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Valles BT, Etzler SP, Meyer JR, Kittle LD, Burns MR, Buckner Petty SA, Curtis BL, Zehring CM, Peters AL, Dangerfield BS. Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community. Pediatr Emerg Care 2024:01269241-990000000-00019. [PMID: 38888408 DOI: 10.1097/ncm.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program. With typical care management models, patients are assigned to registered nurse case managers and social workers according to the inpatient nursing unit rather than patient care complexity. Patients with complex care needs may not receive the amount of time needed to ensure an efficient and effective transition to the community setting. Furthermore, after transitioning to the community, patients with complex care needs often do not have access to care management resources if further care coordination needs arise. PRIMARY PRACTICE SETTING Acute care hospital in the US Southwest. METHODOLOGY AND SAMPLE The CCTT was composed of a registered nurse case manager, social worker, and care management assistant, with physician advisor support. The CCTT followed patients with complex care needs during their hospitalization and transition to the community for 90 days after discharge. The number of inpatient admissions and hospital readmission rates were compared between 6 months before and after enrollment in the CCTT program. Cost savings for decreased hospital length of stay, emergency department visits, and hospital readmissions were also determined. RESULTS The CCTT selected patients according to a complex care algorithm, which identified patients who required high use of the health care system. The CCTT then followed this cohort of patients for an average of 90 days after discharge. A total of 123 patients were enrolled in the CCTT program from July 1, 2019, to April 30, 2021, and 80 patients successfully graduated from the program. Readmission rates decreased from 51.2% at 6 months before the intervention to 22.0% at 6 months after the intervention. This reduced readmission rate resulted in a cost savings of more than $1 million. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The outcomes resulting from implementation of the multidisciplinary CCTT highlight the need for a patient-specific approach to transitioning care to the outpatient setting. The patient social determinants of health that often contributed to overuse of health care resources included poor access to outpatient specialists, difficulty navigating the health care system due to illness or poor health literacy, and limited social support. The success of the CCTT program prompted the implementation of other specialty-specific pilot programs at Mayo Clinic in Arizona. The investment of time and resources, including dedicated personnel to follow patients with high hospital service usage, allows health care systems to reduce emergency department visits and hospital admissions and to provide patients with the best opportunity for success as they transition from the inpatient to outpatient setting.
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Affiliation(s)
- Brittane T Valles
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Sydney P Etzler
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Jillian R Meyer
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Laura D Kittle
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Michelle R Burns
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Skye A Buckner Petty
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Belinda L Curtis
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Cathleen M Zehring
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Ariana L Peters
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
| | - Benjamin S Dangerfield
- Brittane T. Valles, MD, is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management.
- Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work
- Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association
- Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications
- Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona
- Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research
- Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years
- Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications
- Ariana L. Peters, DO, graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona
- Benjamin S. Dangerfield, DO, is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
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Wellman CD, Franks AM, Stickler M, Rollyson W, Korkmaz A, Christiansen MQ, Petrany SM. Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions. Fam Pract 2024; 41:326-332. [PMID: 36730038 DOI: 10.1093/fampra/cmad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions. METHODS Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission. RESULTS Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73-22.75) and coronary artery disease (OR 6.71; 95% CI 1.84-24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96-26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09-0.50), answered calls (OR 0.16; CI 0.07-0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07-0.54), and visit arrival (OR 0.39; 95% CI 0.17-0.91) independently associated with decreased readmission rate. Patient-specific (hypertension-OR 3.65; CI 1.03-12.87) and admission-specific (nephrologic system-OR 3.22; CI 1.02-10.14) factors associated with readmissions which differed from the initial analysis. CONCLUSIONS Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources.
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Affiliation(s)
- Courtney D Wellman
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Adam M Franks
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Morgan Stickler
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - William Rollyson
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Alperen Korkmaz
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Matthew Q Christiansen
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Stephen M Petrany
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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3
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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Sibicky SL, Pogge EK, Bouwmeester CJ, Butterfoss KH, Ulen KR, Meyer KS. Pharmacists' Impact on Older Adults Transitioning To and From Patient Care Centers: A Scoping Review. J Pharm Pract 2024; 37:169-183. [PMID: 36062533 DOI: 10.1177/08971900221125014] [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] [Indexed: 11/16/2022]
Abstract
Objective: Expand upon previous reviews conducted on transitions of care (TOC) services with a focus on pharmacist interventions for older adults specifically transitioning to and from long-term care, acute rehabilitation, residential care facilities, care homes, skilled nursing, or assisted living facilities, collectively termed patient care centers (PCC). Data Sources: A PubMed and Ovid MEDLINE search was conducted including citations between 1974 and July 14, 2022. Bibliographies were also reviewed for additional citations. Methods: Articles included described pharmacist interventions during TOC for patients transitioning to and from PCC, were written in English, and reported outcomes pertaining to TOC services. Of 873 citations reviewed, 22 articles met the inclusion criteria. Results: Most studies were prospective in design with small sample sizes, of limited duration, and with varying interventions and reported outcomes. Most explored the transition from hospital to PCC and included a pharmacist intervention involving the identification of medication errors and discrepancies during the TOC. Few studies reported cost savings or 30- and 60-day reductions in readmission rates or mortality. Conclusions: This scoping review revealed a lack of robust clinical trials to assess the effectiveness of specific interventions performed by pharmacists for patients transitioning to and from PCC. Of the available data, pharmacist involvement within an interprofessional team can be an effective intervention to resolve medication discrepancies, reduce readmissions, and medication-related adverse events. An opportunity exists for future studies to explore ways to improve outcomes during TOC within PCC.
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Affiliation(s)
- Stephanie L Sibicky
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | - Elizabeth K Pogge
- College of Pharmacy - Glendale Campus, Midwestern University, Glendale, AZ, USA
| | - Carla J Bouwmeester
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | | | - Kelly R Ulen
- Department of Geriatrics, UPSTATE Community Hospital, Syracuse, NY, USA
| | - Kristin S Meyer
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
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Heo M, Taaffe K, Ghadshi A, Teague LD, Watts J, Lopes SS, Tilkemeier P, Litwin AH. Effectiveness of Transitional Care Program among High-Risk Discharged Patients: A Quasi-Experimental Study on Saving Costs, Post-Discharge Readmissions and Emergency Department Visits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7136. [PMID: 38063566 PMCID: PMC10706296 DOI: 10.3390/ijerph20237136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
Transitional care programs (TCPs), where hospital care team members repeatedly follow up with discharged patients, aim to reduce post-discharge hospital or emergency department (ED) utilization and healthcare costs. We examined the effectiveness of TCPs at reducing healthcare costs, hospital readmissions, and ED visits. Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement (BPCI) program adjudicated claims files and electronic health records from Greenville Memorial Hospital, Greenville, SC, were accessed. Data on post-discharge 30- and 90-day ED visits and readmissions, total costs, and episodes with costs over BPCI target prices were extracted from November 2017 to July 2020 and compared between the "TCP-Graduates" (N = 85) and "Did Not Graduate" (DNG) (N = 1310) groups. As compared to the DNG group, the TCP-Graduates group had significantly fewer 30-day (7.1% vs. 14.9%, p = 0.046) and 90-day (15.5% vs. 26.3%, p = 0.025) readmissions, episodes with total costs over target prices (25.9% vs. 36.6%, p = 0.031), and lower total cost/episode (USD 22,439 vs. USD 28,633, p = 0.018), but differences in 30-day (9.4% vs. 11.2%, p = 0.607) and 90-day (20.0% vs. 21.9%, p = 0.680) ED visits were not significant. TCP was associated with reduced post-discharge hospital readmissions, total care costs, and episodes exceeding target prices. Further studies with rigorous designs and individual-level data should test these findings.
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Affiliation(s)
- Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Kevin Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, SC 29634, USA
| | - Ankita Ghadshi
- Department of Industrial Engineering, Clemson University, Clemson, SC 29634, USA
| | - Leigh D. Teague
- Department of Medicine, Prisma Health, Greenville, SC 29605, USA
| | - Jeffrey Watts
- Value-Based Care & Network Services, Prisma Health, Greenville, SC 29605, USA
| | - Snehal S. Lopes
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Peter Tilkemeier
- Department of Medicine, Prisma Health, Greenville, SC 29605, USA
- Department of Medicine, University of South Carolina School of Medicine—Greenville, Greenville, SC 29605, USA
| | - Alain H. Litwin
- Department of Medicine, Prisma Health, Greenville, SC 29605, USA
- Department of Medicine, University of South Carolina School of Medicine—Greenville, Greenville, SC 29605, USA
- School of Health Research, Clemson University, Greenville, SC 29634, USA
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Kasireddy TR, Yukselen Z, Muthyala A, Bansal K, Dasari M, Arun Kumar P, Anugu VR, Majmundar V, Nakhla M, Sharma G, Nasir K, Warraich HJ, Ganatra S, Dani SS. Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes? Curr Probl Cardiol 2023; 48:101795. [PMID: 37207818 PMCID: PMC10191728 DOI: 10.1016/j.cpcardiol.2023.101795] [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: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023]
Abstract
Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.
