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Sindet-Pedersen C, El-Chouli M, Nouhravesh N, Lamberts M, Christensen DM, Kümler T, Lock M, Grove EL, Holt A, Schou M, Gislason G, Butt JH, Strange JE. High risk of rehospitalization within 1 year following a pulmonary embolism-insights from the Danish nationwide registries from 2000-2020. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:256-264. [PMID: 37541959 DOI: 10.1093/ehjqcco/qcad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/06/2023]
Abstract
AIM To identify the absolute risk, causes, and factors associated with rehospitalization within 1 year of discharge with a pulmonary embolism (PE). METHODS AND RESULTS Using the Danish nationwide registries, all patients admitted with a first-time PE between 2000 and 2020 and discharged alive were included. Subsequent hospitalizations were categorized and crude cumulative incidences were used to estimate the absolute risk (AR) of any rehospitalization and specific causes of rehospitalizations. Risk factors for rehospitalization were investigated using cause specific Cox regression models.A total of 55 201 patients were identified. The median age of the study population was 70 years (inter quartile range: 59;79), and the most prevalent comorbidities were cancer (29.3%) and ischemic heart disease (12.7%). The 1-year AR of any rehospitalization after discharge with a PE was 48.6% (95% confidence interval (CI); 48.2%-48.8%). The most common cause for being rehospitalized was due to respiratory disease [1-year AR: 9.5% (95% CI: 9.3%-9.8%)], followed by cardiovascular disease [1-year AR: 6.3% (95% CI: 5.9%-6.5%)], cancer [1-year AR: 6.0% (95% CI: 5.8%-6.4%)], venous thromboembolism [1-year AR: 5.2% (95% CI: 5.0%-5.2%)], and symptom diagnoses [1-year AR: 5.2% (95% CI: 5.0%-5.4%)]. Factors that were associated with an increased risk of rehospitalization were cancer, liver disease, chronic obstructive pulmonary disease, chronic kidney disease, and immobilization. CONCLUSION Patients with PE have a high risk of rehospitalization, with almost half of patients being rehospitalized within 1 year. Identification of high-risk patients may help target interventions aiming at reducing the risk of rehospitalization.
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Affiliation(s)
- Caroline Sindet-Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Mohamad El-Chouli
- The Danish Heart Foundation, 1120 Copenhagen K, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Morten Lamberts
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | | | - Thomas Kümler
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Morten Lock
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark
| | - Anders Holt
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- The Danish Heart Foundation, 1120 Copenhagen K, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Jawad Haider Butt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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Lin E, Gandhi D, Volk M. Preventing Readmissions of Hepatic Encephalopathy: Strategies in the Acute Inpatient, Immediate Postdischarge, and Longitudinal Outpatient Setting. Clin Liver Dis 2024; 28:359-367. [PMID: 38548445 DOI: 10.1016/j.cld.2024.01.010] [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: 04/02/2024]
Abstract
Hepatic encephalopathy (HE) is a strong predictor of early hospital readmission in patients with cirrhosis. Early hospital readmission increases health care costs and is associated with worse survival. Herein we provide an overview of strategies to prevent hospital readmissions in patients with HE, divided into 3 contexts: (a) acute inpatient, (b) immediate postdischarge, and (c) longitudinal outpatient setting.
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Affiliation(s)
- Emily Lin
- Department of Gastroenterology, Loma Linda University, Loma Linda, CA, USA
| | - Devika Gandhi
- Department of Gastroenterology, Loma Linda University, Loma Linda, CA, USA.
