Ronald J Lagoe

Publications of Ronald J Lagoe

• Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital.

  Authors: Ine Borghans, Rudolf B Kool, Ronald J Lagoe, Gert P Westert

  Health policy (Amsterdam, Netherlands). 03/2012; 104(3):222-33.

  PURPOSE AND SETTING: In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards inPURPOSE AND SETTING: In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions. DESIGN: We organised, on the hospital ward level, structured meetings with the staff in order to first identify barriers to reduce the length of stay and then later to link them to interventions. The key components of the approach were a benchmark with the fifteenth percentile and the use of a matrix, that on one side was arranged along the main phases of the care process - the admission, stay and discharge - and on the other side to the degree to which the length of stay could be shortened by the medical specialists and nurses themselves or by involving others. FINDINGS AND CONCLUSIONS: The matrix consists of a wide variety of interventions that mainly cover what we found in published research. As a bottom up approach is more likely to succeed, we would advise wards that have to reduce length of stay to make the inventory themselves, using appropriate benchmark data, and by using the matrix.

• Inpatient hospital complications and lengths of stay: a short report.

  Authors: Ronald J Lagoe, Pamela E Johnson, Mark P Murphy

  BMC research notes. 01/2011; 4(1):135.

  Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives forIncreasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area. This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York. It employed the Potentially Preventable Complications (PPC) software developed by 3M™ Health Information Services to identify lengths of stay for patients with and without urinary tract infection and pneumonia. The patient populations included individuals assigned to the same All Patients Refined Diagnosis Related Groups and severity of illness. The comparisons involved two nine month periods in 2008 and 2009.The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of urinary tract infection stayed a mean of 8.9 - 11.9 days or 161 - 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 - 2,427 additional patient days.The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of pneumonia stayed a mean of 13.0 - 16.3 days or 232 - 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 - 3,456 additional patient days. Similar differences were generated for median lengths of stay. The differences in hospital stays for patients in the same APR DRGs and severity of illness with and without urinary tract infection and pneumonia in the Syracuse hospitals were substantial. The additional utilization for these complications was valued at between $2,000,000 - $3,000,000 for a three month period. These differences in the use of hospital resources have important implications for reduction of health care costs among providers and payors of care.

• Reducing potentially preventable complications at the multi hospital level.

  Authors: Ronald J Lagoe, Gert P Westert, Anne Marie Czyz, Pamela E Johnson

  BMC research notes. 01/2011; 4:271.

  ABSTRACT: This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a communityABSTRACT: This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes. This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs.The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced.At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased. Results of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.

• Evaluation of hospital inpatient complications: a planning approach.

  Authors: Ronald J Lagoe, Gert P Westert

  BMC health services research. 01/2010; 10:200.

  Hospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of theHospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of the health care reform efforts in the United States.An objective of this study was to describe the Potentially Preventable Complications software developed as a tool for evaluating hospital inpatient outcomes. Additional objectives included demonstration of the use of this software to evaluate the connection between health care outcomes and expenses in United States administrative data at the state and local levels and the use of the software to plan and implement interventions to reduce hospital complications in one U.S. metropolitan area. The study described the Potentially Preventable Complications software as a tool for evaluating these inpatient hospital outcomes. Through administrative hospital charge data from California and Maryland and through cost data from three hospitals in Syracuse, New York, expenses for patients with and without complications were compared. These comparisons were based on patients in the same All Patients Refined Diagnosis Related Groups and severity of illness categories. This analysis included tests of statistical significance.In addition, the study included a planning process for use of the Potentially Preventable Complications software in three Syracuse hospitals to plan and implement reductions in hospital inpatient complications. The use of the PPC software in cost comparisons and reduction of complications included tests of statistical significance. The study demonstrated that Potentially Preventable Complications were associated with significantly increased cost in administrative data from the United States in California and Maryland and in actual cost data from the hospitals of Syracuse, New York. The implementation of interventions in the Syracuse hospitals was associated with the reduction of complications for urinary tract infection, decubitus ulcer, and pulmonary embolism. The study demonstrated that the Potentially Preventable Complications software could be used to evaluate hospital outcomes and related costs at the aggregate and diagnosis specific levels. It also indicated that the system could be used to plan and implement interventions to improve outcomes on an individual or multihospital basis.