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Affiliation(s)
| | - Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | | | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Michael Nakhla
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Heart And Vascular Institute, Falls Church, VA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist, Houston, TX
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA and Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
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Juanes A, Ruíz J, Puig M, Blázquez M, Gilabert A, López L, Baena MI, Guiu JM, Antònia Mangues M. The Effect of the Drug-Related Problems Prevention Bundle on Early Readmissions in Patients From the Emergency Department: A Randomized Clinical Trial. Ann Pharmacother 2023; 57:1025-1035. [PMID: 36539949 DOI: 10.1177/10600280221143237] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized. OBJECTIVE To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems. METHODS A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause. RESULTS Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed. CONCLUSION AND RELEVANCE In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT03607097).
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Affiliation(s)
- Ana Juanes
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Jesús Ruíz
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Mireia Puig
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Blázquez
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Gilabert
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Laia López
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - M Isabel Baena
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Josep M Guiu
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Maria Antònia Mangues
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
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8
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Pang RK, Srikanth V, Snowdon DA, Weller CD, Berry B, Braun G, Edwards I, McGee F, Azzopardi R, Andrew NE. Targeted care navigation to reduce hospital readmissions in 'at-risk' patients. Intern Med J 2023; 53:1196-1203. [PMID: 34841635 DOI: 10.1111/imj.15634] [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: 09/17/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Care navigation is commonly used to reduce preventable hospitalisation. The use of Electronic Health Record-derived algorithms may enable better targeting of this intervention for greater impact. AIMS To evaluate if community-based Targeted Care Navigation, supported by an Electronic Health Record-derived readmission risk algorithm, is associated with reduced rehospitalisation. METHODS A propensity score matching cohort (5 comparison to 1 intervention cohort ratio) study was conducted in an 850-bed Victorian public metropolitan health service, Australia, from May to November 2017. Admitted acute care patients with a non-surgical condition, identified as at-risk of hospital readmission using an Electronic Health Record-derived readmission risk algorithm provide by the state health department, were eligible. Targeted Care Navigation involved telephone follow-up support provided for 30 days post-discharge by a registered nurse. The hazard ratio for hospital readmission was calculated at 30, 60 and 90 days post-discharge using multivariable Cox Proportional Hazards regression. RESULTS Sixty-five recipients received care navigation and were matched to 262 people who did not receive care navigation. Excellent matching was achieved with standardised differences between groups being <0.1 for all 11 variables included in the propensity score, including the readmission risk score. The Targeted Care Navigation group had a significantly reduced hazard of readmission at 30 days (hazard ratio 0.34; 95% confidence interval: 0.12, 0.94) compared with the comparison group. The effect size was reduced at 60 and 90 days post-discharge. CONCLUSION We provide preliminary evidence that Targeted Care Navigation supported by an Electronic Health Record-derived readmission risk algorithm may reduce 30-day hospital readmissions.
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Affiliation(s)
- Rebecca K Pang
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Belinda Berry
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Gary Braun
- Department of Medicine, Frankston hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Iain Edwards
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Fergus McGee
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Ruth Azzopardi
- Rehabilitation, Ageing, Pain and Palliative Care services, Peninsula Health, Melbourne, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
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Dillon R, Burton T, Anderson AJ, Seare J, Puzniak L. Risk of relapse and readmission among hospitalized adults with carbapenem non-susceptible gram-negative infections. Curr Med Res Opin 2023; 39:881-888. [PMID: 37178145 DOI: 10.1080/03007995.2023.2205227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Infections caused by carbapenem-nonsusceptible gram-negative (C-NS) pathogens are associated with increased mortality and high treatment costs. Identification of potentially modifiable factors that may improve patient outcomes is important for better management of C-NS GN infections. METHODS This was a retrospective study of hospitalized adults with electronic health record evidence of complicated urinary tract infection (cUTI), bacterial pneumonia (BP), complicated intra-abdominal infection (cIAI), or bacteremia (BAC) due to C-NS GN organisms from January 2013 to March 2018. Treatment patterns and clinical characteristics during the index hospitalization were analyzed descriptively and stratified by infection site(s). The effect of patient characteristics on index infection relapse during the postdischarge period and on readmission with 30 days was modeled using logistic regression. RESULTS The study included 2,862 hospitalized patients with C-NS GN infections. Index infection sites were 38.4% cUTI ± BAC, 21.5% BP ± BAC, 18.7% cUTI + BP ± BAC, 14.7% any cIAI, and 6.7% BAC only. The majority of patients (83.6%) received an antibiotic during their index hospitalization; among these, the most common classes given were penicillins (52.9%), fluoroquinolones (50.7%), and carbapenems (38.9%). During the postdischarge period, 21.7% of patients had a relapse of the index infection and 63.9% of patients were readmitted to the hospital. Factors associated with increased adjusted odds ratio (OR) for relapse or readmission included Charlson comorbidity score of ≥3 relative to 0 (relapse: OR [95% CI] = 1.34 [1.01-1.76], p = .040; readmission: OR [95% CI] 1.92 [1.50-2.46], p < .001), preindex immunocompromised status (relapse: OR [95% CI] 1.37 [1.05-1.79], p = .019; readmission: OR [95% CI] = 1.60 [1.27-2.02], p < .001), and preindex carbapenem use (relapse: OR [95% CI] = 1.35 [1.07-1.72], p = .013; readmission: OR [95% CI] = 1.25 [1.00-1.57], p = .048). CONCLUSIONS Adverse postdischarge outcomes were common among hospitalized patients with C-NS GN infections and were significantly associated with previous carbapenem use and patient clinical characteristics such as higher comorbidity burden and immunocompromised status. Adoption of antimicrobial stewardship and consideration of individual patient risk factors in making treatment decisions may help improve clinical outcomes.
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Affiliation(s)
- Ryan Dillon
- Center for Observational & Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA
| | | | | | | | - Laura Puzniak
- Center for Observational & Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA
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10
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Soh YY, Zhang H, Toh JJY, Li X, Wu XV. The effectiveness of tele-transitions of care interventions in high-risk older adults: A systematic review and meta-analysis. Int J Nurs Stud 2023; 139:104428. [PMID: 36682322 DOI: 10.1016/j.ijnurstu.2022.104428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronically ill older patients are often vulnerable to detrimental health outcomes and have increased risk of preventable readmission. Tele-transitions of care interventions utilizing telecommunications and surveillance technologies help monitor patients' conditions after discharge to prevent negative health outcomes. OBJECTIVES This systematic review and meta-analysis aimed to identify and synthesize available evidence on the effectiveness of tele-transitions of care interventions on various health outcomes in older adults at high risk for readmission discharged from acute setting. METHODS Published, unpublished studies and gray literatures were identified through searching PubMed, Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and theses and Google Scholar from inception to December 2021. Only randomized controlled trials published in English language assessing tele-transitions of care interventions on high-risk older adults were included. Meta-analyses were performed using random-effects model in RevMan 5.4. Sensitivity and subgroup and narrative analyses were conducted. RESULTS Fourteen studies were included, of which thirteen were considered for meta-analyses. Tele-transitions of care interventions were effective in reducing readmission rate (RR = 0.59, 95%CI 0.50-0.69, z = 6.28, p < 0.00001), mortality rate (RR = 0.72, 95%CI 0.53-0.98, z = 2.12, p = 0.03), and improving health-related quality of life (SMD = 0.24, Z = 2.04, p = 0.04). However, reduction of emergency department visit (RR = 1.10, 95%CI 0.59-2.06, z = 0.31, p = 0.76) and improvement of functional status (SMD = -0.06, Z = 0.19, p = 0.85) was not observed following intervention. Subgroup analysis found that the positive effects of tele-transitions of care interventions persist up to 180 days even after the intervention. CONCLUSION This systematic review and meta-analysis concluded that tele-transitions of care interventions have promising effects on readmission, mortality rate and health-related quality of life. Tele-transitions of care interventions are cost-effective and suitable for large-scale implementation in healthcare settings. REGISTRATION The protocol was registered on PROSPERO (CRD42022295665). TWEETABLE ABSTRACT Systematic review demonstrates that monitoring older patients at high risk of readmission, following discharge from hospital, using telecommunication and surveillance technologies significantly reduces readmission and mortality rates and improves their quality of life.
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Affiliation(s)
- Yang Yue Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hui Zhang
- St Andrew's Community Hospital, 8 Simei Street 3, Singapore.
| | - Janice Jia Yun Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, Hunan Province, People's Republic of China.
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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11
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Michel J, Jivanji D, Goel AN, Lec PM, Lenis AT, Litwin MS, Chamie K. Readmissions after radical nephrectomy in a national cohort. Scand J Urol 2023; 57:75-80. [PMID: 36644811 DOI: 10.1080/21681805.2023.2166579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyze the factors and costs associated with 30-day readmissions for patients undergoing radical nephrectomy. MATERIALS AND METHODS We used the 2014 Nationwide Readmission Database to identify adults who underwent radical nephrectomy for renal cancer, stratified by surgical approach. We determined patient factors associated with readmission rates, diagnoses, and costs using multivariate logistic regression. RESULTS Among 19,523 individuals, the 30-day readmission rate was 7.7% (n = 1,506). On multivariate regression, odds of readmission were significantly increased with age ≥75 in those who underwent open nephrectomy (OR: 1.35; 95%CI: 1.03-1.78). Subjects with a Charlson comorbidity score ≥3 had significantly higher rates of readmission regardless of surgical approach (Open RN - OR: 1.85; 95%CI: 1.33-2.56; Lap RN - OR: 1.99; 95%CI 1.10-3.59; Robotic RN - OR: 2.18; 95%CI: 1.23-3.86). Common reasons for readmission were gastrointestinal, cardiovascular, urinary tract infections, and wound complications across all surgical approaches. The mean cost per readmission was as high as 126% ($20,357) of the mean index admission cost. CONCLUSION One in 13 adults undergoing radical nephrectomy is readmitted within 30 days of discharge. Associated readmission cost is up to 1.26 times the cost of index admission. Our findings may inform efforts aiming to reduce hospital readmissions and curtail healthcare costs.
