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Judson TJ, Longhurst CA, Horman SF. Hospitalists outside the hospital: Preparing for new settings of care delivery. J Hosp Med 2024; 19:535-538. [PMID: 38439179 DOI: 10.1002/jhm.13323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Timothy J Judson
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah F Horman
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
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Li P, Kang T, Carrillo-Argueta S, Kassapidis V, Grohman R, Martinez MJ, Sartori DJ, Hayes R, Jervis R, Moussa M. Bridging the gap: a resident-led transitional care clinic to improve post hospital care in a safety-net academic community hospital. BMJ Open Qual 2024; 13:e002289. [PMID: 38508663 PMCID: PMC10953301 DOI: 10.1136/bmjoq-2023-002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/11/2024] [Indexed: 03/22/2024] Open
Abstract
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.
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Affiliation(s)
- Patrick Li
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Tiffany Kang
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Vickie Kassapidis
- Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Rebecca Grohman
- Allergy and Immunology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Daniel J Sartori
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rachael Hayes
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
- The Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Ramiro Jervis
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Marwa Moussa
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, Staten Island, NY, USA
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Lost in Follow-Up: Predictors of Patient No-Shows to Clinic Follow-Up After Abdominal Injury. J Surg Res 2022; 275:10-15. [PMID: 35219246 DOI: 10.1016/j.jss.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study is to evaluate risk factors for non-attendance to post-discharge, hospital follow-up appointments for traumatically injured patients who underwent exploratory laparotomy. METHODS This is a retrospective chart review of patients who underwent exploratory laparotomy for traumatic abdominal injury at an urban, Midwestern, level I trauma center with clinic follow-up scheduled after discharge. Clinically, relevant demographic characteristics, patients' distance from hospital, and the presence of staples, sutures, and drains requiring removal were collected. Descriptive statistics of categorical variables were calculated as totals and percentages and compared with a chi-squared test or Fisher's exact when appropriate. RESULTS The sample included 183 patients who were largely assaultive trauma survivors (68%), male (80%), and black (53%) with a mean age of 35.4 ± 14.9 years. Overall, 18.5% no-showed for their follow-up appointment. On multivariate analysis for clinic no-show; length of stay (odds ratio = 0.92 [0.84-0.99], P = 0.04) and the need for suture, staple, or drain removal were protective for clinic attendance (odds ratio = 5.59 [1.07-7.01], P = 0.04). Overall, 12 patients (6.4%) were readmitted. Forty patients (18.3%) had their follow-up in the emergency department (ED). On multivariate regression of risk factors for ED visits, the only statistically significant factors (P < 0.05) were clinic appointment no-show (OR = 2.81) and self-pay insurance (OR = 4.78). CONCLUSIONS Abdominal trauma patients are at high risk of no-show for follow-up appointments and no-show visits are associated with ED visits. Future work is needed evaluating interventions to improve follow-up.
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Development of a Primary Care Transitions Clinic in an Academic Medical Center. J Gen Intern Med 2022; 37:582-589. [PMID: 34327654 PMCID: PMC8321504 DOI: 10.1007/s11606-021-07019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Transitions of care experiences leave patients vulnerable to adverse outcomes, including readmissions, worsening symptoms, and reductions in functional status. AIM To describe and evaluate a primary care transitions clinic that serves patients with medical and/or social needs that must be addressed prior to establishment of primary care. SETTING Brigham Health, an academic medical center in Boston, MA. PROGRAM DESCRIPTION The transitions clinic opened within an existing primary care practice in January 2019. It employs one full-time nurse care coordinator and one full-time medical assistant, and is staffed by one primary care physician (PCP) or nurse practitioner each weekday afternoon. Both medical and social diagnoses that require follow-up post-discharge are addressed. Patients with any insurance are seen as many times as necessary until PCP care is established. PROGRAM EVALUATION In the year after its establishment (January 20, 2019, to January 19, 2020), the transitions clinic received 498 referrals (73.2% from the emergency department (ED), 23.3% from inpatient), with 207 patients ultimately seen. Patients were seen 5 (median; IQR 4-6) work days post-discharge, with 2 (median; IQR 1-3) visits per patient. Patients seen in the transitions clinic had significantly fewer ED visits than a comparator cohort referred to Brigham Health Primary Care after ED or hospital discharge in the year prior (January 20, 2018, to January 20, 2019). Patients seen in the transitions clinic additionally had significantly fewer ED visits and hospitalizations in the three months post-referral than in the three months pre-referral. The most common social determinants addressed by the clinic's nurse coordinator were insurance, transportation, and housing. DISCUSSION A primary care transitions clinic can provide accessible, attentive care post-discharge with positive effects on healthcare utilization. Availability of a multidisciplinary team that can see patients for repeated visits until establishment of PCP care was a key success factor for the transitions clinic.
