Venous thromboembolism risk increases in hospitals due to reduced patient mobility. However, initial mobility evaluations for thromboembolism risk are often subjective and lack standardization, ...potentially leading to inaccurate risk assessments and insufficient prevention.
A retrospective study at a quaternary academic hospital analyzed patients using the Padua risk tool, which includes a mobility question, and the Johns Hopkins-Highest Level of Mobility (JH-HLM) scores to objectively measure mobility. Reduced mobility was defined as JH-HLM scores ≤3 over ≥3 consecutive days. The study evaluated the association between reduced mobility and hospital-acquired venous thromboembolism using multivariable logistic regression, comparing admitting health care professional assessments with JH-HLM scores. Symptomatic, hospital-acquired thromboembolisms were diagnosed radiographically by treating providers.
Of 1715 patients, 33 (1.9%) developed venous thromboembolism. Reduced mobility, as determined by the JH-HLM scores, showed a significant association with thromboembolic events (adjusted OR: 2.53, 95%CI:1.23-5.22, P = .012). In contrast, the initial Padua assessment of expected reduced mobility at admission did not. The JH-HLM identified 19.1% of patients as having reduced mobility versus 6.5% by admitting health care professionals, suggesting 37 high-risk patients were misclassified as low risk and were not prescribed thrombosis prophylaxis; 4 patients developed thromboembolic events. JH-HLM detected reduced mobility in 36% of thromboembolic cases, compared to 9% by admitting health care professionals.
Initial mobility evaluations by admitting health care professionals during venous thromboembolism risk assessment may not reflect patient mobility over their hospital stay. This highlights the need for objective measures like JH-HLM in risk assessments to improve accuracy and potentially reduce thromboembolism incidents.
Intercity patient mobility reflects the geographic mismatch between healthcare resources and the population, and has rarely been studied with big data at large spatial scales. In this paper, we ...investigated the patterns of intercity patient mobility and factors influencing this behavior based on >4 million hospitalization records of patients with chronic kidney disease in China. To provide practical policy recommendations, a role identification framework informed by complex network theory was proposed considering the strength and distribution of connections of cities in mobility networks. Such a mobility network features multiscale community structure with “universal administrative constraints and a few boundary breaches”. We discovered that cross-module visits which accounted for only 20 % of total visits, accounted for >50 % of the total travel distance. The explainable machine learning modeling results revealed that distance has a power-law-like effect on flow volume, and high-quality healthcare resources are an important driving factor. This paper provides not only a methodological reference for patient mobility studies but also valuable insights into public health policies.
•More than 4 million multi-year mobility records from a national database were investigated.•The distribution of travel distance of patients differs from the results of general human mobility studies.•The network features multiscale community structure with “universal administrative constraints and a few boundary breaches”.•An identification framework was proposed to understand cities’ roles in the mobility network.•The explainable AI model revealed that distance and high-quality healthcare resources are two critical factors.
•Patient mobility is mutually constitutive with the healthcare system in a dynamic manner.•The examination of individual patient mobility should be positioned in the hierarchical healthcare delivery ...system.•Patient mobility leads to another dimension of social inequality associated with uneven distributions of healthcare resources.•Female, older adults and other marginal groups travel longer distances for healthcare.•Policies indirectly encouraging patient mobility produce mixed outcomes in healthcare efficiency.
Recent studies on healthcare accessibility have made use of medical records to study the actual patient mobility and its implications for healthcare governance. Drawing on 39,067 cross-city healthcare utilization records of Hefei residents in China between 2019 and 2020, this study extends existing research to examine patient mobility at individual level and its impacts on healthcare equity and efficiency in a hierarchical healthcare delivery system. The results show that 29.62, 30.63, and 39.75 percent of cross-city healthcare utilization was to access China’s top 100 hospitals, Tertiary-A hospitals, and other hospitals respectively, with significantly different distance decay patterns. The multivariate regression models revealed that patient mobility leads to another dimension of social inequality associated with uneven distributions of healthcare resources. Females, older adults, and holders of Basic Medical Insurance of Urban and Rural Residents were disadvantaged in traveling long distances for cross-city healthcare. More inequities in gender and insurance type were found in cross-city utilization of low-level hospitals. The difference-in-difference analysis found that policies indirectly encouraging patient mobility produce mixed outcomes in healthcare efficiency, resulting in cost-saving for patients’ utilization of China’s top 100 hospitals but cost increase for the use of other hospitals. Conceptually, this study presents a novel and meaningful attempt to understand patient mobility, and underscores the need for context-sensitive and dynamic approaches to unraveling the mutual constitution between patient mobility and healthcare system.