| | - Michael Volk
- Department of Medicine, Baylor Scott and White, Central Texas Region, Temple, TX, USA
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Strumann C, Pfau L, Wahle L, Schreiber R, Steinhäuser J. Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach. J Med Internet Res 2024; 26:e47133. [PMID: 38530343 PMCID: PMC11005442 DOI: 10.2196/47133] [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: 03/09/2023] [Revised: 06/13/2023] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. OBJECTIVE This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. METHODS A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. RESULTS Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). CONCLUSIONS This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lisa Pfau
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Laila Wahle
- Lacanja GmbH Health Innovation Port, Hamburg, Germany
| | - Raphael Schreiber
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Kinard T, Brennan-Cook J, Johnson S, Long A, Yeatts J, Halpern D. Effective Care Transitions: Reducing Readmissions to Improve Patient Care and Outcomes. Prof Case Manag 2024; 29:54-62. [PMID: 38015801 DOI: 10.1097/ncm.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE/OBJECTIVES Care transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and payers recognize that care transition interventions are necessary to reduce unnecessary cost and utilization and improve patient outcomes following a hospitalization. Multiple care transition models exist, with varying degrees of intensity and success. This article describes a quality improvement project for a care transition model that incorporates key elements from the American Case Management Association's Transitions of Care Standards and the Transitional Care Management services as outlined by the Centers for Medicare & Medicaid Services. PRIMARY PRACTICE SETTING A collaboratively developed care transition model was implemented between a health system population health management office and a primary care organization. FINDINGS/CONCLUSIONS An effective care transitions model is stronger with collaboration among core members of a patient's care team, including a nurse care manager and a primary care provider. Ongoing quality improvement is necessary to gain efficiencies and effectiveness of such a model. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Care managers are integral in coordinating effective transitions. Care management practice includes transition of care standards that are associated with improved outcomes for patients at high risk for readmission. Interventions inclusive of medication reconciliation, identification and addressing of health-related social needs, review of discharge instructions, and coordinated follow-up are important factors that impact patient outcomes. Patients and their health system care teams benefit from the role of a care manager when there is a collaborative, coordinated, and timely approach to hospital follow-up.
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Affiliation(s)
- Tara Kinard
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
| | - Jill Brennan-Cook
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
| | - Sara Johnson
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
| | - Andrea Long
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
| | - John Yeatts
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
| | - David Halpern
- Tara Kinard, MSN, MBA, RN, ACM-RN, CCM, CENP, is Associate Chief Nursing Officer at Duke Health's Population Health Management Office. She is the DNP student noted during implementation of this quality improvement project, and her interests include improving health equity, patient outcomes, and care delivery for patients during care transitions
- Jill Brennan-Cook, DNP, RN, GERO-BC, is Associate Clinical Professor of Nursing at Duke University School of Nursing. Her current scholarship focuses on older adults, myeloproliferative neoplasm (MPN), and health inequities
- Sara Johnson, MBA, PMP, is the Associate Vice President, Population Health and Innovation at Duke Primary Care. In this role, Sara leads the strategic planning and project management of Duke Primary Care's Population Health programs and initiatives
- Andrea Long, PharmD, is a licensed Pharmacist and Information Technology Director, Population Health Analytics at Duke Health Technology Solutions and the Duke Population Health Management Office
- John Yeatts, MD, MPH, is a practicing internist and serves as Assistant Vice President and Chief Medical Officer of Population Health at Duke Health, as well as the Executive Director of the Population Health Management Office and Duke Connected Care, Duke's Accountable Care Organization
- David Halpern, MD, MPH, FACP, is a practicing internist and serves as the Senior Medical Director for Quality and Population Health at Duke Primary Care
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Hahn B, Ball T, Diab W, Choi C, Bleau H, Flynn A. Utilization of a multidisciplinary hospital-based approach to reduce readmission rates. SAGE Open Med 2024; 12:20503121241226591. [PMID: 38249952 PMCID: PMC10798118 DOI: 10.1177/20503121241226591] [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: 09/13/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Background Hospital readmissions remain a significant and pressing issue in our healthcare system. In 2010, the Affordable Care Act helped establish the Hospital Readmissions Reduction Program, which incentivized reducing readmission rates by instituting penalties. Hospital readmission, specifically unplanned, refers to a patient returning to the hospital shortly after discharge due to the same or a related medical condition, signaling potential issues in initial care, discharge processes, or post-hospitalization management. For this study, we defined readmission as a return to the hospital within 30 days. In 2018, Staten Island University Hospital started a multidisciplinary and coordinated initiative to reduce patient readmissions. The approach involved the departments of emergency medicine, medicine, cardiology, case management, nursing, pharmacy, and transitional care management. This study aimed to determine if this approach reduced 30-day readmissions. Methods This case-control retrospective study reviewed electronic health records between January 2018 and November 2019. Readmission rates within 30 days of index discharge were compared between patients who received transitional care management before and after establishing a multidisciplinary communication of transitional care. Readmission rates were unadjusted and adjusted for patient demographics and predisposed risk for readmission and compared across demographics and select clinical characteristics. Results A total of 772 patients were included in the analyses; 323 were in the control group (41.8%), and 449 were in the intervention group (58.2%). After the hospital adopted the workflow for multidisciplinary communication of transitional care, there was 45.2% less adjusted incidence of readmission, or approximately seven fewer overall readmissions per 100 patients (16.4% readmission vs 9.0% readmission; incident rate ratio, 0.55; 95% CI: 0.34-0.88). Conclusions Multidisciplinary communication approaches led by emergency medicine can help reduce readmissions significantly. Adopting a structured communication workflow can enhance co-managing patients with a high risk of readmission between the emergency department and hospital medicine teams.