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Affiliation(s)
- Joaquin Michel
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dhaval Jivanji
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Alexander N Goel
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick M Lec
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew T Lenis
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Fielding School of Public Health, Los Angeles, CA, USA.,UCLA School of Nursing, Los Angeles, CA, USA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Bülow C, Clausen SS, Lundh A, Christensen M. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2023; 1:CD008986. [PMID: 36688482 PMCID: PMC9869657 DOI: 10.1002/14651858.cd008986.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients. OBJECTIVES We examined the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all-cause mortality, hospital readmissions, emergency department contacts and health-related quality of life. SEARCH METHODS In this Cochrane Review update, we searched for new published and unpublished trials using the following electronic databases from 1 January 2014 to 17 January 2022 without language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). To identify additional trials, we searched the reference lists of included trials and other publications by lead trial authors, and contacted experts. SELECTION CRITERIA We included randomised trials of medication reviews delivered by healthcare professionals for hospitalised adult patients. We excluded trials including outpatients and paediatric patients. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed risk of bias. We contacted trial authors for data clarification and relevant unpublished data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) or standardised mean differences (SMDs) for continuous data (with 95% confidence intervals (CIs)). We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the overall certainty of the evidence. MAIN RESULTS In this updated review, we included a total of 25 trials (15,076 participants), of which 15 were new trials (11,501 participants). Follow-up ranged from 1 to 20 months. We found that medication reviews in hospitalised adults may have little to no effect on mortality (RR 0.96, 95% CI 0.87 to 1.05; 18 trials, 10,108 participants; low-certainty evidence); likely reduce hospital readmissions (RR 0.93, 95% CI 0.89 to 0.98; 17 trials, 9561 participants; moderate-certainty evidence); may reduce emergency department contacts (RR 0.84, 95% CI 0.68 to 1.03; 8 trials, 3527 participants; low-certainty evidence) and have very uncertain effects on health-related quality of life (SMD 0.10, 95% CI -0.10 to 0.30; 4 trials, 392 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Medication reviews in hospitalised adult patients likely reduce hospital readmissions and may reduce emergency department contacts. The evidence suggests that mediation reviews may have little to no effect on mortality, while the effect on health-related quality of life is very uncertain. Almost all trials included elderly polypharmacy patients, which limits the generalisability of the results beyond this population.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stine Søndersted Clausen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research (CCTR), Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Cilla F, Sabione I, D’Amelio P. Risk Factors for Early Hospital Readmission in Geriatric Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1674. [PMID: 36767038 PMCID: PMC9914102 DOI: 10.3390/ijerph20031674] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The number of older patients is constantly growing, and early hospital readmissions in this population represent a major problem from a health, social and economic point of view. Furthermore, the early readmission rate is often used as an indicator of the quality of care. We performed a systematic review of the literature to better understand the risk factors of early readmission (30 and 90 days) in the geriatric population and to update the existing evidence on this subject. The search was carried out on the MEDLINE, EMBASE and PsycINFO databases. Three independent reviewers assessed the potential inclusion of the studies, and then each study was independently assessed by two reviewers using Joanna Briggs Institute critical appraisal tools; any discrepancies were resolved by the third reviewer. Studies that included inpatients in surgical wards were excluded. Twenty-nine studies were included in the review. Risk factors of early readmission can be classified into socio-economic factors, factors relating to the patient's health characteristics, factors related to the use of the healthcare system and clinical factors. Among these risk factors, those linked to patient frailty play an important role, in particular malnutrition, reduced mobility, risk of falls, fatigue and functional dependence. The early identification of patients at higher risk of early readmission may allow for targeted interventions in view of discharge.
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Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Småbrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res 2022; 22:1290. [PMID: 36289541 PMCID: PMC9597977 DOI: 10.1186/s12913-022-08648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08648-1.
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Affiliation(s)
- Jeanette Schultz Johansen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjell H. Halvorsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Surgery, Cancer and Women’s Health Clinic, The University Hospital of North Norway, Tromsø, Norway
| | | | - Hilde Ljones Wetting
- grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| | | | - Lars Småbrekke
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Nøste Private Healthcare Centre, Lier, Norway ,grid.412244.50000 0004 4689 5540Department of Geriatric Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
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Bhandari S, Dawson AZ, Kobylarz Z, Walker RJ, Egede LE. Interventions to Reduce Hospital Readmissions in Older African Americans: A Systematic Review of Studies Including African American Patients. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01378-4. [PMID: 35913544 PMCID: PMC9889568 DOI: 10.1007/s40615-022-01378-4] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This systematic review aims to summarize interventions that effectively reduced hospital readmission rates for African Americans (AAs) aged 65 and older. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were identified by searching PubMed for clinical trials on reducing hospital readmission among older patients published between 1 January 1990 and 31 January 2020. Eligibility criteria for the included studies were mean or median age ≥ 65 years, AAs included in the study, randomized clinical trial or quasi-experimental design, presence of an intervention, and hospital readmission as an outcome. RESULTS There were 5270 articles identified and 11 were included in the final review based on eligibility criteria. The majority of studies were conducted in academic centers, were multi-center trials, and included over 200 patients, and 6-90% of participants were older AAs. The length of intervention ranged from 1 week to over a year, with readmission assessed between 30 days and 1 year. Four studies which reported interventions that significantly reduced readmissions included both inpatient (e.g., discharge planning prior to discharge) and outpatient care components (e.g., follow-ups after discharge), and the majority used a multifaceted approach. CONCLUSION Findings from the review suggest successful interventions to reduce readmissions among AAs aged 65 and older should include inpatient and outpatient care components at a minimum. This systematic review showed limited evidence of interventions successfully decreasing readmission in older AAs, suggesting a need for research in the area to reduce readmission disparities and improve overall health.
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Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Aprill Z. Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Zacory Kobylarz
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
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Information exchange among providers and patient-centeredness in transitional care: A five-year retrospective analysis. Healthcare (Basel) 2022; 10:100626. [DOI: 10.1016/j.hjdsi.2022.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/18/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
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Doshmangir L, Khabiri R, Jabbari H, Arab-Zozani M, Kakemam E, Gordeev VS. Strategies for utilisation management of hospital services: a systematic review of interventions. Global Health 2022; 18:53. [PMID: 35606776 PMCID: PMC9125833 DOI: 10.1186/s12992-022-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background To achieve efficiency and high quality in health systems, the appropriate use of hospital services is essential. We identified the initiatives intended to manage adult hospital services and reduce unnecessary hospital use among the general adult population. Methods We systematically reviewed studies published in English using five databases (PubMed, ProQuest, Scopus, Web of Science, and MEDLINE via Ovid). We only included studies that evaluated interventions aiming to reduce the use of hospital services or emergency department, frequency of hospital admissions, length of hospital stay, or the use of diagnostic tests in a general adult population. Studies reporting no relevant outcomes or focusing on a specific patient population or children were excluded. Results In total, 64 articles were included in the systematic review. Nine utilisation management methods were identified: care plan, case management, care coordination, utilisation review, clinical information system, physician profiling, consultation, education, and discharge planning. Primary case management was shown to effectively reduce emergency department use. Care coordination reduced 30-day post-discharge hospital readmission or emergency department visit rates. The pre-admission review program decreased elective admissions. The physician profiling, concurrent review, and discharge planning effectively reduced the length of hospital stay. Twenty three studies that evaluated costs, reported cost savings in the hospitals. Conclusions Utilisation management interventions can decrease hospital use by improving the use of community-based health services and improving the quality of care by providing appropriate care at the right time and at the right level of care.
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Affiliation(s)
- Leila Doshmangir
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Roghayeh Khabiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Jabbari
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Edris Kakemam
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Dhillon NK, Kolus RC, Patel KA, Conde G, Perez J, Holtz H, Ley EJ. A designated trauma social worker improves coordination of patient care by coordinating ancillary consults. SOCIAL WORK IN HEALTH CARE 2022; 61:158-168. [PMID: 35579262 DOI: 10.1080/00981389.2022.2076763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/04/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Trauma patients face unique challenges that require coordination by social workers knowledgeable in the intricacies of trauma patient psychosocial support which is often achieved by obtaining ancillary consultations. The impact of employing a designated trauma social worker (DTSW) in the utilization of these consults has not been described. A retrospective review was conducted of trauma patients admitted to an academic, urban Level 1 trauma center. The pre-intervention cohort (n = 272) corresponded to patients admitted before the presence of a DTSW (01/2013 to 06/2013), while the post-intervention cohort (n = 282) corresponded to patients admitted afterward (09/2015 to 01/2016). Data collection included demographics, injury profile, and types of interdisciplinary or therapy consultations. Post-intervention patients were found to be older and admitted with more injuries. Supportive care, physical therapy and occupational therapy consultations were more likely to be obtained in the post-intervention cohort. Hospital length of stay remained unchanged. This study suggests that the implementation of a DTSW significantly facilitates the utilization of interdisciplinary consultations. Length of stay remains unchanged, suggesting that a DTSW helps to coordinate care in a timely manner without increasing the hospital stay. DTSW implementation may be considered in trauma centers where one does not currently exist.
