Finlay A McAlister1, Jeffrey A Bakal2, Sumit R Majumdar1, Stafford Dean3, Rajdeep S Padwal1, Narmin Kassam4, Maria Bacchus5, Ann Colbourne6. 1. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada. 2. Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada Data Integration Measurement and Reporting, Alberta Health Services, Calgary, Alberta, Canada. 3. Data Integration Measurement and Reporting, Alberta Health Services, Calgary, Alberta, Canada. 4. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. 5. Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada. 6. Integrated Quality Management, Alberta Health Services, Edmonton, Canada.
Abstract
PURPOSE: Whether improving the efficiency of hospital care will worsen post-discharge outcomes is unclear. We designed this study to evaluate the General Internal Medicine (GIM) Care Transformation Initiative implemented at one of the seven teaching hospitals in the Canadian province of Alberta. METHODS: Controlled before-after study of GIM patients hospitalised at the University of Alberta Hospital (UAH, intervention site, n=1896) or the six other teaching hospitals in Alberta-three in Edmonton (intra-regional controls (IRC), n=4550) and three in Calgary (extra-regional controls (ERC), n=4095). The primary effectiveness outcome was risk-adjusted length of stay (LOS) and the primary safety outcome was 'mortality during index hospitalisation or all-cause readmission or death within 30-days of discharge'. RESULTS: LOS for GIM patients decreased by 0.68 days at Alberta teaching hospitals between 2009 and 2012; GIM patients hospitalised at the UAH exhibited a further 20% relative decline in adjusted LOS (total reduction=1.43 days, 95% CI 0.94 to 1.92 days) from PRE to POST. Interrupted time series (ITS) confirmed that the 1.43 day reduction at the UAH was statistically significant (level change p=0.003), while the declines at the IRC (p=0.37) and ERC (p=0.45) were not. Our safety outcome did not change for UAH patients (18.4% PRE-intervention vs 17.8% POST-intervention, adjusted OR 1.02 (95%CI 0.80 to 1.31), p=0.42 on ITS), nor for those hospitalised at the IRC (p=0.33) or the ERC (p=0.73) sites. CONCLUSIONS: The Care Transformation Initiative was associated with substantial reductions in LOS without increasing post-discharge events commonly quoted as proxies for quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PURPOSE: Whether improving the efficiency of hospital care will worsen post-discharge outcomes is unclear. We designed this study to evaluate the General Internal Medicine (GIM) Care Transformation Initiative implemented at one of the seven teaching hospitals in the Canadian province of Alberta. METHODS: Controlled before-after study of GIM patients hospitalised at the University of Alberta Hospital (UAH, intervention site, n=1896) or the six other teaching hospitals in Alberta-three in Edmonton (intra-regional controls (IRC), n=4550) and three in Calgary (extra-regional controls (ERC), n=4095). The primary effectiveness outcome was risk-adjusted length of stay (LOS) and the primary safety outcome was 'mortality during index hospitalisation or all-cause readmission or death within 30-days of discharge'. RESULTS: LOS for GIM patients decreased by 0.68 days at Alberta teaching hospitals between 2009 and 2012; GIM patients hospitalised at the UAH exhibited a further 20% relative decline in adjusted LOS (total reduction=1.43 days, 95% CI 0.94 to 1.92 days) from PRE to POST. Interrupted time series (ITS) confirmed that the 1.43 day reduction at the UAH was statistically significant (level change p=0.003), while the declines at the IRC (p=0.37) and ERC (p=0.45) were not. Our safety outcome did not change for UAHpatients (18.4% PRE-intervention vs 17.8% POST-intervention, adjusted OR 1.02 (95%CI 0.80 to 1.31), p=0.42 on ITS), nor for those hospitalised at the IRC (p=0.33) or the ERC (p=0.73) sites. CONCLUSIONS: The Care Transformation Initiative was associated with substantial reductions in LOS without increasing post-discharge events commonly quoted as proxies for quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Sachin R Pendharkar; Jaana Woiceshyn; Giovani J C da Silveira; Diane Bischak; Ward Flemons; Finlay McAlister; William A Ghali Journal: BMJ Qual Saf Date: 2015-08-13 Impact factor: 7.035
Authors: Amol A Verma; Yishan Guo; Janice L Kwan; Lauren Lapointe-Shaw; Shail Rawal; Terence Tang; Adina Weinerman; Peter Cram; Irfan A Dhalla; Stephen W Hwang; Andreas Laupacis; Muhammad M Mamdani; Steven Shadowitz; Ross Upshur; Robert J Reid; Fahad Razak Journal: CMAJ Open Date: 2017-12-13
Authors: Margareth Crisóstomo Portela; Peter J Pronovost; Thomas Woodcock; Pam Carter; Mary Dixon-Woods Journal: BMJ Qual Saf Date: 2015-03-25 Impact factor: 7.035