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Griffin BR, Agarwal N, Amberker R, Gutierrez Perez JA, Eichorst K, Chapin J, Schweitzer AC, Hagiwara M, Wu C, Eyck PT, Reisinger HS, Vaughan-Sarrazin M, Kuperman EF, Glenn K, Jalal DI. An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population. J Hosp Med 2021; 16:583-588. [PMID: 34424188 PMCID: PMC8494282 DOI: 10.12788/jhm.3659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVE Hospital readmissions in the United States, especially in patients at high-risk, cost more than $17 billion annually. Although care transitions is an important area of research, data are limited regarding its efficacy, especially among rural patients. In this study, we describe a novel transitions-of-care clinic (TOCC) to reduce 30-day readmissions in a Veterans Health Administration setting that serves a high proportion of rural veterans. METHODS In this quality improvement initiative we conducted a pre-post study evaluating clinical outcomes in adult patients at high risk for 30-day readmission (Care Assessment Needs score > 85) discharged from the Iowa City Veterans Affairs (ICVA) Health Care System from 2017 to 2020. The ICVA serves 184,000 veterans across 50 counties in eastern Iowa, western Illinois, and northern Missouri, with more than 60% of these patients residing in rural areas. We implemented a multidisciplinary TOCC to provide in-person or virtual follow-up to high-risk veterans after hospital discharge. The main purpose of this study was to assess how TOCC follow-up impacted the monthly 30-day patient readmission rate. RESULTS The TOCC resulted in a 19.2% relative reduction in 30-day readmission rates in the 12-month postimplementation period compared to the preimplementation period (9.2% vs 11.4%, P = .04). Virtual visits were more popular than in-person visits among both urban and rural veterans. There was no difference in outcomes between these two follow-up options, and both groups had reduced readmission rates compared to non-TOCC follow-up. CONCLUSIONS A multidisciplinary TOCC within the ICVA featuring both virtual and in-person visits reduced the 30-day readmission rate. This reduction was particularly notable among patients with congestive heart failure.
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Affiliation(s)
- Benjamin R Griffin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Corresponding Author: Benjamin R Griffin, MD; ; Telephone: 319-384-8197
| | - Neeru Agarwal
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Corresponding Author: Benjamin R Griffin, MD; ; Telephone: 319-384-8197
| | - Rachana Amberker
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jeydith A Gutierrez Perez
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kelsi Eichorst
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Jennifer Chapin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | | | - Mariko Hagiwara
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Chaorong Wu
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mary Vaughan-Sarrazin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ethan F Kuperman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kevin Glenn
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Diana I Jalal
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc 2020; 16:947-956. [PMID: 31162935 DOI: 10.1513/annalsats.201812-913fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.
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Xiao M, St Hill CA, Vacquier M, Patel L, Mink P, Fernstrom K, Kirven J, Jeruzal J, Beddow D. Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates. South Med J 2019; 112:357-362. [PMID: 31282963 DOI: 10.14423/smj.0000000000000994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients' ratings of hospital care and hospitalist communication. METHODS Data were retrospectively collected from patients' electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records. RESULTS Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, P = 0.04 and adjusted odds ratio 1.56, P = 0.021) that varied by patient age at first admission (P = 0.001 and P = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant. CONCLUSIONS This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.
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Affiliation(s)
- Mengli Xiao
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Catherine A St Hill
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Marc Vacquier
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Love Patel
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Pamela Mink
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Karl Fernstrom
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Justin Kirven
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Jessica Jeruzal
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - David Beddow
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
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Salim SA, Elmaraezy A, Pamarthy A, Thongprayoon C, Cheungpasitporn W, Palabindala V. Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2019; 9:121-134. [PMID: 31044043 PMCID: PMC6484472 DOI: 10.1080/20009666.2019.1591901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Over the past 20 years, hospitalists have assumed a greater portion of healthcare service for hospitalized patients. This was mainly due to reducing the length of stay (LOS) and hospital costs shown by many studies. In contrast, other studies suggested increased cost and resources utilization associated with hospitalist-run care models. Aim: We aimed to provide class 1 evidence regarding the effect of hospitalist-run care models on the efficiency of care and patient satisfaction. Design: Meta-analysis. Methods: Four electronic medical databases were searched to retrieve all relevant studies. Two authors screened titles and abstracts of search results for eligibility according to predefined criteria. Initially eligible studies were screened for full text inclusion. Included studies were reviewed for data on LOS, hospital cost, readmission, mortality, and patient satisfaction. Available data were abstracted and analyzed using Comprehensive Meta-Analysis. Results: Sixty-one studies were included for analysis. The overall effect size favored hospitalist-run care models in terms of LOS (MD = -0.67 day, 95% CI [-0.78, -0.56], p < 0.001). There was no significant difference in terms of hospital cost (MD = $92.1, 95% CI [-910.4, 1094.6], p = 0.86) whereas patient satisfaction was similar or even better in hospitalist compared to non-hospitalist (NH) service. Conclusion: Our analysis showed that hospitalist care is associated with decreased LOS and increased patient satisfaction compared to NH. This indicates an increase in the efficiency of care that does not come at the expense of care quality.
