Using the data in the Table 1, assess the severity of CHF, MI, Diabetes, Hyperte
ID: 122007 • Letter: U
Question
Using the data in the Table 1, assess the severity of CHF, MI, Diabetes, Hypertension, alcohol use, and ACL surgery (assume that sicker patients have longer stays). Assess the overall severity of the ten eases in Table below. Plot the patient's length of stay against the patient's severity of illness. Is there a patient whose length of stay does not follow what might be expected from his/her severity of illness? Case 1st Diagnosis 2nd Diagnosis 3rd Diagnosis 4th Diagnosis 5th Diagnosis Length of stay 1 MI CHF 4 2 MI 3 3 MI CHF Diabetes 6 4 MI CHF 7 5 CHF Diabetes 4 6 MI Hypertension 2 7 ACL surgery 1 8 MI Diabetes CHF Hypertension Alcohol use 6 9 MI Alcohol use 3 10 CHF 3 Sample Claims Data for 10 Cases MI = Myocardial Infarction: CHF = Congestive Heart Failure: ACL = Anterior Cruciate LigamentExplanation / Answer
Length of hospital or LOS can be predicted as early as preadmission in patients.
In Case 1 the primary diagnosis is Myocardial infaction (ICD410/412), with CHF or Congestive Heart failure as the secondary diagnosis, also may be the comorbidity. The Mean value for a patient with MI or Acute Myocardial infartion is 5 days and if along with CHF should be around the same 5-7 days1. Patients with MI presenting CHF have adverse hospital stay probabilities2. Case 1 with 2 diseases like MI and CHF and only 4 days of LOS seems implausible.
Case 2: MI as a primary diagnosis will have a LOS as 5 days1.
Case 3 Myocardial infarction with CHF and Diabetes. LOS with diabetes and MI as comorbidity is 4 days.
Case 4 MI and CHF 7 days. Usually it is around 4- 6 days.
Case 5 CHF and diabetes + 1.5 days in case of diabetes as a comorbidity (Gueron, Lafuma, Colin 2006). If for CHF as primary diagnosis it has a mean hospital stay of 5.83 days (Joshi et al 2004). so the average stay would be around 7 to 8 days. So case 5 undermines the LOS estimate.
Case 6 MI and Hypertension. +3 days for the hypertesive disease i.e. MI has a mean stay of 5 days and with Hypertensive disease as comorbidity it may extend to 7-8 days (Tsai et al, 2016; Table 1).
Case 7 ACL surgery a surgery where the graft is used to replace ligament and is performed by making incisions in the knee. It is done on outpatient bases so hospitalization is not required.
Case 8: MI with diabetes, CHF, Hypertensio, Alcohol, alcohol alone does a lot of damage and increase the risk of severity in heart failure patients, with all the comorbidiites there is increased risk of an extended hospital stay. 6 days or more depends on the severity of the comorbdidites, as somepatients had an average hospital stay of 21 days.
Case 9: MI and alcohol will definitely increase the hospital day beyond 3 days, as alcohol will interefere with medicines, and prolong the recovery period.
Case 10: CHF 3 days. Mean stay is generally 7 days for CHF (Fang-Pei et al 2016)
So case 1, 5, 6 and 10 are not in cohernce with the statistical data for the patients through research which is available.
References
Tsai, Po-Chia Chen, Yen-You Chen, et al., “Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network,” Journal of Healthcare Engineering, vol. 2016, Article ID 7035463, 11 pages, 2016. doi:10.1155/2016/7035463
Gueron, Lafuma, Colin. (2006). Costs of cardiovascular events of diabetic patients in the French hospitals . Diabetes. 12 (004).
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