Browsing by Subject "Comorbidities"
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Item Comparison of healthcare resource utilization, medication use, and costs among heart failure patients with reduced and preserved ejection fraction(2016-05) Tran, Melody; Rascati, Karen L.; Wilson, James P; Godley, Paul JObjectives: To compare health care resource utilization, medication use, and associated costs among heart failure (HF) patients with reduced versus preserved ejection fraction (EF). Methods: We included patients ≥ 18 years of age who had an inpatient admission with a primary discharge diagnosis of HF between October 1, 2011 and September 30, 2014 along with a recent EF measurement. Those with EF ≤ 40% were placed in the reduced EF group, and those with EF ≥ 50% were placed in the preserved EF group. Patients were excluded if they had an index length of stay (LOS) greater than 30 days, a prior heart transplant or LV atrial defibrillator. Baseline characteristics, healthcare utilization and associated costs, comorbidities, and medication use between the two groups were compared using inferential statistics and generalized linear models adjusted for clinical and demographic covariates were used to address the hypotheses, assessing the effect of EF group on utilization, costs, and medication use. Results: A total of 380 HF patients were identified (54% female; mean [SD] age: 78.1 [12.0]), of which 116 (30%) had a reduced EF and 264 (69%) had a preserved EF. Those with preserved EF had a significantly greater proportion of females (60% vs 39%, p<0.001) and were older (mean [SD]: 79.0 [10.8] vs 76.0 [12.0] years, p=0.044). After adjusting for demographics, baseline utilization, and other clinical factors, EF group was not a significant predictor of any healthcare resource utilization or cost variable. Those with reduced EF had a higher prevalence of coronary heart disease (82% vs 62%, p<0.001) and cardiomyopathy (54% vs 15%, p<0.001) compared to those with preserved EF. Depression was more prevalent in HF patients with preserved EF (22% vs 11%, p=0.014) as compared to those with reduced EF. After controlling for demographics, baseline medication use, and other clinical characteristics, HF patients with reduced EF were shown to be less likely to have use of calcium channel blockers (OR: 0.380, 95% CI: 0.181-0.800, p=0.011). Conclusion: This study demonstrated that healthcare utilization and associated costs are similar between HF patients with reduced and preserved EF, thus HF can be considered a single entity in terms of overall resource use. Findings also showed that HF patients with reduced EF have higher prevalence of coronary heart disease and cardiomyopathy, while having lower prevalence of depression. Those with reduced HF also had less use of calcium channel blockers.Item The lived experience of nonpsychiatric hospitalization for persons with severe mental illness(2013-05) Zolnierek, Cynthia Diamond; Volker, Deborah L.People with severe mental illness experience medical comorbidities to a greater extent than the general population. When hospitalized in general hospital settings, they experience poorer outcomes and are experienced as difficult by nurses. An understanding of the experience of hospitalization from the patient's perspective is important to improving care and outcomes for this population. The purpose of this study was to explore the lived experience of nonpsychiatric hospitalization for persons with severe mental illness. Heideggarian phenomenology provided the philosophical underpinning and informed the methodology employed. Participants were recruited through mental health providers. Ten individuals with severe mental illness participated in minimally structured interviews and described their experience of hospitalization on a medical-surgical unit. Data, including transcribed interviews and field notes, were analyzed within the hermeneutic tradition as described by Cohen et al. (2000). The lived experience of nonpsychiatric hospitalization was expressed in four themes: taking care of me (subthemes: being cared for, not being cared for), it's my life, on my toes (subthemes: needing an advocate, managing my mental health), and being a good patient. Care providers' comportment, perception of the patient's illness, attentiveness, responsiveness, and personalized caring behaviors characterized the participant experience of being cared for or not being cared for. It's my life reflected participants' desire to be informed and involved so they could contribute to their recovery. Participants felt the need to be on my toes in order to look out for and advocate for themselves. The need to be on my toes extended to the management of a chronic illness while hospitalized for an unrelated acute condition. The final theme reflected the perceived patient role obligation to be a "good patient". Findings were consistent with the literature regarding experiences of hospitalization from the perspective of persons without mental illness. Identified themes emphasize the critical importance of the nurse-patient relationship to the patient experience. There are significant implications for how nurses come to know their patients in medical-surgical settings so that they can effectively personalize care. Reflective practices may empower nurses to solicit assistance and support to improve caring practices