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Affiliation(s)
- Sohail Abdul Salim
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ahmed Elmaraezy
- Global Clinical Scholars Research Training (GCSRT) Program, Harvard Medical School, Boston, MA, USA.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Al-Razi Medical Research Academy, Cairo, Egypt
| | - Amaleswari Pamarthy
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
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Dastidar JG, Jiang M. Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients. J Palliat Care 2018; 33:167-174. [PMID: 29732904 DOI: 10.1177/0825859718769095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. OBJECTIVE We sought to characterize this group including mortality rates, with the goal of better understanding this population. DESIGN Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital. SETTING Single large academic medical center. PATIENTS Adult inpatients on general medicine and medicine subspecialty services. MEASUREMENTS The number of nonelective medicine hospitalizations, age, clinical conditions and comorbidities, calculation of an age-adjusted Charlson Comorbidity Index (CCI), outpatient and emergency department visits, length of stay, costs of hospitalization, and mortality over a 5-year period. Descriptive statistics were used to characterize variables of interest. RESULTS We identified 153 patients with a total of 781 nonelective hospitalizations, totaling greater than 4000 hospital days and with charges of approximately US$9 million during the 6 months. Nearly all had insurance coverage and good outpatient follow-up (median of 7 appointments over the 6-month study period). Only 14% of those admissions qualified for observation status. Over 40% of patients had comorbid mental health disease or chronic narcotic dependence. Twenty-nine percent of patients died within 1 year; 50% were dead within 5 years. Age-adjusted CCI scores ranged annually from 3.00 to 3.58 among surviving patients versus 4.31 to 6.60 among deceased patients. CONCLUSIONS These findings point to distinct groups of patients who are frequently hospitalized, and therefore would benefit from tailored management strategies: Those with progression of end-stage disease comprised one-third of the group and targeting that subset with palliative care referrals could help decrease readmission rates. Those with recurrent exacerbations of a chronic medical condition could be managed through telemanagement programs. Those with exacerbations of chronic pain could be addressed through collaboration with pain management specialists. Individualized care management plans may be useful for all, especially the latter two groups. Based on differences between survivors and deceased patients, an age-adjusted CCI score of 4 or 5 could be valuable sensitive or specific cutoffs, respectively, for predicting those who would benefit most from palliative care consultation regarding end-of-life goals and management.
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Affiliation(s)
- Joyeeta G Dastidar
- 1 Division of General Medicine, Department of Medicine, Section of Hospital Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, USA
| | - Min Jiang
- 2 Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
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Marcus P, Hautala K, Allaudeen N. An Initiative to Change Inpatient Practice: Leveraging the Patient Medical Home for Postdischarge Follow-Up. Jt Comm J Qual Patient Saf 2018; 44:101-106. [PMID: 29389458 DOI: 10.1016/j.jcjq.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The standard of care for hospital discharge planning includes arranging follow-up appointments, usually with a primary care provider. However, follow-up phone calls instead of face-to-face visits may be an appropriate alternative for some patients. This option was explored within the framework of the US Department of Veterans Affairs (VA) patient-centered medical home model of care, the Patient Aligned Care Team. METHODS At a VA hospital, a pilot study was conducted on the use of phone calls from members of a patient's medical home as posthospital discharge follow-up rather than the traditional face-to-face provider model. Inpatient providers were educated about the phone follow-up alternative, and this option was standardized as part of discharge planning rounds. RESULTS During Phase 1 at one clinic over three months, 17 of 118 eligible patients received phone call follow-up (14.4% of discharges) instead of traditional face-to-face follow-up. During Phase 2, data from Phase 1 were analyzed, and staff at the other eight clinic sites were trained. After the expansion of the initiative to all regional clinic sites in Phase 3, 76 of 447 eligible discharges (17.0%) were scheduled for phone follow-up. As a balancing metric, there were no significant differences in rates of 30-day emergency department (ED) utilization (11.9% and 5.9%, (p = 0.47)) or nonelective rehospitalization (16.8% and 17.6%, (p = 0.93)) between these groups during Phase 1. CONCLUSION This initiative changed provider practices to use phone call follow-up for select patients instead of face-to-face provider visits after hospital discharge, without significantly increasing rates of 30-day ED utilization or rehospitalization.