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Affiliation(s)
- Navpreet K Dhillon
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Riley C Kolus
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kavita A Patel
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Geena Conde
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jazmin Perez
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heidi Holtz
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eric J Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Abstract
PURPOSE OF REVIEW The past decade has brought increased efforts to better understand causes for ACS readmissions and strategies to minimize them. This review seeks to provide a critical appraisal of this rapidly growing body of literature. RECENT FINDINGS Prior to 2010, readmission rates for patients suffering from ACS remained relatively constant. More recently, several strategies have been implemented to mitigate this including improved risk assessment models, transition care bundles, and development of targeted programs by federal organizations and professional societies. These strategies have been associated with a significant reduction in ACS readmission rates in more recent years. With this, improvements in 30-day post-discharge mortality rates are also being appreciated. As we continue to expand our knowledge on independent risk factors for ACS readmissions, further strategies targeting at-risk populations may further decrease the rate of readmissions. Efforts to understand and reduce 30-day ACS readmission rates have resulted in overall improved quality of care for patients.
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Zheng X, Xiao L, Li Y, Qiu F, Huang W, Li X. Improving safety and efficacy with pharmacist medication reconciliation in orthopedic joint surgery within an enhanced recovery after surgery program. BMC Health Serv Res 2022; 22:448. [PMID: 35387676 PMCID: PMC8985260 DOI: 10.1186/s12913-022-07884-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the impact of medication reconciliation (MR), through avoidance of unintentional medication discrepancies, on enhanced recovery after surgery programs designed for older patients undergoing orthopedic joint surgery. METHOD: Our study was divided into two phases. In the first phase, MR was performed for elderly patients undergoing orthopedic joint surgery. Types of medication discrepancies and their potential risks were analyzed. In the second phase, a controlled study was conducted in a subgroup of patients diagnosed with periprosthetic joint infection (PJI) and who were scheduled for two-stage revision. The primary goal was to investigate the impact of MR on length of stay for the first stage. The secondary goal was to investigate the time between the first admission and the reimplantation of a new prosthesis, the number of readmissions within 30 days, hospitalization cost. RESULTS A total of 506 medication discrepancies were identified in the included 260 patients. Intolerance had the highest incidence (n = 131, 25.7%). The Bayliff tool showed that 71.9% were assessed as level 2 risk, and 10.3% had a life-threatening risk. For patients with PJI, MR reduced the average length of stay in the first stage (16.3 days vs. 20.7 days, P = 0.03) and shortened the time (57.3 days vs. 70.5 days, P = 0.002) between the first admission and the reimplantation of a new prosthesis. The average cost of hospital stay ($8589.6 vs. $10,422.6, P = 0.021), antibiotics ($1052.2 vs. $1484.7, P = 0.032) and other medications ($691.5 vs. $1237.6, P = 0.014) per patient at our hospital were significantly decreased. Notably, significant improvements in patient satisfaction were seen in participants in the MR group. CONCLUSION Through MR by clinical pharmacists, medication discrepancies within the orthopedic ERAS program could be identified. For patients with periprosthetic joint infection, better patient satisfaction and clinical and economical outcomes can be achieved with this method.
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Affiliation(s)
- Xiaoying Zheng
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, 1 Youyi Rd, Chongqing, China
| | - Lei Xiao
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ying Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Qiu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, 1 Youyi Rd, Chongqing, China
| | - Wei Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Li
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, 1 Youyi Rd, Chongqing, China.
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Bhandari N, Epane J, Reeves J, Cochran C, Shen J. Post-Discharge Transitional Care Program and Patient Compliance With Follow-Up Activities. J Patient Exp 2022; 9:23743735221086756. [PMID: 35647268 PMCID: PMC9133863 DOI: 10.1177/23743735221086756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We explore whether the frequency of post-hospital discharge transitional care calls affects patients’ adherence to their discharge plans. We reviewed 1,000 call records of a post-discharge transitional care program run by a large U.S. tertiary care hospital in 2018–2019 and generated binary outcomes capturing patient self-reports of (1) scheduling or completing follow-up appointments, procedures, or prescription fills, (2) missing a scheduled event, and (3) reporting a new adverse clinical event. Our predictor variables captured callers’ success in completing the first and each subsequent call with discharged patients. We ran linear probability models (LPM) for each binary outcome after controlling for sociodemographic and clinical characteristics. Results indicate successful completion of the first two calls was associated with the increased probability of scheduling or completing follow-up appointment (15.5% points, p < 0.01) and follow-up procedure (13.5% points, p < 0.01), and reporting new adverse event (5.9% points, p < 0.05). Our findings suggest that making the first phone call to patients, while crucial, may not be sufficient for effective care transition; making two to three phone calls seems to be more optimal, while further calls may have limited value.
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Affiliation(s)
- Neeraj Bhandari
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Josue Epane
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jerry Reeves
- Comagine Health and Health Innovations, Las Vegas, NV, USA
| | - Christopher Cochran
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jay Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
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The Impact of Payment Reforms on the Quality and Utilisation of Healthcare for Patients With Multimorbidity: A Systematic Review. Int J Integr Care 2022; 22:10. [PMID: 35221826 PMCID: PMC8833260 DOI: 10.5334/ijic.5937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
Inadequate treatment of multimorbidity is recognised as a major determinant of the effectiveness of healthcare and also of its inappropriate expenditures. However, current payment systems target, primarily, the treatment of single diseases, thus hindering integrated delivery of care for patients with multimorbidity (PwM). This review aims to assess the effects of targeted reforms of payment systems which could help attain a higher quality of care and reduce unnecessary healthcare utilisation. In June 2020, a search of Medline and EMBASE revealed 13 relevant articles. The most common payment models were the use of bundled payments (n = 4) and diagnosis-related group payments (n = 4). Except for an increase in hospital admissions (n = 3), no outcome showed unambiguous significant effects across more than one study. The two studies which focused explicitly on PwM showed a significant decrease in 30-day hospital readmissions. This, however, was not maintained after 60 days in one study. No general conclusion could be drawn on the effects of targeted payment reforms for PwM. Our findings suggest that reforms should be combined with more multifaceted healthcare delivery to address the complex patterns of healthcare use effectively. Thorough evaluations of targeted payment reforms are needed urgently to contribute to the body of evidence required.
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Predicting Hospital Readmission for Campylobacteriosis from Electronic Health Records: A Machine Learning and Text Mining Perspective. J Pers Med 2022; 12:jpm12010086. [PMID: 35055401 PMCID: PMC8779953 DOI: 10.3390/jpm12010086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
(1) Background: This study investigates influential risk factors for predicting 30-day readmission to hospital for Campylobacter infections (CI). (2) Methods: We linked general practitioner and hospital admission records of 13,006 patients with CI in Wales (1990–2015). An approach called TF-zR (term frequency-zRelevance) technique was presented to evaluates how relevant a clinical term is to a patient in a cohort characterized by coded health records. The zR is a supervised term-weighting metric to assign weight to a term based on relative frequencies of the term across different classes. Cost-sensitive classifier with swarm optimization and weighted subset learning was integrated to identify influential clinical signals as predictors and optimal model for readmission prediction. (3) Results: From a pool of up to 17,506 variables, 33 most predictive factors were identified, including age, gender, Townsend deprivation quintiles, comorbidities, medications, and procedures. The predictive model predicted readmission with 73% sensitivity and 54% specificity. Variables associated with readmission included male gender, recurrent tonsillitis, non-healing open wounds, operation for in-gown toenails. Cystitis, paracetamol/codeine use, age (21–25), and heliclear triple pack use, were associated with a lower risk of readmission. (4) Conclusions: This study gives a profile of clustered variables that are predictive of readmission associated with campylobacteriosis.
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Davis D, Rogers M, Baker J, Tillery EE. Impact of Pharmacist Counseling at Discharge for Older People. Sr Care Pharm 2021; 36:652-673. [PMID: 34861906 DOI: 10.4140/tcp.n.2021.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To examine the evidence surrounding how the implementation of pharmacist discharge counseling affects the number of readmissions. Data Sources A search was conducted using EBSCOhost and the National Library of Medicine databases for articles published through December 2020 with the keywords "discharge counseling," "discharge teaching," "discharge education," "patient education," "patient teaching," "medication reconciliation," "pharmacist," and "readmission rates." The authors independently screened citations and applied inclusion and exclusion criteria. Study Selection A total of 32 articles were reviewed and analyzed. Inclusion criteria included articles published in the English language with human subjects, and adults (18 years of age and older) involving pharmacist-led discharge counseling and assessment of readmission rates were included. Data Extraction Study characteristics, intervention type, and outcomes with statistical significance where reported were included in the literature analysis. Data Synthesis Studies examined reported varying health care improvements postdischarge with the implementation of pharmacist services in the discharge process. Not all results were significant for reduction in readmission rates, but a downward trend was observed. Conclusion Implementation of pharmacist discharge counseling may decrease the number of hospital readmissions, particularly in older people.
