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      A computer vision system for deep learning-based detection of patient mobilization activities in the ICU

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          Abstract

          Early and frequent patient mobilization substantially mitigates risk for post-intensive care syndrome and long-term functional impairment. We developed and tested computer vision algorithms to detect patient mobilization activities occurring in an adult ICU. Mobility activities were defined as moving the patient into and out of bed, and moving the patient into and out of a chair. A data set of privacy-safe-depth-video images was collected in the Intermountain LDS Hospital ICU, comprising 563 instances of mobility activities and 98,801 total frames of video data from seven wall-mounted depth sensors. In all, 67% of the mobility activity instances were used to train algorithms to detect mobility activity occurrence and duration, and the number of healthcare personnel involved in each activity. The remaining 33% of the mobility instances were used for algorithm evaluation. The algorithm for detecting mobility activities attained a mean specificity of 89.2% and sensitivity of 87.2% over the four activities; the algorithm for quantifying the number of personnel involved attained a mean accuracy of 68.8%.

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          How to solve the cost crisis in health care.

          U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Schön Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.
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            Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure.

            Hospitals are under pressure to provide care that not only shortens hospital length of stay but also reduces subsequent hospital admissions. Hospital readmissions have received increased attention in outcome reporting. The authors identified survivors of acute respiratory failure who then required subsequent hospitalization. A cohort of acute respiratory failure survivors, who participated in an early intensive care unit (ICU) mobility program, was assessed to determine if variables from the index hospitalization predict hospital readmission or death, within 12 months of hospital discharge. Hospital database and responses to letters mailed to 280 acute respiratory failure survivors. Univariate predictor variables shown to be associated with hospital readmission or death (P < 0.1) were included in a multiple logistic regression. A stepwise selection procedure was used to identify significant variables (P < 0.05). Of the 280 survivors, 132 (47%) had at least 1 readmission or died within the first year, 126 (45%) were not readmitted and 22 (8%) were lost to follow-up. Tracheostomy [odds ratio (OR), 4.02 (95%CI, 1.72-9.40)], female gender [OR, 1.94 (95%CI, 1.13-3.32)], a higher Charlson Comorbidity Index assessed upon index hospitalization discharge [OR, 1.15 (95%CI, 1.01-1.31)] and lack of early ICU mobility therapy [OR, 1.77 (95%CI, 1.04-3.01)] predicted readmission or death in the first year postindex hospitalization. Tracheostomy, female gender, higher Charlson Comorbidity Index and lack of early ICU mobility were associated with readmissions or death during the first year. Although the mechanisms of increased hospital readmission are unclear, these findings may provide further support for early ICU mobility for patients with acute respiratory failure.
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              Validity of the AM-PAC "6-Clicks" Inpatient Daily Activity and Basic Mobility Short Forms

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                Author and article information

                Contributors
                +(530) 848-5319 , syyeung@stanford.edu
                +(502) 777-8273 , fsalipur@stanford.edu
                Journal
                NPJ Digit Med
                NPJ Digit Med
                NPJ Digital Medicine
                Nature Publishing Group UK (London )
                2398-6352
                1 March 2019
                1 March 2019
                2019
                : 2
                : 11
                Affiliations
                [1 ]ISNI 0000000419368956, GRID grid.168010.e, Department of Computer Science, , Stanford University, ; 353 Serra Mall, Stanford, CA 94305 USA
                [2 ]ISNI 0000000419368956, GRID grid.168010.e, Clinical Excellence Research Center, , Stanford University School of Medicine, ; 75 Alta Rd, Stanford, CA 94305 USA
                [3 ]ISNI 0000000419368956, GRID grid.168010.e, Division of General Surgery, Department of Surgery, , Stanford University School of Medicine, ; 300 Pasteur Drive, Rm H3680, Stanford, CA 94305 USA
                [4 ]ISNI 0000000419368956, GRID grid.168010.e, Department of Medicine, Center for Biomedical Informatics Research, , Stanford University School of Medicine, ; 1265 Welch Road, Stanford, CA 94305 USA
                [5 ]ISNI 0000000121839049, GRID grid.5333.6, School of Architecture, Civil and Environmental Engineering, , École Polytechnique Fédérale de Lausanne, ; 1015 Lausanne, Switzerland
                [6 ]ISNI 0000 0000 9141 2254, GRID grid.410473.5, Department of Critical Care Medicine, , LDS Hospital, Intermountain Healthcare, ; 8th Avenue, C St. E, Salt Lake City, UT 84143 USA
                Author information
                http://orcid.org/0000-0003-0529-0628
                http://orcid.org/0000-0002-3296-6630
                http://orcid.org/0000-0002-6621-0356
                http://orcid.org/0000-0002-6574-6669
                Article
                87
                10.1038/s41746-019-0087-z
                6550251
                31304360
                8fa84e2d-294a-4d47-972e-0928b2490e4d
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 October 2018
                : 15 February 2019
                Categories
                Brief Communication
                Custom metadata
                © The Author(s) 2019

                health services,computer science
                health services, computer science

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