Annie W.L. Cheung

Unplanned readmission rates, length of hospital stay, mortality, and medical costs of ten common medical conditions: a retrospective analysis of Hong Kong hospital data

BackgroundStudies on readmissions attributed to particular medical conditions, especially heart failure, have generally not addressed the factors associated with readmissions and the implications for health outcomes and costs. This study aimed to investigate the factors associated with 30-day unplanned readmission for 10 common conditions and to determine the cost implications.MethodsThis population-based retrospective cohort study included patients admitted to all public hospitals in Hong Kong in 2007. The sample consisted of 337,694 hospitalizations in Internal Medicine. The disease-specific risk-adjusted odd ratio (OR), length of stay (LOS), mortality and attributable medical costs for the year were examined for unplanned readmissions for 10 medical conditions, namely malignant neoplasms, heart diseases, cerebrovascular diseases, pneumonia, injury and poisoning, nephritis and nephrosis, diabetes mellitus, chronic liver disease and cirrhosis, septicaemia, and aortic aneurysm.ResultsThe overall unplanned readmission rate was 16.7%. Chronic liver disease and cirrhosis had the highest OR (1.62, 95% confidence interval (CI) 1.39-1.87). Patients with cerebrovascular disease had the longest LOS, with mean acute and rehabilitation stays of 6.9 and 3.0 days, respectively. Malignant neoplasms had the highest mortality rate (30.8%) followed by aortic aneurysm and pneumonia. The attributed medical cost of readmission was highest for heart disease (US

Citation Classics in Nursing Journals: The Top 50 Most Frequently Cited Articles From 1956 to 2011

3 199 418, 95% CI US

Validation of inpatient experience questionnaire

2 579 443-803 393).ConclusionsOur findings showed variations in readmission rates and mortality for different medical conditions which may suggest differences in the quality of care provided for various medical conditions. In-hospital care, comprehensive discharge planning, and post-discharge community support for patients need to be reviewed to improve the quality of care and patient health outcomes.

How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong

Background:Assessing the impact of individual journal articles provides information for understanding trends in science and translation of findings on practice. Citation analysis is an important way to highlight the contributions of individual author/investigator and journals on nursing practice. Objective:The purpose of this study was to identify the most frequently cited articles published in nursing journals from 1956 to 2011. Methods:The Science Citation Index Expanded and Social Sciences Citation Index were searched for citations through 2011 to articles published in the 89 nursing journals listed on the Journal Citation Reports (2010 edition). The number of citations, topic, countries, and institutions of origin based on the first author affiliation, year of publication, study design, publishing journal, journal country, and journal impact factor were noted. The most frequently cited articles published in the 89 nursing journals from 1956 to 2011 were identified. Results:The top 50 most frequently cited articles were published in 10 nursing journals between 1970 and 2005. The top cited article received 784 citations. The most common topics were methodology for qualitative studies, validation procedures for tool development, and nursing care and practices in cancer and mental health. The most common study designs were reviews including meta-analysis and instrument validation. Most of the top 50 cited articles were published from 1986 to 1995. Discussion:The findings provide insights into priorities and trends in nursing research and translational science.

Patient Experience and Satisfaction with Inpatient Service: Development of Short Form Survey Instrument Measuring the Core Aspect of Inpatient Experience

OBJECTIVE A validation survey was carried out in this study to assess the acceptability, validity and reliability of the Hong Kong Inpatient Experience Questionnaire (HKIEQ), which was newly developed to measure patient experiences of hospital care in Hong Kong (HK). DESIGN Cross-sectional validation survey. MAIN OUTCOME MEASURES Principal component exploratory factor analysis assessed the construct validity of the questionnaire. Cronbachs alpha coefficients and Spearmans rank correlation coefficient estimated the reliability of the instrument. Acceptability of the questionnaire regarding the percentage of missing value of individual items was also assessed. RESULTS A total of 511 patients discharged from public hospitals in HK were interviewed. Low percentage of missing value (0.2 to 21.3%) showed high acceptability. Nine dimensions of hospital care explaining 75.4% of the variance were derived from factor analysis and content validity. These items showed satisfactory internal reliability consistency (0.49 to 0.97). Test-retest reliability ranged from 0.36 to 0.96. CONCLUSIONS The HKIEQ performed well on several psychometric indicators and is a promising measure of patient experience with public hospital inpatient care in HK. The findings provided important insight on developing tools to measure patient experience in hospitals to improve the quality of care and to lay the foundation for further research on patient expectations and needs regarding hospitalization.

Perspective from health professionals on delivery of sub-acute care in Hong Kong: A qualitative study in a health system

The World Health Organization advocates the goal of universal coverage of health systems to ensure that everyone can avail the services they need and are protected from the associated financial risks. Governments are increasingly engaging and interacting with the private sector in initiatives collectively referred to as public-private partnerships (PPPs) to enhance the capacity of health systems to meet this objective. Understanding the values that motivate partners and demonstrating commitment for building relationships were found to be key lessons in building effective PPPs; however there, remain many research gaps. This study focusses on the practice of PPPs at the inter-organisational (meso) level and interpersonal (micro) level in Hong Kong Special Administrative Region (HKSAR). The influence of the structural components of different PPPs on stakeholder interpretation and actions, as well as the eventual outcomes of the PPPs, is examined, in terms of a realist evaluation, which applies a context-mechanism-outcome configuration as the research methodology. Seven key factors initiating commitment in a partnership, critical for sustainable PPPs, were identified as follows: (1) building of trust; (2) clearly defined objectives and roles; (3) time commitment; (4) transparency and candid information, particularly in relation to risk and benefit; (5) contract flexibility; (6) technical assistance or financial incentive behind procedural arrangements; and (7) the awareness and acceptability of structural changes related to responsibility and decisions (power and authority).

Avoidable readmission in Hong Kong - system, clinician, patient or social factor?

Patient experience reflects quality of care from the patients’ perspective; therefore, patients’ experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients’ experience would reflect the key aspect of inpatient care from patients’ perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients’ experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient’s journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients’ experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.

Citation classics in the integrative and complementary medicine literature: 50 frequently cited articles

OBJECTIVES The perception and understanding of health professionals of the role of sub-acute care in the health system will have an impact on the potential effectiveness in preventing unnecessary hospitalization. This study aims to explore the perceived role and quality of sub-acute care services in the context of Hong Kong from the perspective of health service providers and to identify barriers to effectiveness. METHODS Seven focus groups were conducted and the discussion was led by a guide covering three main areas: definition/component/role of sub-acute, difficulties in the sub-acute care services provision, and suggestion for further improvement in the provision of sub-acute care. RESULTS The participants highlighted the positive role of sub-acute to promote patients health and quality of life so as to reduce unnecessary hospitalization. The potential barriers in the sub-acute care identified were interrelated and focused mainly on systemic issues including lack of service coordination, specialist input and resources. The participants also suggested a number of practical ways to improve the quality of sub-acute care services. CONCLUSIONS The findings showed a need for further improvement in the process of sub-acute care by developing operation guideline and re-evaluating the allocation of resources to support the sub-acute care provision.