Background The record-filing process in China’s cross-region healthcare is similar to the “pre-authorization” in the EU, which is the requirement for patients to seek healthcare services outside the ...affiliated regions. Policymakers are increasingly designing policies that encourage patient choice and giving them the freedom to choose healthcare providers without “pre-authorization”. Some pilot regions in China tried to provide patients with the freedom to choose healthcare services freely without a record-filing process. This study aims to evaluate the effects of the removal of the record-filing process and to provide pieces of evidence for policy decisions on the cross-region healthcare system. Methods In this study, a difference-in-difference model that controlled for potential confounding was applied to ascertain the changes in cross-region inpatient visits, medical expenditures, health insurance payments and medical cost per-visit following the removal of the record-filing process by using cross-region inpatient claim data in the reform region and nonreform region after the policy intervention. Results The number of cross-region inpatient visits and total medical expenditures of cross-region healthcare costs increased significantly by 40.93% ( P =0.010) and 32.41%( P =0.005), respectively. Total health insurance payments increased by 3.83% and were not significant ( P =0.693). The average medical cost per visit for cross-region patients in the treated group was 6.44% lower than that in the control group, also not significantly ( P =0.162). Conclusions The findings suggest that giving patients freedom without a “policy barrier” could significantly encourage more patients to seek healthcare services outside the affiliated regions and increase the total medical expenditures. While the financial concerns of the health insurance funds could be reduced effectively if a higher co-payment was used for cross-region patients.
Stroke inpatients in rehabilitation clinics are highly inactive in their free time and often depend on staff members to transport them to scheduled therapies. This study examines how distances ...between spaces in rehabilitation clinics impact patients' mobility. Seventy patients were shadowed over the course of one ordinary day in rehabilitation. Shadowing was accompanied by patient and staff questionnaires. Both patients and staff members described the labyrinthine built environment with long corridors that all look similar. Patients covered substantial daily distances in the clinics, and longer distances were significantly related to encountering more mobility barriers and dependence on staff. Compact layouts with vertically separate wards and main therapy areas resulted in reduced travel distances compared to more complex building layouts. Patients' mobility abilities were occasionally observed to change on different distances and even throughout the day. As distances result from the building's layout, greater attention needs to be paid to this aspect of the built environment in the early design stages. This is especially the case since other built-environment barriers were found to be intertwined with long distances. All patients may be independently mobile if distances between their most important areas (wards, therapy areas and dining spaces) are carefully planned.
Extracorporeal membrane oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients with severe respiratory or cardiac failure. Studies demonstrated the feasibility of ...in-hospital mobilizing during and after ECMO treatment preventing neuromuscular weakness and impaired physical functioning. Despite more compact mobile ECMO devices, implementation of ambulatory ECMO remains labor-intensive, complex, and challenging. It requires a large multidisciplinary team to carry equipment, monitor and physically support the patient, and to provide a back-up wheelchair in case of fatigue. Moreover, there is no adequate solution to ensure the stability of the patient's cannula and circuit management during ambulation. We developed a system contributing to improvement and innovation of current ambulatory ECMO patient programs. Our modular cart-in-cart system carries necessary ECMO equipment, features an extendable walking frame, and contains a folding seat for patient transport. An adjustable shoulder brace with lockable tubing-connectors enables safe fixation of the blood tubing. ECMOve provides safety, support, and accessibility while performing ambulatory ECMO for both patient and caregiver. Prototype evaluation in a simulated intensive care unit showed feasibility of our design, but needs to be evaluated in clinical care.
