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Abreu P, Correia M, Azevedo E, Sousa-Pinto B, Magalhães R. Rapid systematic review of readmissions costs after stroke. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:22. [PMID: 38475856 DOI: 10.1186/s12962-024-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed. OBJECTIVES To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke. METHODS A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study's currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1-23.4%, of direct costs and 3.3-21% of total costs. Among the included studies, only one identified predictors of readmission costs. CONCLUSION Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.
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Affiliation(s)
- Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Correia
- Department of Neurology, Hospital Santo António- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Leth SV, Graversen SB, Lisby M, StØvring H, SandbÆk A. Patients with repeated acute admissions to somatic departments: sociodemographic characteristics, disease burden, and contact with primary healthcare sector - a retrospective register-based case-control study. Scand J Public Health 2024:14034948241230142. [PMID: 38385163 DOI: 10.1177/14034948241230142] [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: 02/23/2024]
Abstract
BACKGROUND Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking. OBJECTIVE To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector. METHODS This matched register-based case-control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression. RESULTS Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions. CONCLUSIONS This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention.
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Affiliation(s)
- Sara V Leth
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | | | - Marianne Lisby
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Henrik StØvring
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Annelli SandbÆk
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- Department of Public Health, Aarhus University, Denmark
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Fethney J, Kim B, Boustany C, McKenzie H, Hayes L, Cox K, Simpson JM, Horvath LG, Vardy JL, McLeod J, Willcock S, Cook N, Acret L, White K. Evaluating a shared care pathway intervention for people receiving chemotherapy to reduce post-treatment unplanned hospital presentations: a randomised controlled trial. Support Care Cancer 2024; 32:77. [PMID: 38170289 PMCID: PMC10764538 DOI: 10.1007/s00520-023-08261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care. METHODS The number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group adult patients with solid tumours starting outpatient chemotherapy. Poisson regression was used to compare the number of presentations between the intervention and control groups. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Linear regression techniques were used to compare quality of life outcomes. RESULTS The reduction in unplanned presentations in the intervention group relative to the control group was 12% (95% CI, - 25%, 37%; P = 0.48). At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95% CI, - 0.28, 1.22; P = 0.22)), depression (difference = 0.57 (95% CI, - 0.18, 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95% CI, - 2.67, 3.00; P = 0.91)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95% CI, 0.7, 7.9; P = 0.02)). CONCLUSION This RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention. TRIAL REGISTRATION Registered at Australian and New Zealand Clinical Trials Registry: ACTRN12614001113640, registered 21/10/2014.
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Affiliation(s)
- Judith Fethney
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.
| | - Bora Kim
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chantale Boustany
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Lillian Hayes
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Keith Cox
- Chris O'Brien Lifehouse, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
| | - Jodi McLeod
- Sydney District Nursing, Sydney Local Health District, Sydney, Australia
| | - Simon Willcock
- MQ Health, Macquarie University Hospital, Primary Care, Sydney, Australia
| | | | - Louise Acret
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Elkjaer M, Gram B, Mogensen CB, Brabrand M, Primdahl J. Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study. Scand J Caring Sci 2023; 37:740-751. [PMID: 36880291 DOI: 10.1111/scs.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/31/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Older adults receiving homecare have an increased risk of readmission. The transition from hospital to home can be experienced as unsafe, and older adults describe themselves as vulnerable during the post-discharge period. Thus, the objective was to explore the experiences of unplanned readmissions among older adults who receive homecare. METHODS We conducted qualitative individual semi-structured interviews with older adults, 65 years or above, receiving homecare and being readmitted to an emergency department (ED) between August and October 2020. Data were analysed by systematic text condensation as described by Malterud. FINDINGS We included 12 adults aged 67-95 years, seven were male, and eight lived alone. The analysis derived three themes: (1) Responsibility and security at home, (2) the role of family, friends and homecare and (3) the importance of trust. The older adults felt that the hospital strived for too-early discharge, as they still did not feel well. They worried about how to manage their daily life. Active involvement of their family increased their sense of security, but those living alone described feeling anxious being at home by themselves after discharge. Although older adults did not wish to go to the hospital, inadequate treatment at home and the feeling of responsibility for their illness made them feel insecure. They expressed that earlier negative experiences affected their trust in the system and their inclination to ask for help. CONCLUSIONS The older adults were discharged from the hospital despite feeling ill. They described inadequate competencies from healthcare professionals in the home as a contributing factor to their readmission. The readmission increased a sense of security. Support from the family in the process was essential and provided a sense of security, whereas older adults living alone experienced feelings of insecurity in the home environment.
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Affiliation(s)
- Mette Elkjaer
- Department of Emergency Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bibi Gram
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Research Unit of Health Sciences, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Brabrand
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, Hospital Sønderjylland, University Hospital of Southern Denmark, Sønderborg, Denmark
- Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
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Glans M, Kempen TGH, Jakobsson U, Kragh Ekstam A, Bondesson Å, Midlöv P. Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool. BMJ Open 2023; 13:e070559. [PMID: 37536970 PMCID: PMC10401249 DOI: 10.1136/bmjopen-2022-070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge. DESIGN Retrospective cohort study. SETTING The risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden. PARTICIPANTS The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017-2018. MEASURES The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden's index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation. RESULTS The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort. CONCLUSION The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.
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Affiliation(s)
- Maria Glans
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Kristianstad-Hässleholm Hospitals, Department of Medications, Region Skåne, Kristianstad, Sweden
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annika Kragh Ekstam
- Kristianstad-Hässleholm Hospitals, Department of Orthopaedics, Region Skåne, Kristianstad, Sweden
| | - Åsa Bondesson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Medicines Management and Informatics, Region Skåne, Kristianstad, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Tran NQ, Goel G, Pudota N, Suesserman M, Helms J, Lasaga D, Olson D, Bowen E, Bhattacharya S. Leveraging deep survival models to predict quality of care risk in diverse hospital readmissions. Sci Rep 2023; 13:10479. [PMID: 37380704 DOI: 10.1038/s41598-023-37477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
Hospital readmissions rate is reportedly high and has caused huge financial burden on health care systems in many countries. It is viewed as an important indicator of health care providers' quality of care. We examine the use of machine learning-based survival analysis to assess quality of care risk in hospital readmissions. This study applies various survival models to explore the risk of hospital readmissions given patient demographics and their respective hospital discharges extracted from a health care claims dataset. We explore advanced feature representation techniques such as BioBERT and Node2Vec to encode high-dimensional diagnosis code features. To our knowledge, this study is the first to apply deep-learning based survival-analysis models for predicting hospital readmission risk agnostic of specific medical conditions and a fixed window for readmission. We found that modeling the time from discharge date to readmission date as a Weibull distribution as in the SparseDeepWeiSurv model yields the best discriminative power and calibration. In addition, embedding representations of the diagnosis codes do not contribute to improvement in model performance. We find dependency of each model's performance on the time point at which it is evaluated. This time dependency of the models' performance on the health care claims data may necessitate a different choice of model in quality of care issue detection at different points in time. We show the effectiveness of deep-learning based survival-analysis models in estimating the quality of care risk in hospital readmissions.
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Affiliation(s)
- Nhat Quang Tran
- AI Center of Excellence, Deloitte & Touche LLP, New York, USA
| | - Gautam Goel
- AI Center of Excellence, Deloitte & Touche LLP, New York, USA
| | - Nirmala Pudota
- AI Center of Excellence, Deloitte & Touche Assurance & Enterprise Risk Services India Private Limited, Hyderabad, India
| | | | - John Helms
- AI Center of Excellence, Deloitte & Touche LLP, New York, USA
| | - Daniel Lasaga
- Program Integrity, Deloitte & Touche LLP, New York, USA
| | - Dan Olson
- Program Integrity, Deloitte & Touche LLP, New York, USA
| | - Edward Bowen
- AI Center of Excellence, Deloitte & Touche LLP, New York, USA
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Abaatyo J, Kaggwa MM, Favina A, Olagunju AT. Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda. BMC Psychiatry 2023; 23:474. [PMID: 37380963 DOI: 10.1186/s12888-023-04960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Bipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient's overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD. METHOD This study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD. RESULTS A total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels. CONCLUSION The incidence of readmission among individuals living with BAD is high, and readmission was associated with patients' symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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James J, Tan S, Stretton B, Kovoor JG, Gupta AK, Gluck S, Gilbert T, Sharma Y, Bacchi S. Why do we evaluate 30-day readmissions in general medicine? A historical perspective and contemporary data. Intern Med J 2023; 53:1070-1075. [PMID: 37278138 DOI: 10.1111/imj.16115] [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: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
Reducing preventable readmissions is important to help manage current strains on healthcare systems. The metric of 30-day readmissions is commonly cited in discussions regarding this topic. While such thresholds have contemporary funding implications, the rationale for individual cut-off points is partially historical in nature. Through the examination of the basis for the analysis of 30-day readmissions, greater insight into the possible benefits and limitations of such a metric may be obtained.