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Affiliation(s)
- Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Trever Ball
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Wassim Diab
- Northwell, Health Solutions Population Healthcare Management, Manhasset, NY, USA
| | - Chris Choi
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Hallie Bleau
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Anne Flynn
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
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Landi S, Panella MM, Leardini C. Disentangling organizational levers and economic benefits in transitional care programs: a systematic review and configurational analysis. BMC Health Serv Res 2024; 24:46. [PMID: 38195545 PMCID: PMC10777542 DOI: 10.1186/s12913-023-10461-3] [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: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Promoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs. METHODS Using a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs. RESULTS The more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions. CONCLUSIONS The results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.
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Affiliation(s)
- Stefano Landi
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy.
| | - Maria Martina Panella
- IRCCS- Azienda ospedaliera universitaria Bologna, Policlinico di S.Orsola-Malpighi, Via Pietro Albertoni, 15, Bologna, Italy
| | - Chiara Leardini
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy
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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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Shade K, Hidalgo P, Arteaga M, Rowland J, Huang W. Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project. Prof Case Manag 2023; 28:271-279. [PMID: 37787704 DOI: 10.1097/ncm.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE OF STUDY Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission. PRIMARY PRACTICE SETTING The setting was a vertically integrated health care system located in Northern California. METHODOLOGY AND SAMPLE This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic-clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre-/post-health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings. RESULTS Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).
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Affiliation(s)
- Kate Shade
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Paulina Hidalgo
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Manuel Arteaga
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Janet Rowland
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Winnie Huang
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
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Ahadzi D, Beasley M. A Case for Task-Shifting in the Management and Care of Patients With Heart Failure in Ghana: Experience From Yale University. J Card Fail 2023; 29:419-421. [PMID: 36634812 DOI: 10.1016/j.cardfail.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Dzifa Ahadzi
- Department of Medicine, Tamale Teaching Hospital, Tamale, Ghana.
| | - Michael Beasley
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Gemkow JW, Liss DT, Yang TY, Padilla R, King PL, Pereyra S, Cox-Batson S, Tenfelde S, Masinter L. Predicting Postpartum Transition to Primary Care in Community Health Centers. Am J Prev Med 2022; 63:689-699. [PMID: 35840450 DOI: 10.1016/j.amepre.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Although the transition to primary care after routine postpartum care has been recommended to mitigate adverse maternal outcomes, little is known about real-world transition patterns. The objective of this study was to describe the patterns and predictors of transition in a postpartum cohort receiving care at federally qualified health centers and a subcohort of clinically high-risk patients. METHODS Electronic health record data collected between 2017 and 2019 were analyzed in 2021 for unadjusted analyses and multivariable regression models for both the full and high-risk cohorts. The primary outcome was completion of a primary care visit within 6 months of delivery. Primary predictors in both cohorts were insurance loss, postpartum visit, first-trimester visit, and medical visit within the year prepregnancy; for the full cohort, high-risk status was also studied. RESULTS The full cohort (N=7,926) analysis showed that 17.3% completed a primary care visit. In unadjusted and adjusted analysis, all 5 predictors were significantly associated with primary care visit completion; 25.0% of high-risk patients completed a primary care visit, and patients who lost insurance had 66% lower odds of primary care visit completion (95% CI=0.24, 0.48). In unadjusted and adjusted analysis for the high-risk cohort (n=1,956, 24.7% of full cohort), all predictors except postpartum visit were significantly associated with primary care visit completion. CONCLUSIONS Postpartum patients at federally qualified health centers transitioned to primary care at low rates; insurance loss was one significant barrier to care. Strategies to increase continuity, including improving insurance access, should be studied. Future research is needed to study structural inequity, the impact of primary care on maternal outcomes, and patient experience.
