis was used to estimate the association between days of admission and in-hospital mortality while adjusting for potential confounders and assessing the impact of effect modifiers. Results: The study included 194,119 admissions, with 12.6% resulting in death in hospital. Overall, no meaningful increase risk of in-hospital mortality was seen for weekend admissions (N=49,450, 12.9% mortality) compared to weekday admissions (N=144,669, 12.5% mortality)[relative risk (RR)=1.03, 95% confidence interval (CI) 1.01 – 1.06]. Two factors were found to be effect modifiers: type of admission and source of admission. Direct hospital admissions (i.e., not through the emergency room) on the weekend by community physicians were associated with an increased risk of in-hospital mortality compared to the weekday admissions: for those with an emergency admission status (RR=1.15, 95% CI 1.06 – 1.25) and non-emergency admissions status (RR=1.64, 95 % CI 1.43 – 1.89). No association between weekend/weekday admissions was identified for patients admitted through emergency departments. This finding held when analyses were limited to in-hospital mortality occurring within six day of admission, the results are consistent across diagnoses. Discussion: A Canadian Study, focused on diagnoses needing intensive medical interventions and all cause mortality, found that patients admitted through the emergency department on weekends had a higher risk of in-hospital mortality then those admitted on weekdays. For infectious disease admissions among the elderly, we found no increased risk of in-hospital mortality for patients admitted through the emergency department on weekends compared to weekdays. However, the increased risk of in-hospital mortality for patients directly admitted to the hospital by community physicians on weekends raises concerns that need to be addressed. Studies on the effects of staffing and the time period between admission and time of medical evaluation are needed. Implications of present study’s finding, including care of elderly patients on weekends, potential reasons for discrepant findings from a previous study, and limitations of the study will be discussed.
Learning Objectives: By the end of the session, the participant will be able to
Keywords: Health Care Delivery, Hospitals
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.