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Affiliation(s)
- Daijah Davis
- 1Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Melissa Rogers
- 1Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Joni Baker
- 2G. Werber Bryan Psychiatric Hospital, Columbia, South Carolina
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Implementation of a multi-interventional approach to improve medication safety in older hospitalized patients: feasibility and impact on 30-day rehospitalization rate. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:543-553. [PMID: 34742917 DOI: 10.1016/j.pharma.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022]
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Kim H, Han SJ, Lee JH, Lim J, Moon SD, Moon H, Lee SY, Yoon SW, Jung HW. A Descriptive Study of Emergency Department Visits Within 30 Days of Discharge. Ann Geriatr Med Res 2021; 25:245-251. [PMID: 34689542 PMCID: PMC8749036 DOI: 10.4235/agmr.21.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/19/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Unnecessary emergency department (ED) visits are a crucial consideration in discharge planning for acutely admitted patients. This study aimed to identify the reasons for unnecessary visits to the ED within 30 days of discharge from a medical hospitalist unit. METHODS We performed a retrospective review of patients discharged in 2018 from a medical unit of tertiary teaching hospital in Korea. The authors discussed in-depth and determined whether or not an ED visit was unnecessary, and further classified the causes of unnecessary visits into three categories. RESULTS The mean age of the patients was 62.9 years (range, 15-99 years), and among the 1,343 patients discharged from the unit, 720 (53.6%) were men. Overall, 215 patients (16.0%) visited the ED within 30 days after discharge; among them, 16.3% were readmitted. Of the 215 cases of ED visits within 30 days after discharge, 57 (26.5%) were considered unnecessary. Of these, 30 (52.6%) were categorized as having failed care transition, 15 (26.3%) had unestablished care plans for predictable issues, and 12 (21.1%) had insufficient patient education. CONCLUSION A substantial number of short-term ED visits by discharged multimorbid or older medical patients were considered unnecessary. Discharging patients with a thorough discharge plan is essential to avoid unnecessary ED visits.
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Affiliation(s)
- Hyeanji Kim
- Regional Emergency Medical Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Jun Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Jae Hyun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Jin Lim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Sung do Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Hongran Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Seo-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Sock-Won Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Mays G, Li J, Clouser JM, Du G, Stromberg A, Jack B, Nguyen HQ, Williams MV. Understanding the groups of care transition strategies used by U.S. hospitals: an application of factor analytic and latent class methods. BMC Med Res Methodol 2021; 21:228. [PMID: 34696736 PMCID: PMC8543851 DOI: 10.1186/s12874-021-01422-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background After activation of the Hospital Readmission Reduction Program (HRRP) in 2012, hospitals nationwide experimented broadly with the implementation of Transitional Care (TC) strategies to reduce hospital readmissions. Although numerous evidence-based TC models exist, they are often adapted to local contexts, rendering large-scale evaluation difficult. Little systematic evidence exists about prevailing implementation patterns of TC strategies among hospitals, nor which strategies in which combinations are most effective at improving patient outcomes. We aimed to identify and define combinations of TC strategies, or groups of transitional care activities, implemented among a large and diverse cohort of U.S. hospitals, with the ultimate goal of evaluating their comparative effectiveness. Methods We collected implementation data for 13 TC strategies through a nationwide, web-based survey of representatives from short-term acute-care and critical access hospitals (N = 370) and obtained Medicare claims data for patients discharged from participating hospitals. TC strategies were grouped separately through factor analysis and latent class analysis. Results We observed 348 variations in how hospitals implemented 13 TC strategies, highlighting the diversity of hospitals’ TC strategy implementation. Factor analysis resulted in five overlapping groups of TC strategies, including those characterized by 1) medication reconciliation, 2) shared decision making, 3) identifying high risk patients, 4) care plan, and 5) cross-setting information exchange. We determined that the groups suggested by factor analysis results provided a more logical grouping. Further, groups of TC strategies based on factor analysis performed better than the ones based on latent class analysis in detecting differences in 30-day readmission trends. Conclusions U.S. hospitals uniquely combine TC strategies in ways that require further evaluation. Factor analysis provides a logical method for grouping such strategies for comparative effectiveness analysis when the groups are dependent. Our findings provide hospitals and health systems 1) information about what groups of TC strategies are commonly being implemented by hospitals, 2) strengths associated with the factor analysis approach for classifying these groups, and ultimately, 3) information upon which comparative effectiveness trials can be designed. Our results further reveal promising targets for comparative effectiveness analyses, including groups incorporating cross-setting information exchange. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01422-7.
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Affiliation(s)
- Glen Mays
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Colorado University, Anschutz, USA
| | - Jing Li
- Department of Medicine, Washington University School of Medicine, St. Louis, USA
| | - Jessica Miller Clouser
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, USA
| | - Gaixin Du
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, USA
| | - Arnold Stromberg
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, USA
| | - Brian Jack
- Department of Family Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, USA
| | - Huong Q Nguyen
- Division of Health Services Research and Implementation Science, Kaiser Permanente, Southern California, Pasadena, USA
| | - Mark V Williams
- Division of Hospital Medicine, Washington University School of Medicine, 660 S Euclid Ave; CB 8058, St. Louis, MO, 63110, USA.
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Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
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Pang RK, Weller CD, Srikanth V, Shannon B, Andrew NE. Community care navigation intervention for people who are at-risk of unplanned hospital presentations. Hippokratia 2021. [DOI: 10.1002/14651858.cd014713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rebecca K Pang
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
- Community Care (Hospital Admission Risk Program), Community Health; Peninsula Health; Frankston Australia
| | - Carolina D Weller
- School of Nursing and Midwifery; Monash University; Melbourne Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
| | - Brendan Shannon
- Department of Paramedicine; Monash University; Frankston Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
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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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Tomlinson J, Marques I, Silcock J, Fylan B, Dyson J. Supporting medicines management for older people at care transitions - a theory-based analysis of a systematic review of 24 interventions. BMC Health Serv Res 2021; 21:890. [PMID: 34461892 PMCID: PMC8404335 DOI: 10.1186/s12913-021-06890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. METHOD This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. RESULTS Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. CONCLUSION This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.
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Affiliation(s)
- Justine Tomlinson
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Iuri Marques
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Jonathan Silcock
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Beth Fylan
- Medicines Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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Munir H, Morais JA, Goldfarb M. Health-Related Quality of Life in Older Adults With Acute Cardiovascular Disease Undergoing Early Mobilization. CJC Open 2021; 3:888-895. [PMID: 34401695 PMCID: PMC8347843 DOI: 10.1016/j.cjco.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 10/25/2022] Open
Abstract
Background Early mobilization (EM) is safe and feasible in older adults with acute cardiovascular disease (CVD) and may improve posthospitalization patient-centred outcomes. Our objective was to assess posthospitalization health-related quality of life (HRQOL) in older adults with acute CVD undergoing EM. Methods Patients aged ≥ 60 years with acute CVD undergoing EM at an academic tertiary centre in Montreal, Quebec were prospectively enrolled from January 2018 to January 2020. Functional status was measured using the validated Level of Function Mobility Scale. HRQOL was measured using the Short-Form 36 questionnaire at 1 and 12 months posthospitalization. The primary outcome was the questionnaire's physical component summary (PCS) score at 1 month posthospitalization. Results There were 147 patients included in the analysis (aged 75.0 ± 8.7 years; 44.6% female; 48.6% with ischemic heart disease). The mean 1-month PCS score was 34.7 ± 9.7, which was 11.5 points and 8.4 points lower compared to age-matched Canadian normative data for people ages 65-74 years and ≥ 75 years, respectively. The mean PCS score at 12 months (36.5 ± 9.2) and the mean mental component summary scores at 1 and 12 months (36.9 ± 11.1; 40.5 ± 11.5) were lower than those of the age-matched population (all P < 0.0001). In the multivariable analysis, increased age and worse prehospitalization function were associated with lower PCS score at 1 month. Conclusions Older adults with acute CVD had lower HRQOL at 1 and 12 months posthospitalization than age-matched Canadian norms. Prehospitalization functional status was predictive of poor posthospitalization HRQOL. The EM program was safe and feasible in this patient population. Further studies are needed to determine whether EM can improve posthospitalization patient-centred outcomes in older adults, particularly those with poor prehospitalization functional status.
