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Purpose: Dysphagia, common among adult patients in acute care settings, is associated with various complications. This study aimed to identify significant predictors of adverse health outcomes in hospitalized patients with dysphagia. Methods: A consulting committee meeting preceded a retrospective chart review involving 420 adult patients (mean age 72 years, 55% male) hospitalized at CHU de Québec—Université Laval, who underwent an interdisciplinary dysphagia assessment. Multivariate logistic and linear regression analyses were conducted to examine relationships between potential predictors and outcomes (in-hospital mortality and pneumonia), with age and sex as covariates. Results: The consulting committee agreed that most predictors of adverse health outcomes, identified through the research team’s clinical experience and existing literature, were both important and applicable to clinical practice. Stroke, head and neck cancer, all types of malnutrition, and unauthorized food intake were the most significant predictors of mortality (P < 0.04, for all). Intellectual disability, chronic obstructive pulmonary disease, gastroesophageal reflux, and severe malnutrition were the most significant predictors of pneumonia (P ≤ 0.02, for all). Conclusion: This study highlights the importance of addressing malnutrition as a significant modifiable risk factor for mortality and pneumonia among hospitalized patients with dysphagia. These findings underscore the need to manage high-risk patients with dysphagia effectively.

Background: The aim of this study was to develop a patient-reported experience measure (PREM) for comparing the experience of care received by ambulatory patients with acute unexpected needs presenting in emergency departments (EDs), walk-in clinics, and primary care practices. Methods: The Ambulatory Patient EXperience (APEX) questionnaire was developed using a 5-phase mixed-methods approach. The questionnaire was pretested by asking potential users to rate its clarity, usefulness, redundancy, content and face validities, and discrimination on a 9-point scale (1 = strongly disagree to 9 = strongly agree). The pre-final version was then tested in a pilot study. Results: The final questionnaire is composed of 61 questions divided into 7 sections. In the pretest (n = 25), median responses were 8 and above for all dimensions assessed. In the pilot study, 63 participants were enrolled. Adjusted results show that access, cleanliness, and feeling treated with respect and dignity by nurses and physicians were significantly better in the clinics than in the ED. Conclusion: We developed a questionnaire to assess and compare experience of ambulatory care in different clinical settings.

AbstractObjectivesThe aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time. MethodsTDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field. ResultsOverall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals. ConclusionsThe greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.