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Affiliation(s)
- Jonathan James
- Flinders University, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Toby Gilbert
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Yogesh Sharma
- Flinders University, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Fournaise A, Andersen-Ranberg K, Lauridsen JT, Espersen K, Gudex C, Bech M. Conceptual framework for acute community health care services - Illustrated by assessing the development of services in Denmark. Soc Sci Med 2023; 324:115857. [PMID: 37001279 DOI: 10.1016/j.socscimed.2023.115857] [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: 08/02/2022] [Revised: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
Acute community health care services can support continuity of care by acting as a bridge between the primary and secondary health care sectors in the early detection of acute disease and provision of treatment and care. Although acute community health care services are a political priority in many countries, the literature on their organization and effect is limited. We present a conceptual framework for describing acute community health care services that can be used to support the policies and guidelines for such services. For illustrative purposes, we apply the framework to the Danish acute community health care services using implementation data from 2020 and identify gaps and opportunities for learning. The framework identifies two key pairs of dimensions: (1) capacity & capability, and (2) coordination & collaboration. These dimensions, together with the governance structure and quality assurance initiatives, are of key importance to the effect of acute community health care services. While all Danish municipalities have implemented acute community health care services, application of the framework indicates considerable variation in their approaches. The conceptual framework provides a systematic approach supporting the development, implementation, evaluation, and monitoring of acute community health care services and can assist policymakers at both national and local levels in this work.
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Affiliation(s)
- Anders Fournaise
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark; Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | - Karen Andersen-Ranberg
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark; Danish Aging Research Center, University of Southern Denmark, J. B. Winsløws Vej 9b, 5000, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark.
| | - Jørgen T Lauridsen
- Department of Economics, University of Southern Denmark, Campusvej 55, 5000, Odense, Denmark.
| | - Kurt Espersen
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark.
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark; Open Patient data Explorative Network (OPEN), Region of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Mickael Bech
- Department of Political Science and Public Management, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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Effectiveness of Transition Care Intervention Targeted to High-Risk Patients to Reduce Readmissions: Study Protocol for the TARGET-READ Multicenter Randomized-Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11060886. [PMID: 36981543 PMCID: PMC10048511 DOI: 10.3390/healthcare11060886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Hospital readmissions within 30 days represent a burden for the patients and the entire health care system. Improving the care around hospital discharge period could decrease the risk of avoidable readmissions. We describe the methods of a trial that aims to evaluate the effect of a structured multimodal transitional care intervention targeted to higher-risk medical patients on 30-day unplanned readmissions and death. The TARGET-READ study is an investigator-initiated, pragmatic single-blinded randomized multicenter controlled trial with two parallel groups. We include all adult patients at risk of hospital readmission based on a simplified HOSPITAL score of ≥4 who are discharged home or nursing home after a hospital stay of one day or more in the department of medicine of the four participating hospitals. The patients randomized to the intervention group will receive a pre-discharge intervention by a study nurse with patient education, medication reconciliation, and follow-up appointment with their referring physician. They will receive short follow-up phone calls at 3 and 14 days after discharge to ensure medication adherence and follow-up by the ambulatory care physician. A blind study nurse will collect outcomes at 1 month by phone call interview. The control group will receive usual care. The TARGET-READ study aims to increase the knowledge about the efficacy of a bundled intervention aimed at reducing 30-day hospital readmission or death in higher-risk medical patients.
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Puetzler J, Schulze M, Gosheger G, Schwarze J, Moellenbeck B, Theil C. Is long time to reimplantation a risk factor for reinfection in two-stage revision for periprosthetic infection? A systematic review of the literature. Front Surg 2023; 10:1113006. [PMID: 36874470 PMCID: PMC9981955 DOI: 10.3389/fsurg.2023.1113006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
The two-stage revision arthroplasty is a common treatment option for chronic periprosthetic infection (PJI). The time to reimplantation (TTR) reported in the literature varies substantially from a few days to several hundred days. It is hypothesized that longer TTR could be associated with worse infection control after second stage. A systematic literature search was performed according to Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in Pubmed, Cochrane Library and Web of Science Core Collection in clinical studies published until January 2023. Eleven studies investigating TTR as a potential risk factor for reinfection met the inclusion criteria (ten retrospective and one prospective study, published 2012-2022). Study design and outcome measures differed notably. The cutoff points above which TTR was regarded as "long" ranged from 4 to 18 weeks. No study observed a benefit for long TTR. In all studies, similar or even better infection control was observed for short TTR. The optimal TTR, however, is not yet defined. Larger clinical studies with homogeneous patient populations and adjustment for confounding factors are needed.
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Affiliation(s)
- Jan Puetzler
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Martin Schulze
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Jan Schwarze
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
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Accuracy of the Simplified HOSPITAL Score to Predict Nonelective Readmission in a Brazilian Tertiary Care Public Teaching Hospital. Qual Manag Health Care 2023; 32:30-34. [PMID: 35383714 DOI: 10.1097/qmh.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Predictive models to identify patients at high risk of readmission have gained the attention of health care teams, which have focused the strategies to reduce unnecessary readmissions on the "at-risk" patients. The HOSPITAL score includes 7 predictor variables with a C-statistic of 0.70 or more when applied to international datasets. Its simplified version retains a C-statistic at around the same level, but only incipient external validation has been attempted to date. The primary objective of this study was to evaluate the prognostic accuracy of the simplified HOSPITAL score to predict nonelective hospital readmissions in a tertiary care public teaching hospital in Brazil. METHODS We used a retrospective cohort that included all patients discharged from the internal medicine service of a Brazilian tertiary care public teaching hospital in 2018. We excluded patients who died before index discharge, were transferred to another institution, left against medical advice, or were readmitted electively. We calculated the simplified HOSPITAL score for each admission, and admissions were divided into low (0-4 points) or high risk (≥ 5 points) of nonelective 30-day readmission. We estimated accuracy, area under the receiver operating characteristic curve (AUC), and observed/expected (O/E) readmission ratio; the latter using the mid-P exact test with Miettinen's modification at a 95% confidence interval (CI). A P value < .05 was considered significant. RESULTS A total of 4472 hospital discharges were analyzed during the study period after application of the exclusion criteria. The nonelective 30-day readmission rate was 14.0% (n = 625). Of all patients discharged, 3173 (71.0%) were considered to be at low risk and 1299 (29.0%) at high risk of readmission according to the simplified HOSPITAL score. The AUC was 0.68 (95% CI: 0.66-0.71; P < .001). The nonelective 30-day readmission rate was 9.2% in the low-risk group (expected: 9.2%; O/E: 1.0 [95% CI: 0.89-1.12]) and 25.7% in the high-risk group (expected: 27.2%; O/E: 0.95 [95% CI: 0.85-1.05]) ( P < .001). At a cut-off of 5 points, the score had a sensitivity of 53.4%, specificity of 74.9%, positive predictive value of 25.7%, and negative predictive value (NPV) of 90.8%. CONCLUSIONS The parameters of the score were almost identical to the original study, with better applicability to exclude low-risk patients given its high NPV. Additional adjustments are still needed for better applicability in daily clinical practice.
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Lin C, Pan LF, He ZQ, Hsu S. Early prediction of 30- and 14-day all-cause unplanned readmissions. Health Informatics J 2023; 29:14604582231164694. [PMID: 36913624 DOI: 10.1177/14604582231164694] [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: 03/15/2023]
Abstract
BACKGROUND An unplanned readmission is a dual metric for both the cost and quality of medical care. METHODS We employed the random forest (RF) method to build a prediction model using a large dataset from patients' electronic health records (EHRs) from a medical center in Taiwan. The discrimination abilities between the RF and regression-based models were compared using the areas under the ROC curves (AUROC). RESULTS When compared with standardized risk prediction tools, the RF constructed using data readily available at admission had a marginally yet significantly better ability to identify high-risk readmissions within 30 and 14 days without compromising sensitivity and specificity. The most important predictor for 30-day readmissions was directly related to the representing factors of index hospitalization, whereas for 14-day readmissions the most important predictor was associated with a higher chronic illness burden. CONCLUSIONS Identifying dominant risk factors based on index admission and different readmission time intervals is crucial for healthcare planning.
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Affiliation(s)
- Chaohsin Lin
- Department of Risk Management and Insurance, 517768National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Li-Fei Pan
- Department of General Affairs Administration, 38024Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Zuo-Quan He
- Department of Risk Management and Insurance, 517768National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Shuofen Hsu
- Department of Risk Management and Insurance, 517768National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
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Bogh SB, Fløjstrup M, Möller S, Bech M, Lassen AT, Brabrand M, Mogensen CB. Readmission trends before and after a national reconfiguration of emergency departments in Denmark. J Health Serv Res Policy 2023; 28:42-49. [PMID: 35968608 DOI: 10.1177/13558196221108894] [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: 02/01/2023]
Abstract
OBJECTIVE In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates. METHODS We included all unplanned hospital admissions (aged ≥18 years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes. RESULTS The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]). CONCLUSIONS Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.