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Affiliation(s)
- Haroon Munir
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - José A Morais
- Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Abstract
BACKGROUND Approximately 5.7 million people in the United States are diagnosed and living with heart failure (HF), with projected prevalence rates to increase 46% by 2030. Heart failure leads hospital admissions in the United States for individuals 65 years or older, with many acute exacerbation admissions resulting from a lack of medication management, poor patient treatment plan adherence, and lack of appropriate follow-up within the health care system. In 2017, the 30-day HF readmission rate at the facility of implementation was 27%, 3% higher than the national average and, more specifically, 18.5% for the cardiac care unit (CCU). OBJECTIVE The aim of this study was to develop an HF disease management program to reduce 30-day readmission rates for HF patients through the implementation of a structured program including self-care education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. PRIMARY PRACTICE SETTING The implementation of the disease management program took place at a major military treatment facility in the continental United States. The facility is a teaching facility housing a 272-bed multispecialty hospital and an ambulatory complex. The implementation took place on the CCU, the primary unit for cardiac admissions, with approximately 30 admissions a month for a primary diagnosis of HF. METHODOLOGY AND SAMPLE In August 2018, a multidisciplinary disease management program was implemented to include patient education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. Data were collected and analyzed for 90 days and compared with retrospective data from 2017. FINDINGS Participants in the disease management program had a statistically significant improvement (p < .001) in the hospital readmission rate. The overall 30-day readmission rate decreased from 27% to 10.2% during the implementation period, a decrease of 38%. Ninety-three percent of the patients completed the self-care education, and telephone follow-up was successfully achieved with 96% of these patients. Only 4 patients in the HF disease management program experienced readmission within 30 days. Patients and caregivers reported increased satisfaction with their care due to the disease management program and increased follow-up with care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The findings of this innovation suggest that a multidisciplinary disease management program can reduce avoidable 30-day readmissions. The program improved patient follow-up and decreased follow-up appointment no-shows. Multiple participants expressed increased patient satisfaction. The program supports the need for coordinated, interdisciplinary disease management to improve the quality of life of those affected by HF and improve the use of resources to reduce the overall health care burden. Case management is critical to the organized care of HF patients due to the complex, individualized care to achieve optimum patient outcomes.
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Hansen MA, Hasbun R. US Hospitalizations and 60-Day Readmission Rates Associated with Herpes simplex virus Encephalitis: Analysis of All Cause Readmissions and Encephalopathy Associated Readmissions. Clin Infect Dis 2021; 74:1174-1182. [PMID: 34240104 DOI: 10.1093/cid/ciab613] [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: 05/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is the most common cause of encephalitis hospitalizations. We sought to describe and analyze features associated with all cause readmissions and encephalopathy associated readmissions amongst HSE cases. METHODS HSE hospitalizations and 60-day rehospitalizations were assessed in a retrospective cohort using linked hospitalizations from the Healthcare Utilization Project (HCUP) National Readmission Database (NRD) from 2010 through 2017. Risk factors for all-cause readmissions and encephalopathy associated readmissions were assessed with a weighted logistic regression model. RESULTS There were 10,272 HSE cases in the US between 2010 and 2017, resulting in a national rate of 4.95 per 100,000 hospitalizations. A total of 23.7% were readmitted at least once within 60-days. Patients that were readmitted were older (mean age 62.4 vs. 57.9, p<0.001), had a greater number of procedures at the index hospitalization (aOR 1.03, p<0.001) and have a higher Charlson comorbidity score (aOR 1.11, p<0.001). Amongst those readmitted, 465 (16.5%) had an encephalopathy related diagnosis. Over eight years, the rate of encephalopathy associated readmissions increased from 0.12 to 0.20. Encephalopathy specific readmissions were found to be associated with greater age (mean age 65.9 vs. 61.7, p = 0.004) and findings of cerebral edema at index hospitalization (aOR 2.16, p <0.001). CONCLUSIONS HSE readmissions are relatively common, particularly among older and sicker individuals. However, early signs and symptoms of neurological disease at index were correlated with encephalopathic specific readmissions.
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Affiliation(s)
- Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Rodrigo Hasbun
- Division of Infectious Disease, Department of Internal Medicine, UT Health McGovern Medical School, Houston, TX
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Zhu W, DeLonay A, Smith M, Carayon P, Li J. Reducing Fall-Related Revisits for Elderly Diabetes Patients in Emergency Departments: A Transition Flow Model. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3082115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fry CH, Fluck D, Han TS. Frequent identical admission-readmission episodes are associated with increased mortality. Clin Med (Lond) 2021; 21:e351-e356. [PMID: 35192477 PMCID: PMC8313203 DOI: 10.7861/clinmed.2020-0930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Frequent emergency readmissions may associate with health consequences. We examined the association between readmissions within 28 days of hospital discharge and mortality in 32,270 alive-discharge episodes (18-107 years). Data collected between 1 April 2017 and 31 March 2019 are presented as age- and sex-adjusted hazard ratios (HR) with 95% confidence interval (CI).Compared with no readmission, mortality risk over a 2-year period was increased with one non-identical admission-readmission (AR) episode: HR = 2.4 (2.2-2.7), two or more non-identical AR episodes: HR = 3.0 (2.7-3.4), one identical AR episode: HR = 4.7 (3.6-6.1) and two or more identical AR episodes: HR = 5.0 (3.8-6.7). Eight conditions associated with AR episodes had increased risk of mortality including congestive heart failure: HR = 2.7 (2.2-3.2), chronic pulmonary obstructive disease: HR = 3.0 (2.5-3.6), pneumonia: HR = 2.0 (1.8-2.3), sepsis: HR = 2.2 (1.9-2.5), endocrine disorders: HR = 1.9 (1.6-2.3), urinary tract infection: HR = 1.5 (1.3-1.7), psychiatric disorders: HR = 1.5 (1.1-2.1) and haematological disorders: HR = 1.5 (1.2-1.9). Frequent identical AR episodes, particularly from chronic and age-related conditions, are associated with increased mortality.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK, and senior lecturer, Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
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Delgado-Silveira E, Vélez-Díaz-Pallarés M, Muñoz-García M, Correa-Pérez A, Álvarez-Díaz AM, Cruz-Jentoft AJ. Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review. Eur Geriatr Med 2021; 12:509-544. [PMID: 33959912 DOI: 10.1007/s41999-021-00487-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/16/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. METHODS We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. RESULTS Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. CONCLUSION There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions.
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Affiliation(s)
- E Delgado-Silveira
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
| | | | - M Muñoz-García
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A Correa-Pérez
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - A M Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - A J Cruz-Jentoft
- Geriatric Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
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Kurteva S, Tamblyn R, Khosrow-Khavar F, Meguerditchian AN. Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery. J Surg Oncol 2021; 124:431-440. [PMID: 33893741 DOI: 10.1002/jso.26504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative pain control is an important cancer care component. However, opioid consumption has resulted in a surge of adverse events, with thoracic surgery patients having the highest rate of persistent use. The effect of opioid duration post-discharge and the risk of increased acute healthcare use in this population remains unclear. METHODS A prospective cohort of non-metastatic cancer patients was assembled from an academic health center in Montreal (Canada). Clinical data linked to administrative claims from the universal healthcare program was used to determine the association between time-varying opioid patterns and emergency department (ED) visits/re-admissions/death 3 months following thoracic surgery. RESULTS Of the 610 patients, 77% had at least one opioid dispensed post-discharge. Compared to non-opioid users, <15 days of use was associated with a 42% decreased risk of acute healthcare events, adjusted HR 0.58, 95% CI (0.40-0.85); longer durations were not associated with an increased risk. Compared to short-term use (<15 days), use of >30 days was associated with a 72% increased risk of the outcome, aHR: 1.72, 95% CI (1.01-2.93). CONCLUSION There was a variation in the risk of acute healthcare use associated with postsurgical opioid use. Findings from this study may be used to inform postoperative prescribing practices.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.,St. Mary's Research Institute, Montreal, Quebec, Canada
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Pouget AM, Civade E, Cestac P, Rouzaud-Laborde C. From hospitalisation to primary care: integrative model of clinical pharmacy with patients implanted with a PICC line-research protocol for a prospective before-after study. BMJ Open 2021; 11:e039490. [PMID: 33827827 PMCID: PMC8031034 DOI: 10.1136/bmjopen-2020-039490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical pharmacy improves patient safety and secures drug management using information, education and good clinical practices. However, medical device management is still unexplored, and proof of effectiveness is needed. A PICC line (peripherally inserted central catheter) is a medical device for infusion. It accesses the central venous system after being implanted in a peripheral vein. However, complications after implantation often interfere with smooth execution of the treatment. We hypothesise that clinical pharmacy for medical devices could be as effective as clinical pharmacy for medications. The main objective is to assess the effectiveness of clinical pharmacy activities on the complication rate after PICC line implantation. METHODS AND ANALYSIS This is a before-after prospective study. The study will begin with an observational period without clinical pharmacy activities, followed by an interventional period where pharmacists will intervene on drug and medical device management and provide personalised follow-up and advice. Sixty-nine adult patients will be recruited in each 6-month period from all traditional care units. The main inclusion criteria will be the implantation of a PICC line. The primary outcome is the decrease in the number of complications per patient and per month. Secondary outcomes are the consultation and hospital readmission rates, the acceptance rate of pharmaceutical interventions, the patients' quality of life, the direct hospital induced or avoided costs and the participants' satisfaction. Data will be collected using case report forms during hospitalisation and telephone follow-up after discharge. The analysis will compare these criteria during the two periods. ETHICS AND DISSEMINATION The study has received the approval of our Ethics Committee (Clermont-Ferrand Southeast VI, France, number AU1586). Results will be made available to the patients or their caregivers, the sponsor and other researchers when asked, as described in the consent form. TRIAL REGISTRATION NUMBER NCT04359056.
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Affiliation(s)
- Alix Marie Pouget
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
| | - Elodie Civade
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Philippe Cestac
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Charlotte Rouzaud-Laborde
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
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Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients. Ann Vasc Surg 2021; 75:461-470. [PMID: 33831518 DOI: 10.1016/j.avsg.2021.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality. METHODS We performed a retrospective cohort study including adult non-cardiac vascular surgery patients (open, endovascular and venous procedures) surviving hospitalization in Boston, Massachusetts, USA. The exposure of interest was functional status determined by a licensed physical therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90-day mortality after hospital discharge. The secondary outcome was readmission within 30days. Adjusted odds ratios were estimated by multivariable logistic regression models. RESULTS This cohort included 2318 patients (male 51%; mean age 61 ± 17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 moderately high and 581 scored the highest functional status. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70-6.84) compared to patients with the highest functional status. When excluding venous intervention patients, the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04-2.20). CONCLUSIONS In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting.