• Electronic daily reporting of community-wide healthcare information.

  Authors: Ronald J Lagoe, Gert P Westert

  Healthcare quarterly (Toronto, Ont.). 02/2007; 10(3):104-8, 4.

  The development of electronic healthcare data systems has proceeded rapidly; concerns regarding the impact and costs of electronic healthcare data have also been raised. This study describes theThe development of electronic healthcare data systems has proceeded rapidly; concerns regarding the impact and costs of electronic healthcare data have also been raised. This study describes the development and implementation of a community-wide program for daily electronic exchange of aggregate healthcare data in Syracuse, NY, addressing major concerns and producing important lessons learned.

• Community wide electronic distribution of summary health care utilization data.

  Authors: Ronald J Lagoe, Gert P Westert

  BMC medical informatics and decision making. 02/2006; 6:17.

  BACKGROUND: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be aBACKGROUND: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data. METHODS: The development of the community wide data system focused on the following objectives: ongoing monitoring of the health care system, evaluation of community wide individual provider initiatives, identification and development of new initiatives. The system focused on the sharing of data related to hospital acute care, emergency medical services, long term care, and mental health. It was based on the daily distribution of reports among all health care providers related to these services. RESULTS: The development of the summary reports concerning health care utilization produced a system wide view of health care in Syracuse, New York on a daily basis. It was not possible to isolate the results of these reports because of the impact of specific projects and other factors. At the same time, the reports were associated with reduction of hospital inpatient stays, improvement of access to hospital emergency departments, reductions in stays for patients discharged to nursing homes, and increased access of mental health patients to hospital inpatient units. CONCLUSION: The implementation of the system demonstrated that summary electronic utilization data could provide daily information that would support the improvement of health care outcomes and efficiency. This approach could be implemented in a simple, direct manner with minimal expenses.

• An international study of hospital readmissions and related utilization in Europe and the USA.

  Authors: Gert P Westert, Ronald J Lagoe, Ilmo Keskimäki, Alastair Leyland, Mark Murphy

  Health policy (Amsterdam, Netherlands). 10/2002; 61(3):269-78.

  This study concerns a comparative analysis of hospital readmission rates and related utilization in six areas, including three European countries (Finland, Scotland and the Netherlands) and threeThis study concerns a comparative analysis of hospital readmission rates and related utilization in six areas, including three European countries (Finland, Scotland and the Netherlands) and three states in the USA (New York, California, Washington State). It includes a data analysis on six major causes of hospitalization across these areas. Its main focus is on two questions. (1) Do hospital readmission rates vary among the causes of hospitalization and the study populations? (2) Are hospital inpatient lengths of stay inversely related to readmissions rates? The study demonstrated that diagnoses such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) were the major causes of hospital readmission rates. The data showed that (initial) hospital stays were generally longer for patients who were readmitted than for those who were not. As a result, short stays were not associated with a higher risk of readmission, meaning that hospital readmissions were not produced by premature hospital discharges in the study population. Furthermore, the spatial variation in readmission rates within 7 versus 8-30 days showed to be identical. Finally, it was found that countries or states with relatively shorter stays showed higher readmission rates and vice versa. Since patients with readmissions in all of the areas had on average longer initial stays, this finding at country level does illustrate that there seems to be a country specific trade off between length of stay and rate of readmission. An explanation should be sought in differences in health care arrangements per area, including factors that determine length of stay levels and readmission rates in individual countries (e.g. managed care penetration, after care by GP's or home care).

• Development and implementation of a community-wide infusion therapy program by hospitals and nursing homes in Syracuse, New York.

  Authors: Ronald J Lagoe, Janet Dauley Altwarg, Cheryl M Noetscher

  Journal of infusion nursing : the official publication of the Infusion Nurses Society. 28(5):307-13.

