Evidence map›Paper›PMID 28018883›Full record

ArticleCMAJ open

Determinants of alternate-level-of-care delayed discharge among acute care survivors of hypoxic-ischemic brain injury: a population-based cohort study.

David Stock, Cassandra Cowie, Vincy Chan, Angela Colantonio, Walter P Wodchis, David Alter, Nora Cullen

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 14 citations in OpenAlex.

  1. Alternate Level of Care Patients in Canada: a Scoping Review.Canadian geriatrics journal : CGJ · 2024
    Article
  2. Article
  3. Article
  4. Article
  5. Delayed discharge after major surgical procedures in Ontario, Canada: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020
    Article
  6. Observational
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

David StockToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Cassandra CowieToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Vincy ChanToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Angela ColantonioToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Walter P WodchisToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
David AlterToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Nora CullenToronto Rehabilitation Institute (Stock, Cowie, Chan, Colantonio, Wodchis, Alter, Cullen), University Health Network; Rehabilitation Sciences Institute (Stock, Chan, Colantonio), University of Toronto; Institute of Health Policy, Management and Evaluation (Colantonio, Wodchis, Alter), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Alter); Westpark Healthcare Centre (Cullen), Toronto, Ont.
Institute for Clinical Evaluative Sciences · CAToronto Rehabilitation Institute · CAUniversity Health Network · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDelayed discharge, captured as alternate-level-of-care days, represents inefficient use of high-demand acute care resources and results in potentially poorer patient outcomes. We performed a study to determine the extent of alternate-level-of-care days among patients who survived hypoxic-ischemic brain injury in inpatient hospital care in Ontario and to identify predictors of alternate-level-of-care use in this population.

methodsA population-based cohort of acute care survivors of hypoxic-ischemic brain injury aged 20 years or more from 2002/03 through 2011/12 was identified. We used 2 case definitions, the more specific identifying patients with a most responsible diagnosis of "anoxic brain damage," and the more sensitive capturing additional likely causative conditions as the most responsible diagnosis. Multivariable zero-inflated negative binomial regression was used to estimate independent effects on the relative incidence of alternate-level-of-care days.

resultsWe identified 491 patients using the specific case definition and 669 patients using the extended case definition. After deaths were excluded, 232 patients (47.2%) and 278 patients (41.6%), respectively, had at least 1 alternate-level-of-care day (median 20 and 19 d, respectively). In both cohorts, decreasing age, no special care unit hours and acute care episode earlier in the study period were predictive of increased alternate-level-of-care days relative to length of stay. Discharge disposition and psychiatric/behavioural comorbidity were most predictive of having any alternate-level-of-care days.

interpretationPatients with hypoxic-ischemic brain injury had a greater proportion of alternate-level-of-care days than has been reported for patients with other types of acquired brain injury. This finding suggests that substantial barriers to appropriate discharge exist for this population. Predictors of increased alternate-level-of-care days were also shown to be unique. Further study of care deficits among patients with hypoxic-ischemic brain injury is warranted.

Identifiers

PMID28018883
PMCPMC5173471
OpenAlexW2554073137

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.