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Affiliation(s)
- Søren Bie Bogh
- Odense Patient Exploratory Network (Open), 11286University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Marianne Fløjstrup
- Department of Emergency Medicine, 6174Hospital of South West Jutland, Esbjerg, Denmark
| | - Sören Möller
- Department of Clinical Research, 532010University of Southern Denmark, Odense, Denmark
| | | | - Annmarie T Lassen
- Department of Emergency Medicine, 306920Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, 306920Odense University Hospital, Odense, Denmark
| | - Christian B Mogensen
- Focused Research Unit in Emergency Medicine, 11286Hospital of Southern Denmark, Aabenraa, Denmark
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Frequency and patient attributes associated with emergency department visits after discharge: Retrospective cohort study. PLoS One 2022; 17:e0275215. [PMID: 36240133 PMCID: PMC9565411 DOI: 10.1371/journal.pone.0275215] [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: 01/22/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The utilization of emergency department (ED) during the post-discharge period may provide relevant insights to reduce fragmentation of care, particularly in a context of general intense use. We aimed to describe frequency and patient attributes associated with emergency department (ED) visits within 30 days of inpatient discharge in a Portuguese health region-Algarve. METHODS Secondary data on inpatient and emergency care, for adult patients discharged in 2016. To analyse the association between outcome-ED visit within 30 days of discharge-and selected variables (admission type and groups of or individual illnesses/conditions), we used age- and sex-adjusted odds ratios (aOR). We included all adult patients (aged ≥18 years) discharged during 2016 from the region's public hospital inpatient departments. The period for ED visits also included January 2017. RESULTS For 21,744 adults discharged in 2016 (mean age: 58 years; 60% female), 23 percent visited ED at least once within 30 days of discharge. Seventy-five percent of those visits were triaged with high clinical priority. Patients with more comorbidities or specific groups of illnesses/conditions had a significant increased risk of returning ED (aOR and 95% confidence intervals-endocrine: 1.566; 1.256-1.951; mental illness: 1.421; 1.180-1.713; respiratory: 1.308; 1.136-1.505). CONCLUSION Patients returned ED after inpatient discharge frequently and for severe reasons. Patients with more comorbidities or specific groups of illnesses/conditions (endocrine, mental illness or respiratory) had an increased risk of returning ED, so these groups may be prioritized in further research and health system initiatives to improve care before and after discharge.
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Haneuse S, Schrag D, Dominici F, Normand SL, Lee KH. MEASURING PERFORMANCE FOR END-OF-LIFE CARE. Ann Appl Stat 2022; 16:1586-1607. [PMID: 36483542 PMCID: PMC9728673 DOI: 10.1214/21-aoas1558] [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: 12/14/2022]
Abstract
Although not without controversy, readmission is entrenched as a hospital quality metric with statistical analyses generally based on fitting a logistic-Normal generalized linear mixed model. Such analyses, however, ignore death as a competing risk, although doing so for clinical conditions with high mortality can have profound effects; a hospital's seemingly good performance for readmission may be an artifact of it having poor performance for mortality. in this paper we propose novel multivariate hospital-level performance measures for readmission and mortality that derive from framing the analysis as one of cluster-correlated semi-competing risks data. We also consider a number of profiling-related goals, including the identification of extreme performers and a bivariate classification of whether the hospital has higher-/lower-than-expected readmission and mortality rates via a Bayesian decision-theoretic approach that characterizes hospitals on the basis of minimizing the posterior expected loss for an appropriate loss function. in some settings, particularly if the number of hospitals is large, the computational burden may be prohibitive. To resolve this, we propose a series of analysis strategies that will be useful in practice. Throughout, the methods are illustrated with data from CMS on N = 17,685 patients diagnosed with pancreatic cancer between 2000-2012 at one of J = 264 hospitals in California.
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Affiliation(s)
- Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health,
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute
| | | | | | - Kyu Ha Lee
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
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Huang J, Su Y, Mao X. Analysis of the Application Effect of Multidisciplinary Team Cooperation Model in Chronic Heart Failure under WeChat Platform. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4051955. [PMID: 36059410 PMCID: PMC9436525 DOI: 10.1155/2022/4051955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
Methods From April 2020 to May 2021, 56 patients with CHF who were discharged from the cardiology department of our hospital after treatment were randomly divided into two groups: experimental group (n = 28) and control group (n = 28). The control group was given conventional nursing measures and health education and discharge instructions, while the experimental group received collaborative multidisciplinary team nursing care based on the WeChat platform on the basis of the control group, all for 3 months. All enrolled patients underwent the Self-Care of Heart Failure Index Version 6.2 (SCHFI v6.2), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the 6-minute walking test (6MWT test). The SCHFI v6.2 and MLHFQ scores, 6 MWT test results, and readmission rates within 3 months were observed and compared between the two groups. Results There was no significant difference between the SCHFIv6.2 and MLHFQ scores of the two patients at admission and at discharge, and the scores of the experimental group were significantly higher than the scores of the control group at the end of 3 months after discharge. On the other hand, the SCHFIv6.2 and MLHFQ scores of the two groups were significantly higher at discharge compared to admission; the 6-minute walking distance of the experimental group was significantly higher than that of the control group at the end of 3 months. The readmission rate in the experimental group was significantly lower than that in the control group. Conclusion The multidisciplinary teamwork model based on the WeChat platform can significantly improve the self-care ability and quality of life of CHF patients and reduce the readmission rate.
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Affiliation(s)
- Jieyu Huang
- Department of Cardiovascular Medicine, Hezhou People's Hospital, Second Ward, Hezhou, China
| | - Yu Su
- Department of Nephrology, Hezhou People's Hospital, Hezhou, China
| | - Xiucai Mao
- Hezhou People's Hospital Nursing Department, Hezhou, China
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Jones AW, McKenzie JE, Osadnik CR, Stovold E, Cox NS, Burge AT, Lahham A, Lee JYT, Hoffman M, Holland AE. Non-pharmacological interventions for the prevention of hospitalisations in stable chronic obstructive pulmonary disease: component network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015153] [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)
- Arwel W Jones
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | | | - Elizabeth Stovold
- Population Health Research Institute; St George's, University of London; London UK
| | - Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanna YT Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Mariana Hoffman
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
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Rajaguru V, Kim TH, Han W, Shin J, Lee SG. LACE Index to Predict the High Risk of 30-Day Readmission in Patients With Acute Myocardial Infarction at a University Affiliated Hospital. Front Cardiovasc Med 2022; 9:925965. [PMID: 35898272 PMCID: PMC9309494 DOI: 10.3389/fcvm.2022.925965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background The LACE index (length of stay, acuity of admission, comorbidity index, and emergency room visit in the past 6 months) has been used to predict the risk of 30-day readmission after hospital discharge in both medical and surgical patients. This study aimed to utilize the LACE index to predict the risk of 30-day readmission in hospitalized patients with acute myocardial infraction (AMI). Methods This was a retrospective study. Data were extracted from the hospital's electronic medical records of patients admitted with AMI between 2015 and 2019. LACE index was built on admission patient demographic data, and clinical and laboratory findings during the index of admission. The multivariate logistic regression was performed to determine the association and the risk prediction ability of the LACE index, and 30-day readmission were analyzed by receiver operator characteristic curves with C-statistic. Results Of the 3,607 patients included in the study, 5.7% (205) were readmitted within 30 days of discharge from the hospital. The adjusted odds ratio based on logistic regression of all baseline variables showed a statistically significant association with the LACE score and revealed an increased risk of readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of emergency revisits within 30 days from the index discharge than those with low LACE scores. Despite this, analysis of the receiver operating characteristic curve indicated that the LACE index had favorable discrimination ability C-statistic 0.78 (95%CI; 0.75–0.81). The Hosmer–Lemeshow goodness- of-fit test P value was p = 0.920, indicating that the model was well-calibrated to predict risk of the 30-day readmission. Conclusion The LACE index demonstrated the good discrimination power to predict the risk of 30-day readmissions for hospitalized patients with AMI. These results can help clinicians to predict the risk of 30-day readmission at the early stage of hospitalization and pay attention during the care of high-risk patients. Future work is to be focused on additional factors to predict the risk of 30-day readmissions; they should be considered to improve the model performance of the LACE index with other acute conditions by using administrative data.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Whiejong Han
- Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea
- *Correspondence: Sang Gyu Lee
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Rajaguru V, Kim TH, Shin J, Lee SG, Han W. Ability of the LACE Index to Predict 30-Day Readmissions in Patients with Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12071085. [PMID: 35887582 PMCID: PMC9318277 DOI: 10.3390/jpm12071085] [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: 05/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: This study aimed to utilize the existing LACE index (length of stay, acuity of admission, comorbidity index and emergency room visit in the past six months) to predict the risk of 30-day readmission and to find the associated factors in patients with AMI. Methods: This was a retrospective study and LACE index scores were calculated for patients admitted with AMI between 2015 and 2019. Data were utilized from the hospital’s electronic medical record. Multivariate logistic regression was performed to find the association between covariates and 30-day readmission. The risk prediction ability of the LACE index for 30-day readmission was analyzed by receiver operating characteristic curves with the C statistic. Results: A total of 205 (5.7%) patients were readmitted within 30 days. The odds ratio of older age group (OR = 1.78, 95% CI: 1.54–2.05), admission via emergency ward (OR = 1.45; 95% CI: 1.42–1.54) and LACE score ≥10 (OR = 2.71; 95% CI: 1.03–4.37) were highly associated with 30-day readmissions and statistically significant. The receiver operating characteristic curve C statistic of the LACE index for AMI patients was 0.78 (95% CI: 0.75–0.80) and showed favorable discrimination in the prediction of 30-day readmission. Conclusion: The LACE index showed a good discrimination to predict the risk of 30-day readmission for hospitalized patients with AMI. Further study would be recommended to focus on additional factors that can be used to predict the risk of 30-day readmission; this should be considered to improve the model performance of the LACE index for other acute conditions by using the national-based administrative data.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Whiejong Han
- Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
- Correspondence:
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Sims SA, Pereira G, Preen D, Fatovich D, O'Donnell M. Young people with prior health service contacts have increased risk of repeated alcohol-related harm hospitalisations. Drug Alcohol Rev 2022; 41:1226-1235. [PMID: 35385585 DOI: 10.1111/dar.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION After a first alcohol-related hospitalisation in youth, subsequent hospitalisations may demonstrate an increased risk of further alcohol-related hospitalisations, but there is no existing data on this. METHODS A retrospective longitudinal study between July 1992 and June 2017 using linked hospital administrative data identified 23 464 Western Australian young people [9009 (38.4%) females and 14 455 (61.6%) males], aged 12-24 years hospitalised for at least one alcohol-related harm (ARH) episode of care. Cox regression was used to estimate hazard ratios (HR) between risk factors and repeated alcohol-related hospitalisation after the first discharge for ARH. RESULTS Of those admitted for an alcohol-related hospitalisation (n = 23 464), 21% (n = 4996) were readmitted for ARH. This high-risk sub-group comprised 46% (n = 16 017) of the total alcohol-related admissions (n = 34 485). After the first discharge for ARH, 16% (804) of people who experienced an alcohol-related readmission were readmitted within 1 month, and 51.8% (2589) were readmitted within 12 months. At increased risk of readmission were Aboriginal people and those with prior health service contacts occurring before their first alcohol-related hospitalisation, including illicit drug hospitalisations, mental health contacts and, in a sub-analysis, emergency department presentations. DISCUSSION AND CONCLUSIONS The probability of a repeated ARH hospitalisation was highest in the first month after initial discharge. There is a high-risk sub-group of young people more likely to have a repeat ARH hospitalisation. This represents an opportunity to provide interventions to those most at risk of repeated ARH.