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Affiliation(s)
| | - David T Liss
- Health Research and Education Team, AllianceChicago, Chicago, Illinois; Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ta-Yun Yang
- Health Research and Education Team, AllianceChicago, Chicago, Illinois
| | - Roxane Padilla
- Health Research and Education Team, AllianceChicago, Chicago, Illinois
| | | | | | | | - Sandi Tenfelde
- Near North Health Service Corporation, Chicago, Illinois; Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois
| | - Lisa Masinter
- Health Research and Education Team, AllianceChicago, Chicago, Illinois
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The Evolving Roles of Nurses Providing Care at Home: A Qualitative Case Study Research of a Transitional Care Team. Int J Integr Care 2022; 22:3. [PMID: 35087352 PMCID: PMC8782082 DOI: 10.5334/ijic.5838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 01/06/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose: To examine the roles of transitional care nurses in an integrated healthcare system and how the integrated healthcare system influences their evolving roles. Background: Transitional care teams have been introduced to enable the seamless transfer of patients from acute-care to the home settings. A qualitative case study of the transitional care team was conducted to understand the changing roles of these nurses in an integrated Regional Health System (RHS) in Singapore. Methods: A hospital transitional team of an integrated RHS was studied. Purposive sampling was used. Non-participant observations and follow-up interviews were conducted with four nurses. Data were triangulated with the interviews of two managers and three healthcare professionals, and the analysis of documents. Within-case thematic analysis was carried out. Results: Three themes were identified: ‘Coming together to meet the needs of all’; ‘Standing strong amidst the stormy waves’; and ‘Searching for the right formula in handling complexity’. These themes have explained on the atypical roles taken on by nurses in their attempts to close the gaps and meet the patients’ needs. Various factors influencing the evolving roles were revealed. Conclusion: The roles of nurses have ‘emerged differently’ from their traditional counterparts. Various nursing roles have been undertaken to facilitate care integration. The findings emphasised the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development.
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Hepatic Encephalopathy-Related Hospitalizations in Cirrhosis: Transition of Care and Closing the Revolving Door. Dig Dis Sci 2022; 67:1994-2004. [PMID: 34169435 PMCID: PMC9167177 DOI: 10.1007/s10620-021-07075-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/24/2021] [Indexed: 12/09/2022]
Abstract
Cirrhosis is associated with substantial morbidity and mortality. Development of complications of cirrhosis, including hepatic encephalopathy (HE), portends poorer outcomes. HE is associated with hospital readmission, impaired patient and caregiver quality of life, risk of falls, and mortality. Guidelines recommend lactulose as first-line therapy for HE and rifaximin in combination with lactulose for reducing the risk of HE recurrence. Improving post-discharge outcomes, including readmissions, is an important aspect in the management of patients with HE. Approaches focused on improving management and prevention of HE, including properly titrating lactulose dosing, overcoming medication-related nonadherence, and incorporating rifaximin as therapy to reduce the risk of recurrence, as well as incorporating supportive care initiatives, may ease the transition from hospital to home. Strategies to decrease readmission rates include using hospital navigators, who can offer patient/caregiver education, post-discharge planning, and medication review; and involving pharmacists in post-discharge planning. Similarly, telemedicine offers providers the opportunity to monitor patients with HE remotely and improves outcomes. Providers offering transitional care management may be reimbursed when establishing contact with patients within 2 days post-discharge and conducting an outpatient visit within 7 days or 14 days. Several approaches have been shown to improve outcomes broadly in patients post-discharge and may also be effective for improving outcomes specifically in patients hospitalized with cirrhosis and HE, thus closing the revolving door on rehospitalizations in this population.