  The development and implementation of an infusion therapy program in the metropolitan area of Syracuse, New York is described. The program was implemented in a number of nursing homes with trainingThe development and implementation of an infusion therapy program in the metropolitan area of Syracuse, New York is described. The program was implemented in a number of nursing homes with training and financial support from area hospitals. It resulted in a reduced number of hospital patient days and related savings for the healthcare system.

• Reducing ambulance diversion: a multihospital approach.

  Authors: Ronald J Lagoe, Janis C Kohlbrenner, Leslie D Hall, Michael Roizen, Patricia A Nadle, Richard C Hunt

  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 7(1):99-108.

  OBJECTIVE: To evaluate the impact of procedures for reducing ambulance diversion in the metropolitan area of Syracuse, New York. METHODS: This was a retrospective review of procedures for reducingOBJECTIVE: To evaluate the impact of procedures for reducing ambulance diversion in the metropolitan area of Syracuse, New York. METHODS: This was a retrospective review of procedures for reducing ambulance diversion at the system-wide and hospital-specific levels between January 1, 2001, and June 30, 2002. System-wide procedures involved exchange of information concerning diversion. Hospital-specific procedures involved implementation of additional planning and criteria for implementing ambulance diversion and development of additional patient care resources within the respective hospitals. RESULTS: Between 2000 and 2001, hours on ambulance diversion for the combined Syracuse hospitals declined by 24.8%. Between January and June 2001 and 2002, hours on diversion declined by 33.6%. These reductions in diversion hours occurred as numbers of ambulance transports increased by 7%, and numbers of emergency department visits increased by 5%. CONCLUSION: The study demonstrated that a combination of approaches can produce meaningful reductions of ambulance diversion at the community-wide and hospital-specific levels. It also demonstrated that substantial amounts of diversion time remained after these efforts, which must be addressed by payers and consumers.

• Improving outcomes with community-wide distribution of health care data.

  Authors: Ronald J Lagoe, Gert P Westert

  Health care management review. 29(1):67-76.

  This study describes the impact of the exchange of daily, weekly, and quarterly information among a full range of health care administrators and practitioners on the accessibility and efficiency ofThis study describes the impact of the exchange of daily, weekly, and quarterly information among a full range of health care administrators and practitioners on the accessibility and efficiency of care. These efforts produced increased accessibility of hospital emergency departments and greater efficiency of acute and long-term care.

• Managing hospital length of stay reduction: a multihospital approach.

  Authors: Ronald J Lagoe, Gert P Westert, Kathleen Kendrick, Gene Morreale, Saundra Mnich

  Health care management review. 30(2):82-92.

  Major financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions withMajor financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions with physicians and nursing homes to reduce inpatient lengths of stay by four hospitals in Syracuse, New York. These initiatives saved over 28,000 patient days and an average daily census of 96.0 over a 3.5-year period.

• Utilization and impact of ambulance diversion at the community level.

  Authors: Ronald J Lagoe, Richard C Hunt, Patricia A Nadle, Janis C Kohlbrenner

  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 6(2):191-8.

  OBJECTIVE: To evaluate the utilization and impact of ambulance diversion in the metropolitan area of Syracuse, New York. METHODS: This was a retrospective review of the ambulance diversion systemOBJECTIVE: To evaluate the utilization and impact of ambulance diversion in the metropolitan area of Syracuse, New York. METHODS: This was a retrospective review of the ambulance diversion system operated by the hospitals of Syracuse, New York. This system allows each emergency department to divert incoming ambulances during periods of extreme overcrowding. Data collected included numbers of hours on ambulance diversion by hospital, numbers of hours when all four hospitals were on diversion simultaneously, and numbers of ambulances received while the hospitals were on and off diversion. RESULTS: For three of the five years evaluated, ambulance diversion hours were most numerous during the period between January and March. For the most recent year studied (2000), ambulance diversion hours did not decline after the first quarter. During periods of diversion, hospital emergency departments received 30%-50% fewer ambulances than they did while open. CONCLUSION: This study demonstrated that, in Syracuse, New York, ambulance diversion was once a seasonal phenomenon, but is increasingly occurring throughout the year because of staff and resource limitations. It also demonstrated that ambulance diversion can be employed to reduce numbers of incoming transports.