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Affiliation(s)
- Scott A Sims
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia.,enAble Institute, Curtin University, Perth, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - David Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Australia.,Emergency Medicine, University of Western Australia, Perth, Australia
| | - Melissa O'Donnell
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia.,Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
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Lockwood KJ, Porter J. Effectiveness of Hospital-Based Interventions by Occupational Therapy Practitioners on Reducing Readmissions: A Systematic Review With Meta-Analyses. Am J Occup Ther 2022; 76:7601180050. [PMID: 35044450 DOI: 10.5014/ajot.2022.048959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Readmission to the hospital can lead to poorer patient outcomes and increased health care costs. The effect of occupational therapy interventions for adult hospitalized patients on readmission rates has not been previously evaluated. OBJECTIVE To systematically examine the published literature to determine the effects of occupational therapy interventions for adult hospitalized patients on readmission rates. DATA SOURCES Systematic search of five electronic databases was performed from database inception until May 2020, supplemented by citation and reference list searches. Study Selection and Data Collection: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively; methodological quality of the included studies was assessed using the Downs and Black checklist. Meta-analyses were conducted with clinically homogeneous data; the overall body of evidence was graded for quality. FINDINGS Meta-analysis of 7 studies with 16,718 participants provided low-quality evidence that 1-mo readmission rates were reduced when adult patients hospitalized for general medical and surgical care received additional occupational therapy interventions compared with standard care. Subgroup analysis of 4 studies provided moderate-quality evidence that interventions focusing on the transition from hospital to the community were effective in reducing 1-mo readmissions to hospitals compared with standard care. CONCLUSIONS AND RELEVANCE Occupational therapy interventions can be effective in reducing readmissions among some adult hospitalized patient populations, including those admitted for surgery or management of acute medical conditions, with stronger evidence to support transitional care interventions. What This Article Adds: Occupational therapy interventions can be effective in reducing readmissions among adult hospitalized patients. There is a continued need for occupational therapy practitioners to understand their value and contribution to reducing avoidable readmissions to hospitals.
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Affiliation(s)
- Kylee J Lockwood
- Kylee J. Lockwood, PhD, is Lecturer, Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Judi Porter
- Judi Porter, PhD, is Professor in Dietetics, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia;
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Hwang AB, Schuepfer G, Pietrini M, Boes S. External validation of EPIC's Risk of Unplanned Readmission model, the LACE+ index and SQLape as predictors of unplanned hospital readmissions: A monocentric, retrospective, diagnostic cohort study in Switzerland. PLoS One 2021; 16:e0258338. [PMID: 34767558 PMCID: PMC8589185 DOI: 10.1371/journal.pone.0258338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/24/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Readmissions after an acute care hospitalization are relatively common, costly to the health care system, and are associated with significant burden for patients. As one way to reduce costs and simultaneously improve quality of care, hospital readmissions receive increasing interest from policy makers. It is only relatively recently that strategies were developed with the specific aim of reducing unplanned readmissions using prediction models to identify patients at risk. EPIC’s Risk of Unplanned Readmission model promises superior performance. However, it has only been validated for the US setting. Therefore, the main objective of this study is to externally validate the EPIC’s Risk of Unplanned Readmission model and to compare it to the internationally, widely used LACE+ index, and the SQLAPE® tool, a Swiss national quality of care indicator. Methods A monocentric, retrospective, diagnostic cohort study was conducted. The study included inpatients, who were discharged between the 1st of January 2018 and the 31st of December 2019 from the Lucerne Cantonal Hospital, a tertiary-care provider in Central Switzerland. The study endpoint was an unplanned 30-day readmission. Models were replicated using the original intercept and beta coefficients as reported. Otherwise, score generator provided by the developers were used. For external validation, discrimination of the scores under investigation were assessed by calculating the area under the receiver operating characteristics curves (AUC). Calibration was assessed with the Hosmer-Lemeshow X2 goodness-of-fit test This report adheres to the TRIPOD statement for reporting of prediction models. Results At least 23,116 records were included. For discrimination, the EPIC´s prediction model, the LACE+ index and the SQLape® had AUCs of 0.692 (95% CI 0.676–0.708), 0.703 (95% CI 0.687–0.719) and 0.705 (95% CI 0.690–0.720). The Hosmer-Lemeshow X2 tests had values of p<0.001. Conclusion In summary, the EPIC´s model showed less favorable performance than its comparators. It may be assumed with caution that the EPIC´s model complexity has hampered its wide generalizability—model updating is warranted.
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Affiliation(s)
- Aljoscha Benjamin Hwang
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- * E-mail:
| | - Guido Schuepfer
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Mario Pietrini
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Le Guillou A, Chrusciel J, Sanchez S. The impact of hospital support function centralization on patient outcomes: A before-after study. PUBLIC HEALTH IN PRACTICE 2021; 2:100174. [PMID: 36101612 PMCID: PMC9461299 DOI: 10.1016/j.puhip.2021.100174] [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: 04/21/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Integrated health systems including multiple hospitals are increasingly frequent and can lead to economies of scale. We found a decrease in readmissions and average length of stay associated with the centralization of support functions. Additional studies are needed to evaluate the effect of health systems integration on patient outcomes.
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Factors associated with early 14-day unplanned hospital readmission: a matched case-control study. BMC Health Serv Res 2021; 21:870. [PMID: 34433448 PMCID: PMC8390214 DOI: 10.1186/s12913-021-06902-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Purpose Early unplanned hospital readmissions are burdensome health care events and indicate low care quality. Identifying at-risk patients enables timely intervention. This study identified predictors for 14-day unplanned readmission. Methods We conducted a retrospective, matched, case–control study between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Adult patients aged ≥ 20 years and readmitted for the same or related diagnosis within 14 days of discharge after initial admission (index admission) were included as cases. Cases were 1:1 matched for the disease-related group at index admission, age, and discharge date to controls. Variables were extracted from the hospital’s electronic health records. Results In total, 300 cases and 300 controls were analyzed. Six factors were independently associated with unplanned readmission within 14 days: previous admissions within 6 months (OR = 3.09; 95 % CI = 1.79–5.34, p < 0.001), number of diagnoses in the past year (OR = 1.07; 95 % CI = 1.01–1.13, p = 0.019), Malnutrition Universal Screening Tool score (OR = 1.46; 95 % CI = 1.04–2.05, p = 0.03), systolic blood pressure (OR = 0.98; 95 % CI = 0.97–0.99, p = 0.01) and ear temperature within 24 h before discharge (OR = 2.49; 95 % CI = 1.34–4.64, p = 0.004), and discharge with a nasogastric tube (OR = 0.13; 95 % CI = 0.03–0.60, p = 0.009). Conclusions Factors presented at admission (frequent prior hospitalizations, multimorbidity, and malnutrition) along with factors presented at discharge (clinical instability and the absence of a nasogastric tube) were associated with increased risk of early 14-day unplanned readmission.