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Assessing the impact of adding pharmacist management services to an existing discharge planning program on 30-day readmissions. J Am Pharm Assoc (2003) 2021; 62:734-739. [PMID: 34975006 DOI: 10.1016/j.japh.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although hospital readmission rates are declining nationally, avoidable readmissions remain a public health concern. Effective readmission interventions are multifaceted and include discharge planning and transition-of-care coordination. Clinical pharmacists are effective contributors to these processes, bringing expertise to discharge counseling, medication reconciliation, medication adherence, and postdischarge follow-up counseling. OBJECTIVE We evaluated the impact of adding health plan clinical pharmacy management services to an existing discharge program on all-cause readmissions and postdischarge primary physician visits. METHOD Pharmacy management services by health plan clinical pharmacists of a large regional integrated delivery system were added to an existing optimal discharge planning (ODP) program. Criteria for eligibility for these pharmacists' services included patients who prescribed a new maintenance medication after discharge, received a therapeutic substitution, had a previous discharge within 30 days, or were taking a high-risk medication. A retrospective, observational analysis of a subgroup of patients, who received the pharmacy management services as part of ODP, was performed using a difference-in-difference model, by comparing propensity-matched discharges from February 22, 2016, to January 31, 2017 (preprogram implementation) with discharges from February 22, 2017, to January 31, 2018 (implementation period), to estimate changes in 30-day readmission rates and postdischarge primary physician visits. RESULTS A total of 111 of the propensity matched received the pharmacy management services; of these, 73% (ODP) versus 64% (non-ODP) were ≥ 58 years, 60% were females, and 62% (ODP) versus 52% (non-ODP) were Medicare beneficiaries. There was a 16.7% (P = 0.022) statistically significant reduction in combined inpatient and observation 30-day readmissions and a 19.7% increase in 5-day postdischarge follow-up physician visits (P = 0.037) for the subgroup who also received the pharmacy management services. CONCLUSION Addition of pharmacist management services to an existing hospital discharge program for select at-risk patients was associated with reduced inpatient and observation 30-day readmissions.
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Yerasi C, Tripathi B, Wang Y, Forrestal BJ, Case BC, Khan JM, Torguson R, Ben-Dor I, Satler LF, Garcia-Garcia HM, Weintraub WS, Rogers T, Waksman R. National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016. Am Heart J 2021; 231:25-31. [PMID: 33091365 DOI: 10.1016/j.ahj.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/28/2020] [Indexed: 01/27/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved toward a minimalist approach, resulting in shorter hospital stays. Real-world trends of next-day discharge (NDD) TAVR are unknown. This study aimed to evaluate underlying trends and readmissions of NDD TAVR. METHODS This study was derived from the Nationwide Readmissions Database from 2012 to 2016. International Classification of Diseases, Ninth and Tenth Revisions, codes were used to identify patients. Any discharge within 1 day of admission was identified as NDD. NDD TAVR trends over the years were analyzed, and any admissions within 30 days were considered readmissions. A hierarchical logistic regression model was used to identify predictors of readmission. RESULTS Of 49,742 TAVR procedures, 3,104 were NDD. The percentage of NDD TAVR increased from 1.5% (46/3,051) in 2012 to 12.2% (2,393/19,613) in 2016. However, the 30-day readmission rate remained the same over the years (8.6%). The patients' mean age was 80.3 ± 8.4 years. Major readmission causes were heart-failure exacerbation (16%), infections (9%), and procedural complications (8%). In 2016, there were significantly higher late conduction disorder and gastrointestinal bleeding readmission rates than in 2012-2015. Significant predictors of readmission were anemia, baseline conduction disease, cardiac arrhythmias, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic disorders, and discharge to facility. CONCLUSIONS The percentage of NDD TAVR increased over the years; however, readmission rates remained the same, with a higher rate of conduction abnormality-related hospitalizations in 2016. Careful discharge planning that includes identification of baseline factors that predict readmission and knowledge of etiologies may further prevent 30-day readmissions.