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Babich T, Eliakim-Raz N, Turjeman A, Pujol M, Carratalà J, Shaw E, Gomila Grange A, Vuong C, Addy I, Wiegand I, Grier S, MacGowan A, Vank C, van den Heuvel L, Leibovici L. Risk factors for hospital readmission following complicated urinary tract infection. Sci Rep 2021; 11:6926. [PMID: 33767321 PMCID: PMC7994309 DOI: 10.1038/s41598-021-86246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022] Open
Abstract
Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013-2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55-80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005-1.03), diabetes mellitus (OR 1.63, 95% CI 1.04-2.55), cancer (OR 1.7, 95% CI 1.05-2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14-2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07-2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67-8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.
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Affiliation(s)
- Tanya Babich
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Noa Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Turjeman
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Aina Gomila Grange
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Barcelona, Spain
| | - Cuong Vuong
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Ibironke Addy
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Irith Wiegand
- AiCuris Anti-Infective Cures GmbH, Wuppertal, Germany
| | - Sally Grier
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Leo van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Zhao P, Yoo I, Naqvi SH. Early Prediction of Unplanned 30-Day Hospital Readmission: Model Development and Retrospective Data Analysis. JMIR Med Inform 2021; 9:e16306. [PMID: 33755027 PMCID: PMC8077543 DOI: 10.2196/16306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Existing readmission reduction solutions tend to focus on complementing inpatient care with enhanced care transition and postdischarge interventions. These solutions are initiated near or after discharge, when clinicians’ impact on inpatient care is ending. Preventive intervention during hospitalization is an underexplored area that holds potential for reducing readmission risk. However, it is challenging to predict readmission risk at the early stage of hospitalization because few data are available. Objective The objective of this study was to build an early prediction model of unplanned 30-day hospital readmission using a large and diverse sample. We were also interested in identifying novel readmission risk factors and protective factors. Methods We extracted the medical records of 96,550 patients in 205 participating Cerner client hospitals across four US census regions in 2016 from the Health Facts database. The model was built with index admission data that can become available within 24 hours and data from previous encounters up to 1 year before the index admission. The candidate models were evaluated for performance, timeliness, and generalizability. Multivariate logistic regression analysis was used to identify readmission risk factors and protective factors. Results We developed six candidate readmission models with different machine learning algorithms. The best performing model of extreme gradient boosting (XGBoost) achieved an area under the receiver operating characteristic curve of 0.753 on the development data set and 0.742 on the validation data set. By multivariate logistic regression analysis, we identified 14 risk factors and 2 protective factors of readmission that have never been reported. Conclusions The performance of our model is better than that of the most widely used models in US health care settings. This model can help clinicians identify readmission risk at the early stage of hospitalization so that they can pay extra attention during the care process of high-risk patients. The 14 novel risk factors and 2 novel protective factors can aid understanding of the factors associated with readmission.
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Affiliation(s)
- Peng Zhao
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States
| | - Illhoi Yoo
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States.,Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Syed H Naqvi
- Division of Hospital Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, United States
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Abstract
OBJECTIVE. This article aimed to assess changing use of brain imaging tests among patients with Alzheimer disease and vascular dementia who visited U.S. emergency departments (EDs) between 2006 and 2014. MATERIALS AND METHODS. Using the largest publicly available all-payer ED database, the Nationwide Emergency Department Sample, we identified a weighted cohort of 427,705 individuals with Alzheimer disease and 33,743 individuals with vascular dementia who visited U.S. EDs between 2006 and 2014. Logistic regression analyses were performed to identify factors associated with use. RESULTS. Between 2006 and 2014, ED visits among patients with Alzheimer disease and vascular dementia declined by 24.7% and 20.3%, respectively. However, there was a significant increase in utilization rates of head CT (from 4.4% to 11.1% in patients with Alzheimer disease and from 1.5% to 2.9% in patients with vascular dementia) and brain MRI (from 0.04% to 0.5% in patients with Alzheimer disease and 0.0% to 0.1% in those with vascular dementia) in the same time period. Among patients with Alzheimer disease, age, median income in patient ZIP code, day of the week of the ED visit, hospital teaching status, and hospital geographic region were significant predictors of imaging use. Among patients with vascular dementia, insurance type and hospital classification (urban vs rural) were significant predictors of imaging use. CONCLUSION. Despite declining ED visits, ED brain imaging in patients with Alzheimer disease and vascular dementia has increased. Various patient-specific and hospital-specific factors contribute to differential utilization rates.
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Elysee G, Yu H, Herrin J, Horwitz LI. Association between 30-day readmission rates and health information technology capabilities in US hospitals. Medicine (Baltimore) 2021; 100:e24755. [PMID: 33663091 PMCID: PMC7909153 DOI: 10.1097/md.0000000000024755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.
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Affiliation(s)
- Gerald Elysee
- Health Information Technology Programs, Benjamin Franklin Institute of Technology, Boston, MA
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven
| | - Jeph Herrin
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, New Haven, CT
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, Center for Healthcare Innovation and Delivery Science, New York University Grossman School of Medicine, New York, NY
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Khan S, Kaltenmeier C, Hrebinko K, Nassour I, Hoehn RS, Medich DS, Zureikat A, Tohme S. Readmission After Surgical Resection for Colon and Rectal Cancers: A Retrospective Cohort Study. Am Surg 2021; 88:1118-1130. [PMID: 33517684 DOI: 10.1177/0003134820988810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Colorectal adenocarcinoma is a leading cause of cancer mortality worldwide, often requiring patients to undergo anatomy-altering surgical interventions leading to increased postoperative readmission. Hospital readmission rates have been correlated with increased mortality. Therefore, it is important to understand the association between 30-day readmission rates and mortality as well as the factors associated with increased readmission rates. STUDY DESIGN This is a retrospective review utilizing data from the National Cancer Database. Our primary outcomes of interest were 30- and 90-day mortality rates. Our primary independent variable of interest was 30-day readmission. RESULTS Between 2010 and 2016, 207 299 patients underwent surgery for rectal cancer and 754 895 for colon cancer. The readmission rates within 30 days of discharge were 5.4% and 5.5% for patients after surgery for rectal or colon cancer, respectively. 30-day readmission was not associated with 30-day mortality, but it was independently associated with increased 90-day mortality and inferior long-term survival for both cohorts (P = .001). Independent risk factors significantly associated with increased readmission included race, non-private insurance, and low income. CONCLUSION This study provides a large, up-to-date, and comprehensive analysis of readmission rates for colon and rectal cancers. We demonstrate that socioeconomic factors are associated with increased 30-day readmission. 30-day readmission is also independently associated with increased 90-day mortality as well as lower overall survival rates. Our study supports the need for implementation of programs that support patients of lower socioeconomic status undergoing surgery to further decrease readmission rates and mortality.
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Affiliation(s)
- Sidrah Khan
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katherine Hrebinko
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Nassour
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard S Hoehn
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - David S Medich
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Amer Zureikat
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Samer Tohme
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Montaleytang M, Correard F, Spiteri C, Boutier P, Gayet S, Honore S, Villani P, Daumas A. Medication reconciliation in the geriatric unit: impact on the maintenance of post-hospitalization prescriptions. Int J Clin Pharm 2021; 43:1183-1190. [PMID: 33464484 DOI: 10.1007/s11096-021-01229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
Background Medication reconciliation prevents medication errors at care transition points. This process improves communication with general practitioners regarding the reasons for therapeutic changes, allowing those changes to be maintained after hospital discharge. Objective To investigate the impact of medication reconciliation in geriatrics on the sustainability of therapeutic optimization after hospital discharge. Setting This study was conducted in a geriatric unit in a University Hospital Centre in France. Method This was a retrospective study. For 6 months, all patients over 65 years who underwent the process of medication reconciliation performed by a clinical hospital pharmacist and a physician at admission and discharge, were included. A comparison between drug prescriptions at hospital discharge and the first prescription made outside the hospital was made to identify any differences. Main outcome measure The main outcome measures were the provision of the results of the medication reconciliation performed in the hospital to the relevant general practitioner, the subsequent acceptance of that information, the type of medication discrepancies one month after discharge and the therapeutic classes affected by the modifications. Results Among the 112 patients, medication reconciliation allowed us to identify and correct 87 unintentional discrepancies at admission (88% corrected) and 54 at discharge (92% corrected). Patients were discharged to homes or nursing homes (61%), geriatric rehabilitation units (38%) or psychiatric clinics (1%). A general practitioner wrote the first prescription renewal a mean of 36 ± 23 days after discharge, having been made aware of the medication reconciliation in only 24% of the cases (received and taken into account). The impact was a decrease in the number of patients with at least one discrepancy. Twenty-five percent of general practitioners who were aware about the medication reconciliation process accepted all therapeutic changes, while only 7% of those who were not informed did so (p = 0.02). The number of medication discrepancies observed was correlated with the number of medications for which prescriptions were renewed (p < 0.01). Conclusion Medication reconciliation involving therapeutic optimization and the justification of changes is essential to ensure the safety of the prescriptions written for patients. However, its impact after discharge is hampered by the fact that the results are often not received or taken into account by general practitioners. Taking medication reconciliation into account was associated with a significant increase in prescriptions that maintained therapeutic changes made in the hospital, confirming the positive impact of communication between care providers on therapeutic optimization.