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Thomsen K, Fournaise A, Matzen LE, Andersen-Ranberg K, Ryg J. Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study. BMJ Open 2021; 11:e046698. [PMID: 34389564 PMCID: PMC8365788 DOI: 10.1136/bmjopen-2020-046698] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes. OBJECTIVE We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF). DESIGN A retrospective single-centre before-and-after cohort study. SETTING AND PARTICIPANTS Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed. INTERVENTION OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT). MAIN OUTCOME MEASURES Unplanned hospital readmission between 4 hours and 30 days following initial discharge. RESULTS Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period. CONCLUSION Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.
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Affiliation(s)
- Katja Thomsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anders Fournaise
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Vejle, Denmark
| | - Lars Erik Matzen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Jayakody A, Carey M, Bryant J, Ella S, Hussein P, Warren E, Bacon S, Field B, Sanson-Fisher R. Exploring experiences and perceptions of Aboriginal and Torres Strait Islander peoples readmitted to hospital with chronic disease in New South Wales, Australia: a qualitative study. AUST HEALTH REV 2021; 45:411-417. [PMID: 34334156 DOI: 10.1071/ah20342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
Objective This study explored the experiences and perceptions of unplanned hospital readmissions from the perspective of Aboriginal and Torres Strait Islander peoples with chronic disease. Method We conducted semi-structured interviews with Aboriginal and Torres Strait Islander patients readmitted to hospital with chronic disease. Interviews covered perceptions of avoidable readmissions, experiences of health care, medications and carer support. Inductive thematic analysis was used to code and analyse the data. Results Fifteen patients with multiple chronic diseases were interviewed. Several participants believed their readmission was unavoidable due to their poor health, while others considered their readmission was avoidable due to perceived health professional and system failures. Enablers to chronic disease management included the importance of continuity of care and strong family networks, although a few participants struggled with isolation. Four themes emerged as barriers: poor communication from health professionals; low levels of health literacy and adherence to chronic disease management; poor access to community services; and health risk behaviours. Conclusions The participants in our study identified complex and interacting patient-, environmental-, encounter- and organisational-level factors as contributing to chronic disease management and unplanned readmissions. Our findings suggest systemic failures remain in access to basic services and access to culturally appropriate care. Family support and continuity of care were valued by participants. What is known about the topic? Aboriginal and Torres Strait Islander peoples with chronic diseases are more likely to be readmitted to hospital compared with non-Aboriginal people. Unplanned readmissions are associated with high health system costs, as well as poorer quality of life and psychological distress for the patient. What does this paper add? This paper describes the experiences and perceptions of unplanned readmissions by Aboriginal and Torres Strait Islander peoples with chronic disease. Our findings suggest systemic failures exist in access to basic services for a safe and secure living environment, and access to culturally appropriate care that is delivered in a manner which promotes health literacy and self-management capacity. What are the implications for practitioners? Practitioners and policy makers should consider involving family members in discharge planning and other medical care, and funding for Aboriginal and Torres Strait Islander health and community services to enhance transport, care coordination, culturally appropriate disability and housing services, and health promotion.
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Affiliation(s)
- Amanda Jayakody
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. ; ; ; and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; and Corresponding author.
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. ; ; ; and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. ; ; ; and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Stephen Ella
- Nunyara Aboriginal Health Unit, Central Coast Local Health District, Ward Street, Gosford, NSW, Australia. ;
| | - Paul Hussein
- Yerin Aboriginal Health Services Ltd, Suites 8 and 9, 36 Alison Road, Wyong, NSW, Australia. ; ;
| | - Eloise Warren
- Yerin Aboriginal Health Services Ltd, Suites 8 and 9, 36 Alison Road, Wyong, NSW, Australia. ; ;
| | - Shanell Bacon
- Nunyara Aboriginal Health Unit, Central Coast Local Health District, Ward Street, Gosford, NSW, Australia. ;
| | - Belinda Field
- Yerin Aboriginal Health Services Ltd, Suites 8 and 9, 36 Alison Road, Wyong, NSW, Australia. ; ;
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. ; ; ; and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Lawson C, Crothers H, Remsing S, Squire I, Zaccardi F, Davies M, Bernhardt L, Reeves K, Lilford R, Khunti K. Trends in 30-day readmissions following hospitalisation for heart failure by sex, socioeconomic status and ethnicity. EClinicalMedicine 2021; 38:101008. [PMID: 34308315 PMCID: PMC8283308 DOI: 10.1016/j.eclinm.2021.101008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Reducing the high patient and economic burden of early readmissions after hospitalisation for heart failure (HF) has become a health policy priority of recent years. METHODS An observational study linking Hospital Episode Statistics to socioeconomic and death data in England (2002-2018). All first hospitalisations with a primary discharge code for HF were identified. Quasi-poisson models were used to investigate trends in 30-day readmissions by age, sex, socioeconomic status and ethnicity. FINDINGS There were 698,983 HF admissions, median age 81 years [IQR 14].In-hospital deaths reduced by 0.7% per annum (pa), whilst additional deaths at 30-days remained stable at 5%. Age adjusted 30-day readmissions (21% overall), increased by 1.4% pa (95% CI 1.3-1.5). Readmissions for HF (6%) and 'other cardiovascular disease (CVD)' (3%) remained stable, but readmissions for non-CVD causes (12%) increased at a rate of 2.6% (2.4-2.7) pa. Proportions were similar by sex but trends diverged by ethnicity. Black groups experienced an increase in readmissions for HF (1.8% pa, interaction-p 0.03) and South Asian groups had more rapidly increasing readmission rates for non-CVD causes (interaction-p 0.04). Non-CVD readmissions were also more prominent in the least (15%; 15-15) compared to the most affluent group (12%; 12-12). Strongest predictors for HF readmission were Black ethnicity and chronic kidney disease, whilst cardiac procedures were protective. For non-CVD readmissions, strongest predictors were non-CVD comorbidities, whilst cardiologist care was protective. INTERPRETATION In HF, despite readmission reduction policies, 30-day readmissions have increased, impacting the least affluent and ethnic minority groups the most. FUNDING NIHR.
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Key Words
- AF, Atrial fibrillation
- CI, Confidence Interval
- COPD, Chronic obstructive pulmonary disease
- CRT, Cardiac resynchronisation therapy
- CVA, Cerebrovascular accident
- CVD, Cardiovascular disease
- HES, Hospital Episode Statistics
- HF, Heart failure
- Heart failure
- ICD, Implantable cardioverter defibrillator
- IHD, Ischaemic heart disease
- IMD, Index of Multiple Deprivation
- MI, Myocardial infarction
- ONS, Office of National Statistics
- PCI, Percutaneous coronary intervention
- Readmission
- hospitalisation
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Affiliation(s)
- C Lawson
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Real World Evidence Unit, University of Leicester, UK
- Corresponding author at: University of Leicester, Leicester, Leicestershire, LE5 4PW, England, UK
| | | | | | - I Squire
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - F Zaccardi
- Real World Evidence Unit, University of Leicester, UK
- Diabetes Centre, University of Leicester, UK
| | - M Davies
- Diabetes Centre, University of Leicester, UK
| | - L Bernhardt
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | | | - K Khunti
- Real World Evidence Unit, University of Leicester, UK
- Diabetes Centre, University of Leicester, UK
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Care Strategies for Reducing Hospital Readmissions Using Stochastic Programming. Healthcare (Basel) 2021; 9:healthcare9080940. [PMID: 34442079 PMCID: PMC8393874 DOI: 10.3390/healthcare9080940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022] Open
Abstract
A hospital readmission occurs when a patient has an unplanned admission to a hospital within a specific time period of discharge from an earlier or initial hospital stay. Preventable readmissions have turned into a critical challenge for the healthcare system globally, and hospitals seek care strategies that reduce the readmission burden. Some countries have developed hospital readmission reduction policies, and in some cases, these policies impose financial penalties for hospitals with high readmission rates. Decision models are needed to help hospitals identify care strategies that avoid financial penalties, yet maintain balance among quality of care, the cost of care, and the hospital’s readmission reduction goals. We develop a multi-condition care strategy model to help hospitals prioritize treatment plans and allocate resources. The stochastic programming model has probabilistic constraints to control the expected readmission probability for a set of patients. The model determines which care strategies will be the most cost-effective and the extent to which resources should be allocated to those initiatives to reach the desired readmission reduction targets and maintain high quality of care. A sensitivity analysis was conducted to explore the value of the model for low- and high-performing hospitals and multiple health conditions. Model outputs are valuable to hospitals as they examine the expected cost of hitting its target and the expected improvement to its readmission rates.