Analysis of patient mobility in a country not only gives an idea of how the health-care system works, but also can be a guideline to determine the quality of health care and health disparity among ...regions. Even though determination of patient movement is important, it is not often realized that patient mobility could have a unique pattern beyond health-related endowments (e.g., facilities, medical staff). This study therefore addresses the following research question: Is there a way to identify regions with similar patterns using spatio-temporal distribution of patient mobility? The aim of the paper is to answer this question and improve a classification method that is useful for populous countries like Turkey that have many administrative areas.
The data used in the study consist of spatio-temporal information on patient mobility for the period between 2009 and 2013. Patient mobility patterns based on the number of patients attracted/escaping across 81 provinces of Turkey are illustrated graphically. The hierarchical clustering method is used to group provinces in terms of the mobility characteristics revealed by the patterns. Clustered groups of provinces are analyzed using non-parametric statistical tests to identify potential correlations between clustered groups and the selected basic health indicators.
Ineffective health-care delivery in certain regions of Turkey was determined through identifying patient mobility patterns. High escape values obtained for a large number of provinces suggest poor health-care accessibility. On the other hand, over the period of time studied, visualization of temporal mobility revealed a considerable decrease in the escape ratio for inadequately equipped provinces. Among four of twelve clusters created using the hierarchical clustering method, which include 64 of 81 Turkish provinces, there was a statistically significant relationship between the patterns and the selected basic health indicators of the clusters. The remaining eight clusters included 17 provinces and showed anomalies.
The most important contribution of this study is the development of a way to identify patient mobility patterns by analyzing patient movements across the clusters. These results are strong evidence that patient mobility patterns provide a useful tool for decisions concerning the distribution of health-care services and the provision of health care equipment to the provinces.
Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care provider. PubMed and Embase were ...searched for relevant articles between 1990 and 2015. Of 5,994 titles/abstracts reviewed, 26 studies were included. The studies used three main methodological models to establish mobility. Variation in the extent of patient mobility was observed across the studies. Mobility was positively associated with lower waiting times, indicators of better service quality, and access to advanced technology. It was negatively associated with advanced age or lower socioeconomic backgrounds. From a policy perspective we demonstrate that a significant proportion of patients are prepared to travel beyond their nearest provider for elective services. As a consequence, some providers are likely to be “winners” and others “losers,” which could result in overall decreased provider capacity or inefficient utilization of existing services. Equity also remains a key concern.
Many countries have introduced policies that enable patients to select a health care provider of their choice with the aim of improving the quality of care. However, there is little information about ...the drivers or the impact of patient mobility. Using administrative hospital data (n=19256) we analysed the mobility of prostate cancer patients who had radical surgery in England between 2010 and 2014. Our analysis, using geographic information systems and multivariable choice modelling, found that 33·5% (n=6465) of men bypassed their nearest prostate cancer surgical centre. Travel time had a strong impact on where patients moved to but was less of a factor for men who were younger, fitter, and more affluent (p always < 0.001). Men were more likely to move to hospitals that provided robotic prostate cancer surgery (odds ratio: 1.42, p<0.001) and to hospitals that employed surgeons with a strong media reputation (odds ratio: 2.18, p<0.001). Patient mobility occurred in the absence of validated measures of the quality of care, instead influenced by the adoption of robotic surgery and the reputation of individual clinicians. National policy based on patient choice and provider competition may have had a negative impact on equality of access, service capacity, and health system efficiency.
In this study, we assessed the reasons why men would choose to have prostate cancer surgery at a centre other than their nearest. We found that in England men were attracted to centres that carried out robotic surgery and employed surgeons with a national reputation.
One in three men bypassed their nearest prostate cancer surgical centre for treatment, especially those who were younger, fitter, and more affluent. In the absence of indicators reflecting treatment quality, centres that offered robotic techniques or employed clinicians with a national reputation were attractive to patients.
Inter-regional patient mobility represents both a resource and a challenge for the organization and financing of health systems, particularly in decentralised countries. We use cross-sectional time ...series regression analysis to test the determinants of imbalances in regional funds to finance inter-regional patient mobility for the 17 Spanish regions for the period 2014-2020. The findings indicate that highly specialised health centres and bilateral agreements partly explain the budget imbalance from inter-regional patient referrals, while local tourism partly explains the budget imbalance from non-referred patient mobility. Developing effective national schemes to compensate net patient recipient regions would be fundamental to addressing territorial imbalances.
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