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Affiliation(s)
- Maeva Montaleytang
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Florian Correard
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Charlotte Spiteri
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Philippe Boutier
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Gayet
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Stéphane Honore
- Pôle Pharmacie, Unité D'Expertise Pharmaceutique Et Recherche Biomédicale, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Patrick Villani
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France
| | - Aurélie Daumas
- Service de Médecine Interne, Gériatrie Et Thérapeutique, Aix Marseille Univ, APHM, Hôpital de La Timone, Marseille, France.
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Fønss Rasmussen L, Grode LB, Lange J, Barat I, Gregersen M. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open 2021; 11:e040057. [PMID: 33419903 PMCID: PMC7799140 DOI: 10.1136/bmjopen-2020-040057] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients. DESIGN A systematic review. METHOD Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated. RESULT We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor. CONCLUSION Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions. PROSPERO REGISTRATION NUMBER CRD42019121795.
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Affiliation(s)
- Lisa Fønss Rasmussen
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Louise Bang Grode
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Jeppe Lange
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
| | - Ishay Barat
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Merete Gregersen
- Departments of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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Villeneuve Y, Courtemanche F, Firoozi F, Gilbert S, Desbiens MP, Desjardins A, Dinh C, LeBlanc VC, Attia A. Impact of pharmacist interventions during transition of care in older adults to reduce the use of healthcare services: A scoping review. Res Social Adm Pharm 2020; 17:1361-1372. [PMID: 33250364 DOI: 10.1016/j.sapharm.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current literature has shown increasing risk of error in transition of care between different healthcare settings, especially in the older population. Moreover, drug-related hospital readmission has been reported due to lack of appropriate communication. However, the literature is not clear about the impact of pharmacist interventions during transition of care of older adults on the reduction in use of healthcare services. OBJECTIVE The goal of the scoping review was to describe the impact of pharmacist interventions during transitions of care for older adults on the use of healthcare services. METHODS MEDLINE was searched for randomized controlled trials and controlled studies that analyzed pharmacist interventions during transition of care of older adults with regard to use of healthcare services. Four reviewers, grouped in pairs, independently screened all references published from 1990 to 2019 and extracted and analyzed the data. A pharmaceutical model of 8 pharmacist-led interventions was adapted from literature to compare the included studies. RESULTS There were 1527 publications screened, 17 of which met inclusion criteria. Pharmacist-led interventions decreased the use of healthcare services in 11 of these studies. The majority of studies were of very good or good quality based on Mixed Methods Appraisal Tool. Pharmacist were implicated at all times during the transition of care process (i.e. admission/during stay, discharge and post-discharge) in 4 of the effective studies, whereas none did in the not effective studies. More interventions were accomplished by pharmacists in studies with positive outcomes. CONCLUSION By diversifying their interventions at different moments throughout transition of care, pharmacists can reduce the use of healthcare services for older adults during transition of care. This scoping review also shows the need to better understand key components of post-discharge interventions and to have a dynamic pharmaceutical model accepted by the scientific community.
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Affiliation(s)
- Yannick Villeneuve
- Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W 1W5, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary Rd, Montreal, Quebec, H3W 1W6, Canada.
| | - Fanny Courtemanche
- Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W 1W5, Canada.
| | - Faranak Firoozi
- Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W 1W5, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary Rd, Montreal, Quebec, H3W 1W6, Canada.
| | - Suzanne Gilbert
- Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W 1W5, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary Rd, Montreal, Quebec, H3W 1W6, Canada.
| | - Marie-Pier Desbiens
- Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada; Department of Pharmacy, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec, Canada.
| | - Audrey Desjardins
- Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada; Department of Pharmacy, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec, Canada.
| | - Christine Dinh
- Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada; Department of Pharmacy, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec, Canada.
| | - Véronique C LeBlanc
- Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada; Department of Pharmacy, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec, Canada.
| | - Audrey Attia
- Geriatrics and Gerontology Library, Institut Universitaire de Gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W 1W5, Canada.
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49
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Capiau A, Foubert K, Van der Linden L, Walgraeve K, Hias J, Spinewine A, Sennesael AL, Petrovic M, Somers A. Medication Counselling in Older Patients Prior to Hospital Discharge: A Systematic Review. Drugs Aging 2020; 37:635-655. [PMID: 32643062 DOI: 10.1007/s40266-020-00780-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older patients are regularly exposed to multiple medication changes during a hospital stay and are more likely to experience problems understanding these changes. Medication counselling is often proposed as an important component of seamless care to ensure appropriate medication use after hospital discharge. OBJECTIVES The purpose of this systematic review was to describe the components of medication counselling in older patients (aged ≥ 65 years) prior to hospital discharge and to review the effectiveness of such counselling on reported clinical outcomes. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology (PROSPERO CRD42019116036), a systematic search of MEDLINE, EMBASE and CINAHL was conducted. The QualSyst Assessment Tool was used to assess bias. The impact of medication counselling on different outcomes was described and stratified by intervention content. RESULTS Twenty-nine studies were included. Fifteen different components of medication counselling were identified. Discussing the dose and dosage of patients' medications (19/29; 65.5%), providing a paper-based medication list (19/29; 65.5%) and explaining the indications of the prescribed medications (17/29; 58.6%) were the most frequently encountered components during the counselling session. Twelve different clinical outcomes were investigated in the 29 studies. A positive effect of medication counselling on medication adherence and medication knowledge was found more frequently, compared to its impact on hard outcomes such as hospital readmissions and mortality. Yet, evidence remains inconclusive regarding clinical benefit, owing to study design heterogeneity and different intervention components. Statistically significant results were more frequently observed when counselling was provided as part of a comprehensive intervention before discharge. CONCLUSIONS Substantial heterogeneity between the included studies was found for the components of medication counselling and the reported outcomes. Study findings suggest that medication counselling should be part of multifaceted interventions, but the evidence concerning clinical outcomes remains inconclusive.
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Affiliation(s)
- Andreas Capiau
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium. .,Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
| | - Katrien Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Lorenz Van der Linden
- Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Julie Hias
- Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Brussels, Belgium.,Department of Pharmacy, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Anne-Laure Sennesael
- Department of Pharmacy, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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50
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Guisado-Gil AB, Ramírez-Duque N, Barón-Franco B, Sánchez-Hidalgo M, De la Portilla F, Santos-Rubio MD. Impact of a multidisciplinary medication reconciliation program on clinical outcomes: A pre-post intervention study in surgical patients. Res Social Adm Pharm 2020; 17:1306-1312. [PMID: 33023830 DOI: 10.1016/j.sapharm.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have evaluated the effects of medication reconciliation (MR) and suggest that it is effective in decreasing medication discrepancies. Nevertheless, a recent overview of systematic reviews concluded that there is no clear evidence in favor of MR in patient-related outcomes and healthcare utilization, and further research about it is needed. OBJECTIVE To evaluate the impact of a multidisciplinary MR program on clinical outcomes in patients with colorectal cancer presenting other chronic diseases, undergoing elective colorectal surgery. METHODS We performed a pre-post study. Adult patients scheduled for elective colorectal cancer surgery were included if they presented at least one "high-risk" criteria. The MR program was developed by internists, pharmacists and surgeons, and ended with the obtention of the patient's pre-admission medication list and follow-up care until discharge. The primary outcome was the length of stay (LOS). Secondly, we evaluated mortality, preventable surgery cancellations and risk factors for complications. RESULTS Three hundred and eight patients were enrolled. Only one patient in the pre-intervention group suffered a preventable surgery cancellation (p = 0.317). The mean LOS was 13 ± 12 vs. 11 ± 5 days in the pre-intervention and the intervention cohort, respectively (p = 0.435). A difference in favor of the intervention group in patients with cardiovascular disease (p = 0.038) and those >75 years old (p = 0.043) was observed. No difference was detected in the mortality rate (p = 0.999) neither most of the indicators of risk factors for complications. However, the management of preoperative systolic blood pressure of hypertensive patients (p = 0.004) and insulin reconciliation in patients with treated diabetes (p = 0.003) were statistically better in the intervention group. CONCLUSIONS No statistically significant change was observed in the mean global LOS. A statistically significant positive effect on LOS was observed in vulnerable populations: patients >75 years old and those with cardiovascular disease, who presented a 5-day reduction in the mean LOS.
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Affiliation(s)
- A B Guisado-Gil
- Unidad de Gestión Clínica Farmacia. Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Farmacología. Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain.
| | - N Ramírez-Duque
- Unidad de Gestión Clínica Medicina Interna. Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - B Barón-Franco
- Unidad de Gestión Clínica Medicina Interna. Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Sánchez-Hidalgo
- Departamento de Farmacología. Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - F De la Portilla
- Unidad de Gestión Clínica Cirugía General y Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M D Santos-Rubio
- Unidad de Gestión Clínica Farmacia. Hospital Juan Ramón Jiménez, Huelva, Spain
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