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Castillo D, Barril S, Rodrigo-Troyano A, Millan-Billi P, Suárez-Cuartín G, Alonso A, Franquet T, López-Vilaró L, Castellví I, Plaza V, Sibila O. Early hospital readmission increases short and long - term mortality in patients with interstitial lung disease. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021021. [PMID: 34316260 PMCID: PMC8288207 DOI: 10.36141/svdld.v38i2.10709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
Objective: To investigate the prognostic impact of early readmission (30 days) on hospitalized patients with Interstitial Lung Disease (ILD). Methods: Observational study analysing a cohort of patients hospitalized in a respiratory ward at a University Hospital. Demographic, clinical data and survival status were collected from patients’ records. Early readmission was defined as hospitalization within 30 days after patient’s discharge. The primary outcome was 90-day and 1-year all-cause mortality. Results: Between 2013 to 2016, a total of 2.238 patients were admitted to the respiratory ward and 98 (%) had a diagnosis of ILD. Among them, 74 patients were discharged (25% in-hospital mortality). Early readmission was observed in 15 cases (20.2%). Early readmitted patients were more frequently current smokers (20% vs. 2%, p=0.02). After a multivariate analysis, early readmission was found to be independently associated with 90-day and 1 year mortality (Odds Ratio (OR) 17.6, 95% Confidence Interval (CI) 4.5-69-2, p=0.001 and OR 4.5; 95CI 1.3-15.2, p=0.01, respectively). Conclusion: In patients with ILD, early readmission after hospitalization increases both short-term and long term mortality. Thus, preventing early readmission after discharge from hospital admission may have an impact in the clinical course of ILD patients. Further studies are required to identify factors contributing to early readmission.
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Affiliation(s)
- Diego Castillo
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain)
| | - Silvia Barril
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Respiratory Department. Hospital Universitari Arnau de Vilanova. Lleida (Spain)
| | - Ana Rodrigo-Troyano
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Respiratory Deparment. Hospital Universitari Son Espases, Palma, Illes Balears (Spain)
| | - Paloma Millan-Billi
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Respiratory Department. Hospital Germans Trias I Pujol. Badalona (Spain)
| | - Guillermo Suárez-Cuartín
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Respiratory Department. Hospital Universitari Bellvitge. L'Hospitalet de Llobregat (Spain)
| | - Ana Alonso
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain)
| | - Tomás Franquet
- Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain).,Radiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. (Spain)
| | - Laura López-Vilaró
- Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain).,Histopathology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. (Spain)
| | - Iván Castellví
- Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain).,Rheumatology Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain)
| | - Vicente Plaza
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Sant Pau Biomedical Research Institute (IIB-SantPau). Barcelona (Spain)
| | - Oriol Sibila
- Respiratory Department. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain).,Thorax Institute. Hospital Clínic. Barcelona (Spain)
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Reid M, Kephart G, Andreou P, Robinson A. Potential of community-based risk estimates for improving hospital performance measures and discharge planning. BMJ Open Qual 2021; 10:bmjoq-2020-001230. [PMID: 33926991 PMCID: PMC8094366 DOI: 10.1136/bmjoq-2020-001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/26/2021] [Accepted: 04/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Risk-adjusted rates of hospital readmission are a common indicator of hospital performance. There are concerns that current risk-adjustment methods do not account for the many factors outside the hospital setting that can affect readmission rates. Not accounting for these external factors could result in hospitals being unfairly penalized when they discharge patients to communities that are less able to support care transitions and disease management. While incorporating adjustments for the myriad of social and economic factors outside of the hospital setting could improve the accuracy of readmission rates as a performance measure, doing so has limited feasibility due to the number of potential variables and the paucity of data to measure them. This paper assesses a practical approach to addressing this problem: using mixed-effect regression models to estimate case-mix adjusted risk of readmission by community of patients’ residence (community risk of readmission) as a complementary performance indicator to hospital readmission rates. Methods Using hospital discharge data and mixed-effect regression models with a random intercept for community, we assess if case-mix adjusted community risk of readmission can be useful as a quality indicator for community-based care. Our outcome of interest was an unplanned repeat hospitalisation. Our primary exposure was community of residence. Results Community of residence is associated with case-mix adjusted risk of unplanned repeat hospitalisation. Community risk of readmission can be estimated and mapped as indicators of the ability of communities to support both care transitions and long-term disease management. Conclusion Contextualising readmission rates through a community lens has the potential to help hospitals and policymakers improve discharge planning, reduce penalties to hospitals, and most importantly, provide higher quality care to the people that they serve.
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Affiliation(s)
- Michael Reid
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George Kephart
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alysia Robinson
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Harvey G, Pham CT, Inacio MC, Laver K, Lynch EA, Jorissen RN, Karnon J, Bourke A, Forward J, Maddison J, Whitehead C, Rupa J, McNamara C, Crotty M. An integrated knowledge translation approach to address avoidable rehospitalisations and unplanned admissions for older people in South Australia: implementation and evaluation program plan. Implement Sci Commun 2021; 2:36. [PMID: 33827707 PMCID: PMC8025566 DOI: 10.1186/s43058-021-00141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. Discussion This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.
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Affiliation(s)
- Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - John Forward
- Aged Care, Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
| | - John Maddison
- Medical Services, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Jesmin Rupa
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia.
| | - Carmel McNamara
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Cioci A, Kedar W, Urrechaga E, Gold J, Parreco JP, Coll AS, Curry CL, Rattan R. Uncaptured rates of postpartum venous thromboembolism: a US national analysis. BJOG 2021; 128:1694-1702. [PMID: 33686733 DOI: 10.1111/1471-0528.16693] [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] [Accepted: 03/03/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To quantify the proportion of postpartum venous thromboembolism (VTE) readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome. DESIGN Retrospective observational study. SETTING US hospitals included in the Nationwide Readmissions Database. SAMPLE A total of 3 719 238 patients >14 years of age with a delivery-associated hospitalisation in 2014. METHODS Univariate analysis was performed to identify patient and hospital factors associated with readmissions. Significant factors were included in multivariate logistic regression to identify independent risk factors. Results were weighted for national estimates. MAIN OUTCOME MEASURES Readmission with VTE to both index and different hospitals at 30, 60 and 90 days. RESULTS The VTE cumulative readmission rate was 0.053% (n = 1477), 0.063% (n = 1765) and 0.069% (n = 1938) at 30, 60 and 90 days, respectively. Patients were readmitted to different hospitals 31% of the time within 90 days. Risk factors for different hospital VTE readmission were unique and included younger age and initial admission to a small/medium-sized hospital. Initial admission to a for-profit hospital increased the likelihood of readmission to a different hospital. CONCLUSIONS Nearly one in three postpartum VTEs are missed by the current quality metrics, with significant implications for outcomes and quality. For-profit hospitals have a significant portion of their VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. TWEETABLE ABSTRACT US analysis shows 1 in 3 readmissions for postpartum venous thromboembolism currently missed.
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Affiliation(s)
- A Cioci
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - W Kedar
- Kupot Holim Clalit, Jerusalem, Israel
| | - E Urrechaga
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Gold
- University of Tennessee - Memphis, Memphis, TN, USA
| | - J P Parreco
- Lawnwood Regional Medical Center, Fort Pierce, FL, USA
| | - A S Coll
- Baptist Health South Florida, Coral Gables, FL, USA
| | | | - R Rattan
- University of Miami Miller School of Medicine, Miami, FL, USA
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Weiss ME, Piacentine LB, Candela L, Bobay KL. Effectiveness of using a simulation combined with online learning approach to develop discharge teaching skills. Nurse Educ Pract 2021; 52:103024. [PMID: 33774567 DOI: 10.1016/j.nepr.2021.103024] [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: 01/22/2020] [Revised: 01/19/2021] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite evidence of the impact of discharge teaching on patient outcomes, nursing students are poorly prepared in the pedagogical skills necessary for their role as patient and family educators in clinical practice. This study evaluated the effectiveness of simulation combined with online learning to improve nursing students' discharge teaching skills. METHODS The module included simulations before and after an online module on patient/family teaching for hospital discharge. Evaluation measures were student and independent rater evaluations using the Quality of Discharge Teaching Scale- Evaluation form (QDTS-E). RESULTS Students (n = 153) improved their performance on both content and delivery subscales of the QDTS-E by 20% (student self-evaluations) and 18% (independent raters). However, correlations between student and rater scores were low (r = 0.08-0.22). CONCLUSION Use of simulation with online learning in a discharge teaching module can help students build patient education skills to improve post-discharge patient outcomes, contributing to national health priorities to reduce hospital readmissions. With further refinement and testing, the learning module and QDTS-E evaluation form may also be useful for evaluation and continuing education of clinical nursing staff.
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Affiliation(s)
- Marianne E Weiss
- College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Linda B Piacentine
- College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Lori Candela
- School of Nursing, University of Nevada Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA.
| | - Kathleen L Bobay
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 South First Avenue, Maywood, IL, 60153, USA.