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11
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Chakravarthy V, Ryan MJ, Jaffer A, Golden R, McClenton R, Kim J, Press I, Johnson TJ. Efficacy of a Transition Clinic on Hospital Readmissions. Am J Med 2018; 131:178-184.e1. [PMID: 28941749 DOI: 10.1016/j.amjmed.2017.08.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A primary care-staffed transition clinic is one potential strategy for reducing 30-day re-admissions for patients without an established primary care physician, but the effectiveness has not been studied. The objective was to test whether patients who completed a postdischarge transition clinic appointment were less likely to be readmitted within 30 days. METHODS This retrospective cross-sectional study included adults with Medicare or Medicaid coverage who were discharged from general medicine units at Rush University Medical Center between October 2013 and October 2014. All patients had a follow-up appointment scheduled within 30 days of discharge in the transition clinic or with their primary care physician. A binary logistic regression model was constructed to test the relationship between 30-day readmission and follow-up appointment status, controlling for patient factors. RESULTS The sample included 1149 patients with scheduled follow-up appointments (24% in the transition clinic and 76% with their primary care physician). After controlling for patient demographic characteristics and clinical factors, patients who did not complete a scheduled transition clinic appointment had approximately 3 times higher odds of readmission compared with patients who completed a transition clinic appointment (adjusted odds ratio, 2.80; P = .004). There was no significant difference in the likelihood of 30-day readmission between patients completing a transition clinic appointment and those who were scheduled with their primary care physician. CONCLUSIONS A primary care-staffed transition clinic is a promising strategy for providing access after a recent hospitalization and effectively managing the initial posthospital discharge needs of vulnerable populations.
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Affiliation(s)
| | - Mary J Ryan
- Rush University Medical Center, Chicago, Ill
| | - Amir Jaffer
- Rush University Medical Center, Chicago, Ill
| | | | | | - Jisu Kim
- Rush University Medical Center, Chicago, Ill
| | - Irwin Press
- Rush University Medical Center, Chicago, Ill
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12
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Abstract
Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addition, little attention has been given to other clinical outcomes, such as reducing preventable harm and mortality. A review of dedicated, hospitalist-led postdischarge clinics, of the data supporting postdischarge physician visits, and of the role of hospitalists in these clinics may be instructive for hospitalists and health systems considering the postdischarge clinic environment. Journal of Hospital Medicine 2017;12:467-471.
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Affiliation(s)
- Lauren Doctoroff
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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13
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Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED. Am J Emerg Med 2016; 34:1230-5. [PMID: 27066931 DOI: 10.1016/j.ajem.2016.03.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Transitional care clinics (TCCs) represent one strategy to facilitate follow-up and primary care linkage for patients with no regular source of care who are discharged from the emergency department (ED). We assessed factors associated with completion of TCC follow-up among these patients and characterized their subsequent ED use. METHODS Retrospective study of 660 randomly sampled patients with a scheduled appointment to a TCC at time of ED discharge. Patient- and visit-level characteristics were abstracted from the medical records of these patients and linked to a state visit database to characterize ED use after referral. Multiple logistic regression was used to determine factors associated with completion of follow-up and subsequent ED utilization. RESULTS Half (50%) of the patients completed their follow-up appointment with a mean follow-up time of 6.9days. Non-English language (odds ratio [OR], 2.21; confidence interval [CI], 1.30-3.75) was the only factor associated with improved follow-up; however, patients who were homeless (OR, 0.42; CI, 0.26-0.66) had a substance use history (OR, 0.68; CI, 0.45-1.00), and those with more baseline ED visits (OR, 0.94 per additional ED visit; CI, 0.89-0.99) were significantly less likely to complete follow-up. After adjusting for demographic, clinical, and visit-level characteristics, patients who completed their appointment had significantly fewer ED visits in the subsequent year compared to patients who did not complete their appointment (mean, 2.3 vs 3.3 visits; difference, -1.0 visits in subsequent calendar year; CI for difference, -1.2 to -0.7). CONCLUSION Transitional care clinics represent a promising strategy to improve the continuity of care for emergency patients and may reduce unnecessary ED use.
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