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Schreiter NA, Fisher A, Barrett JR, Acher A, Sell L, Edwards D, Leverson G, Joachim A, Weber SM, Abbott DE. A telephone-based surgical transitional care program with improved patient satisfaction scores and fiscal neutrality. Surgery 2020; 169:347-355. [PMID: 33092810 PMCID: PMC10042266 DOI: 10.1016/j.surg.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited data exist regarding the downstream effects of surgical transitional care programs. We explored the impact of such programs on patient satisfaction and fiscal metrics. METHODS A telephone-based surgical transitional care program enrolled patients undergoing complex abdominal surgery between 2015 to 2017. A matched cohort undergoing similar procedures between 2010 to 2015 were used as controls. Press Ganey scores were used to reflect patient satisfaction. Hospital costs, reimbursements, and margins were analyzed for index hospitalizations and readmissions within 90 days of surgery. RESULTS There were 607 patients in the control group and 608 in the transitional care program; survey response rates were 37% and 35%, respectively. Transitional care patients rated their understanding of personal responsibilities in post-discharge care higher than controls (59% vs 69%, P = .02). Transitional care patients felt they received better educational materials about their condition or treatment (55% vs 68%, P < .01) and rated their global hospital experience higher (46% vs 57%, P = .02). The aggregate (index plus readmission) cost was greater for the transitional care ($22,814 vs $25,827, P < .01), but there was no difference in aggregate margin ($7,027 vs $4,698, P = .25). Multivariable adjustment yielded similar results for the aggregate cost (ref vs $2,232, P = .03) and margin (ref vs $1,299, P = .23). CONCLUSION The use of this dedicated abdominal surgery transitional care program is associated with improved Press Ganey patient education and global rating scores. The cost to support this program did not adversely affect the hospital margin when considering all factors. These data support broader investment in patient centered initiatives that may significantly enhance patient experience.
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Affiliation(s)
- Nicholas A Schreiter
- School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Alexander Fisher
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - James R Barrett
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Alexandra Acher
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Laura Sell
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Dani Edwards
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Glen Leverson
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Alyssa Joachim
- School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Sharon M Weber
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI.
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Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30): A Pragmatic Randomized Controlled Real-world Effectiveness Trial. Med Care 2020; 58:785-792. [PMID: 32732787 DOI: 10.1097/mlr.0000000000001353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RESEARCH DESIGN Pragmatic randomized controlled real-world effectiveness trial. SUBJECTS We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation. MEASURES Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings. RESULTS All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups. CONCLUSIONS We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.
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Bonaccorsi G, Romiti A, Ierardi F, Innocenti M, Del Riccio M, Frandi S, Bachini L, Zanobini P, Gemmi F, Lorini C. Health-Literate Healthcare Organizations and Quality of Care in Hospitals: A Cross-Sectional Study Conducted in Tuscany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2508. [PMID: 32268620 PMCID: PMC7178271 DOI: 10.3390/ijerph17072508] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/22/2022]
Abstract
The concept of Health-Literate Healthcare Organization (HLHO) concerns the strategies by which healthcare organizations make it easier for people to navigate, understand, and use information and services to take care of their health. The aims of this study were to validate the HLHO-10 questionnaire in the Italian language; to measure the degree of implementation of the 10 attributes of HLHOs in a sample of hospitals placed in Tuscany; and to assess the association between the degree of implementation of the 10 attributes of HLHOs and the perceived quality of care. This was a cross-sectional study where data were collected using a self-administered questionnaire including three sections: a descriptive section, a section focused on the perceived quality, and the Italian version of the HLHO-10 questionnaire. A total amount of 405 healthcare managers answered the questionnaire (54.9%). The analysis shows that the HLHO score is significantly associated with the type of hospitals: accredited private hospitals have higher HLHO scores. Moreover, the perceived quality increases with the increasing of the HLHO score, with the highest coefficient for local public hospitals. In conclusion, Organizational Health Literacy culture should be an integral element for the management to improve the quality of care.
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Affiliation(s)
- Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
| | - Anna Romiti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Francesca Ierardi
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy; (F.I.); (L.B.); (F.G.)
| | - Maddalena Innocenti
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
| | - Marco Del Riccio
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
| | - Silvia Frandi
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
| | - Letizia Bachini
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy; (F.I.); (L.B.); (F.G.)
| | - Patrizio Zanobini
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
| | - Fabrizio Gemmi
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy; (F.I.); (L.B.); (F.G.)
| | - Chiara Lorini
- Department of Health Science, University of Florence, 50134 Florence, Italy; (G.B.); (M.I.) (S.F.); (P.Z.); (C.L.)
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Zanobini P, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031036. [PMID: 32041282 PMCID: PMC7037285 DOI: 10.3390/ijerph17031036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.
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Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
- Correspondence: ; Tel.: +39-3663435179
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Central Tuscany LHU, Via di San Salvi, 12, 50135 Florence, Italy;
| | - Claudia Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Florence, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
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