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UyaroĞlu OA, BaŞaran NÇ, ÖziŞik L, Dİzman GT, EroĞlu İ, Şahİn TK, TaŞ Z, İnkaya AÇ, TanriÖver MD, Metan G, GÜven GS, Ünal S. Thirty-day readmission rate of COVID-19 patients discharged from a tertiary care university hospital in Turkey: an observational, single-center study. Int J Qual Health Care 2021; 33:5940459. [PMID: 33104780 PMCID: PMC7665548 DOI: 10.1093/intqhc/mzaa144] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The 30-day readmission rate is an important indicator of patient safety and hospital’s quality performance. In this study, we aimed to find out the 30-day readmission rate of mild and moderate severity COVID-19 patients discharged from a tertiary care university hospital and to demonstrate the possible factors associated with readmission. Methods This is an observational, single-center study. Epidemiological and clinical data of patients who were hospitalized with a diagnosis of COVID-19 were retrieved from a research database where patient information was recorded prospectively. Readmission data was sought from the hospital information management system and National Health Record System to detect if the patients were readmitted to any hospital within 30 days of discharge. Adult patients (≥18 years-old) hospitalized in COVID-19 wards with a diagnosis of mild or moderate COVID-19 between March 20, 2020 (when the first case was admitted to our hospital), and April 26, 2020 were included. Results From March 26 to May 1, there were 154 mild or moderate severity (non-critical) COVID-19 patients discharged from COVID-19 wards, of which 11 (7.1%) were readmitted The median time of readmission was 8.1 days (IQR=5.2). Two patients (18.1%) were categorized to have mild disease and the remaining 9 (81.9%) as moderate disease. Two patients who were over 65 years of age and had metastatic cancers and hypertension developed sepsis and died in the hospital during the readmission episode. Malignancy (18.7% vs 2.1%, P = 0.04) and hypertension (45.5% vs 14%, P = 0.02) were more common in those who were readmitted. Conclusions This is one of the first studies to report on 30-day readmission rate of COVID-19 in the literature. More comprehensive studies are needed to reveal the causes and predictors of COVID-19 readmissions.
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Affiliation(s)
- Oğuz Abdullah UyaroĞlu
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Nursel Çalik BaŞaran
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Lale ÖziŞik
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülçİn Tellİ Dİzman
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - İmdat EroĞlu
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Taha Koray Şahİn
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Zahİt TaŞ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Ahmet Çağkan İnkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Mıne Durusu TanriÖver
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gökhan Metan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülay Saİn GÜven
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Serhat Ünal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
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Wong CH, Cheung WK, Zhong CC, Yeoh EK, Hung CT, Yip BH, Wong EL, Wong SY, Chung VC. Effectiveness of nurse-led peri-discharge interventions for reducing 30-day hospital readmissions: Network meta-analysis. Int J Nurs Stud 2021; 117:103904. [PMID: 33691220 DOI: 10.1016/j.ijnurstu.2021.103904] [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: 07/13/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Existing systematic reviews have compared the effectiveness of nurse-led peri-discharge interventions comprising different components with usual care on reducing all-cause 30-day hospital readmissions. However, conflicting results were reported. OBJECTIVE We conducted a network meta-analysis to evaluate the comparative effectiveness of different nurse-led peri-discharge interventions, compared with usual care, for reducing all-cause 30-day hospital readmissions. DESIGN Network meta-analysis. METHODS A total of five international databases were searched for systematic reviews of randomized controlled trials. Additional searches for most updated randomized controlled trials published between 2014 to 2019 were conducted. Data from included randomized controlled trials were extracted for random-effect pairwise meta-analyses. Pooled risk ratios with 95% confidence interval were used to quantify impact of nurse-led peri-discharge interventions on all-cause 30-day hospital readmissions. Network meta-analysis was used to evaluate the comparative effectiveness of different interventions. RESULTS From two systematic reviews and additional randomized controlled trial searches, 12 eligible randomized controlled trials (n=150,840) assessing 15 different nurse-led peri-discharge interventions were included. For reducing all-cause 30-day hospital readmissions, pairwise meta-analysis showed that there was no significant difference between nurse-led peri-discharge interventions and usual care (pooled risk ratios = 0.86, 95% confidence interval: 0.71-1.04, moderate quality of evidence). Network meta-analysis indicated no significant difference across different interventions despite variation in complexity. CONCLUSIONS Our results indicated that nurse-led peri-discharge interventions were not significantly different from usual care for reducing all-cause 30-day hospital readmissions. Simpler nurse-led peri-discharge interventions are on par with more complex interventions in terms of effectiveness. Benefits of nurse-led peri-discharge interventions may vary across health system context. Therefore, careful consideration is required prior to implementation. REGISTRATION DETAILS The protocol for this study has been registered in PROSPERO (Registration No. CRD42020186938). Tweetable abstract: This study suggested that nurse-led peri-discharge interventions do not differ from usual care for reducing all-cause 30-day hospital readmissions.
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Affiliation(s)
- Charlene Hl Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - William Kw Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Claire Cw Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Tim Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Benjamin Hk Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eliza Ly Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Ys Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Ch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Cowie MR, Schöpe J, Wagenpfeil S, Tavazzi L, Böhm M, Ponikowski P, Anker SD, Filippatos GS, Komajda M. Patient factors associated with titration of medical therapy in patients with heart failure with reduced ejection fraction: data from the QUALIFY international registry. ESC Heart Fail 2021; 8:861-871. [PMID: 33569926 PMCID: PMC8006614 DOI: 10.1002/ehf2.13237] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/01/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Failure to prescribe key medicines at evidence-based doses is associated with increased mortality and hospitalization for patients with Heart Failure with reduced Ejection Fraction (HFrEF). We assessed titration patterns of guideline-recommended HFrEF medicines internationally and explored associations with patient characteristics in the global, prospective, observational, longitudinal registry. METHODS AND RESULTS Data were collected from September 2013 through December 2014, with 7095 patients from 36 countries [>18 years, previous HF hospitalization within 1-15 months, left ventricular ejection fraction (LVEF) ≤ 40%] enrolled, with dosage data at baseline and up to 18 months from 4368 patients. In 4368 patients (mean age 63 ± 17 years, 75% male) ≥ 100% target doses at baseline: 30.6% (ACEIs), 2.9% (ARBs), 13.9% (BBs), 53.8% (MRAs), 26.2% (ivabradine). At final follow-up, ≥100% target doses achieved in more patients for ACEI (34.8%), BB (18.0%), and ivabradine (30.5%) but unchanged for ARBs (3.2%) and MRAs (53.7%). Adjusting for baseline dosage, uptitration during follow-up was more likely with younger age, higher systolic blood pressure, and in absence of chronic kidney disease or diabetes for ACEIs/ARBs; younger age, higher body mass index, higher heart rate, lower LVEF, and absence of coronary artery disease for BBs. For ivabradine, uptitration was more likely with higher resting heart rate. CONCLUSIONS The international QUALIFY Registry suggests that few patients with HFrEF achieve target doses of disease-modifying medication, especially older patients and those with co-morbidity. Quality improvement initiatives are urgently required.
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Affiliation(s)
- Martin R Cowie
- National Heart & Lung Institute, Imperial College London (Royal Brompton Hospital), Dovehouse Street, London, SW3 6LY, UK
| | - Jakob Schöpe
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Universität des Saarlandes Homburg, Saar, Germany
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Medical University, Wroclaw, Poland
| | - Stefan D Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (Campus CVK), Berlin, Germany
| | - Gerasimos S Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Michel Komajda
- Department of Cardiology, Saint Joseph Hospital, Paris, France
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Gilmore-Bykovskyi A, Cotton Q, Morgan J, Block L. Diverse perspectives on hospitalisation events among people with dementia: protocol for a multisite qualitative study. BMJ Open 2021; 11:e043016. [PMID: 33550256 PMCID: PMC7925923 DOI: 10.1136/bmjopen-2020-043016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION People living with dementia (PLWD) are more likely to experience hospitalisation events (hospitalisation, rehospitalisation) than those without dementia. Many hospitalisation events, particularly rehospitalisation within 30 days of discharge, are thought to be avoidable. Yet our understanding of dementia-specific risk and protective factors surrounding avoidable hospitalisation is limited to specific intersetting transitions and predominantly clinician perspectives. Broader insights are needed to design accessible and effective solutions for reducing avoidable hospitalisations. We have designed the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study to address these gaps. The objectives of the SUPPORT Study are to elicit and examine family caregiver, community and hospital providers' perspectives on avoidable hospitalisation events among PLWD, and to identify opportunities for effective prevention. METHODS AND ANALYSIS We will conduct a multisite, descriptive qualitative study to interview around 100 family caregivers, community and hospital providers. We will identify and sample from regions and communities with higher socio-contextual disadvantage and hospital utilisation, and will aim to recruit individuals representing diverse racial/ethnic backgrounds. Interviews will follow a descriptive qualitative design in conjunction with constant comparison techniques to sample divergent situations and events. We will employ a range of analytical approaches to address specific research questions including thematic (inductive and deductive), comparative and dimensional analysis. Interviews will be conducted individually or in focus groups and follow a semistructured interview guide. ETHICS AND DISSEMINATION The study is approved by the University of Wisconsin-Madison Institutional Review Board. Informed consent procedures will incorporate steps to evaluate capacity to provide informed consent in the event that participants express concerns with thinking or memory or demonstrate challenges recalling study details during the consent process to ensure capacity to consent to participation. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with collaborating organisation partners.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Quinton Cotton
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer Morgan
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura Block
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Tsai WJ, Qian TY, Lu CM, Liu Q, Wang LS. Derivation and validation of a prediction model for neonate unplanned rehospitalization in a tertiary center in China. Transl Pediatr 2021; 10:256-264. [PMID: 33708511 PMCID: PMC7944176 DOI: 10.21037/tp-20-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To construct and externally validate a prediction model for neonate unplanned rehospitalization within 31 days of discharge. METHODS A retrospective study was performed in the Department of Neonatology of the Children's Hospital of Fudan University. A binominal regression method was applied to construct and validate the prediction model. Analysis was performed on a total of 11,116 neonates with an index admission between 11/1/2016 and 12/31/2018. Neonates admitted from 11/1/2016 to 1/31/2018 were used for the selection of prognostic variables and construction of the model. Model validation was then performed with neonates admitted from 2/1/2018 to 12/31/2018. RESULTS The rehospitalization rate for neonates was 3.27% (373/11,116). A total of 512 neonates were enrolled for the construction of the prediction model. Gestational age (GA), NICU length of stay (LOS), nonmedical order discharge and younger maternal age were strongly correlated with rehospitalization. By incorporating these 4 strong risk factors, we constructed a model to predict neonate unplanned rehospitalization within 31 days of discharge. The formula was turned into a nomogram for use in clinical practice. The nomogram has a total score of 180, with a predicted risk from 0 to 100%. Neonates are at high risk for rehospitalization if they have a total score greater than 39 points, according to the cutoff point established by the Youden index. The model was shown to have good discriminatory ability, with area under the receiver operating characteristic curves of 0.68 and 0.65 in the model construction and validation datasets, respectively. A total of 39 points is the cutoff for follow-up. CONCLUSIONS The model is able to predict neonate unplanned rehospitalization well. A total score greater than 39 indicates that follow-up is necessary.
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Affiliation(s)
- Wan-Ju Tsai
- Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Tian-Yang Qian
- Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Chun-Mei Lu
- Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Qing Liu
- Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
| | - Lai-Shuan Wang
- Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China
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Gould D, Dowsey MM, Spelman T, Jo O, Kabir W, Trieu J, Bailey J, Bunzli S, Choong P. Patient-Related Risk Factors for Unplanned 30-Day Hospital Readmission Following Primary and Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:E134. [PMID: 33401763 PMCID: PMC7795505 DOI: 10.3390/jcm10010134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023] Open
Abstract
Total knee arthroplasty (TKA) is a highly effective procedure for advanced osteoarthritis of the knee. Thirty-day hospital readmission is an adverse outcome related to complications, which can be mitigated by identifying associated risk factors. We aimed to identify patient-related characteristics associated with unplanned 30-day readmission following TKA, and to determine the effect size of the association between these risk factors and unplanned 30-day readmission. We searched MEDLINE and EMBASE from inception to 8 September 2020 for English language articles. Reference lists of included articles were searched for additional literature. Patients of interest were TKA recipients (primary and revision) compared for 30-day readmission to any institution, due to any cause, based on patient risk factors; case series were excluded. Two reviewers independently extracted data and carried out critical appraisal. In-hospital complications during the index admission were the strongest risk factors for 30-day readmission in both primary and revision TKA patients, suggesting discharge planning to include closer post-discharge monitoring to prevent avoidable readmission may be warranted. Further research could determine whether closer monitoring post-discharge would prevent unplanned but avoidable readmissions. Increased comorbidity burden correlated with increased risk, as did specific comorbidities. Body mass index was not strongly correlated with readmission risk. Demographic risk factors included low socioeconomic status, but the impact of age on readmission risk was less clear. These risk factors can also be included in predictive models for 30-day readmission in TKA patients to identify high-risk patients as part of risk reduction programs.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
- Department of Othopaedics, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Olivia Jo
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Wassif Kabir
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Jason Trieu
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - James Bailey
- School of Computing and Information Systems, University of Melbourne, 3052 Melbourne, Australia;
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
| | - Peter Choong
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, 3065 Melbourne, Australia; (M.M.D.); (T.S.); (O.J.); (W.K.); (J.T.); (S.B.); (P.C.)
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Wong J, Milroy S, Sun K, Iorio P, Seto M, Monakova J, Sutherland JM. Reallocating Cancer Surgery Payments for Alternate Level of Care in Ontario: What Are the Options? ACTA ACUST UNITED AC 2020; 16:41-54. [PMID: 33337313 PMCID: PMC7710964 DOI: 10.12927/hcpol.2020.26354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines how alternate-level-of-care (ALC) days are funded through the cancer surgery funding model in Ontario and evaluates policy options to better address ALC days. The contribution of ALC days to hospital funding and the impact of removing or reallocating this funding from cancer surgery is measured. Though costs associated with ALC days in cancer surgery are low, this article highlights the need for policy options that would realign funding across the healthcare system in Ontario to better meet the needs of patients waiting for ALC, reduce pressure on inpatient bed capacity and improve value for money.
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Affiliation(s)
- Judith Wong
- Methodologist, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Shannon Milroy
- Health Economist, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Katherine Sun
- Senior Analyst, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Pierre Iorio
- Methodologist, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - May Seto
- Group Manager, Funding Unit, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Julia Monakova
- Group Manager, Funding Unit, Ontario Health (Cancer Care Ontario), Toronto, ON
| | - Jason M Sutherland
- Faculty, UBC Centre for Health Services and Policy Research; Professor, UBC School of Population and Public Health, University of British Columbia, Vancouver, BC
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Adeyemi A, Nherera L, Trueman P, Ranawat A. Cost-effectiveness analysis of Coblation versus mechanical shaver debridement in patients following knee chondroplasty. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:44. [PMID: 33088223 PMCID: PMC7566123 DOI: 10.1186/s12962-020-00240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background To compare costs and outcomes following knee chondroplasty with Coblation versus mechanical shaver debridement (MSD) in patients with grade III articular cartilage lesions of the knee. Methods A decision-analytic model was developed to compare costs and outcomes of the two methods from a US payer perspective. We used published clinical data from a single-center randomized clinical trial (RCT) designed to compare outcomes between Coblation and MSD in patients with grade III articular cartilage lesions of the medial femoral condyle. Following primary knee chondroplasty, patients experienced either treatment success (no additional surgery required) or required a revision over the 4 year follow-up period. Costs associated with the initial chondroplasty, physical therapy sessions through the 6 week postoperative period, and revision rates at 4 years post-surgery were estimated using 2018 US Medicare Physician Fee Schedule. Sensitivity analyses including a 10 year time horizon and threshold analyses were performed to test the robustness of the model. Results The estimated total cost per patient was $4614 and $7886 for Coblation and MSD, respectively, resulting in cost-savings of $3272 in favor of Coblation, making it a dominant strategy because of lower costs and improved clinical outcomes. Threshold analysis showed that Coblation remained dominant even when revision rates were assumed to increase from the base case rate of 14–66%. Sensitivity analyses showed that cost-saving results were insensitive to variations in revision rates, number of physical therapy sessions and the time horizon used. Conclusion Coblation chondroplasty is a cost-saving procedure compared with MSD in the treatment of patients with grade III articular cartilage lesions of the knee.
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Affiliation(s)
| | - Leo Nherera
- Smith & Nephew, Inc, Hull, UK.,Smith & Nephew Inc, 5600 Clearfork Main Street, Fort Worth, TX 76109 USA
| | | | - Anil Ranawat
- Department of Sports, Hospital for Special Surgery, New York, NY USA
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43
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Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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44
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Conroy T, Heuzenroeder L, Feo R. In-hospital interventions for reducing readmissions to acute care for adults aged 65 and over: An umbrella review. Int J Qual Health Care 2020; 32:414-430. [PMID: 32558919 DOI: 10.1093/intqhc/mzaa064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this umbrella review was to synthesize existing systematic review evidence on the effectiveness of in-hospital interventions to prevent or reduce avoidable hospital readmissions in older people (≥65 years old). DATA SOURCES A comprehensive database search was conducted in May 2019 through MEDLINE, EMBASE, CINAHL, the JBI Database of Systematic Reviews, DARE and Epistemonikos. STUDY SELECTION Systematic reviews and other research syntheses, including meta-analyses, exploring the effectiveness of hospital-based interventions to reduce readmissions for people aged 65 and older, irrespective of gender or clinical condition, were included for review. If a review did not exclusively focus on this age group, but data for this group could be extracted, then it was considered for inclusion. Only reviews in English were included. DATA EXTRACTION Data extracted for each review included the review objective, participant details, setting and context, type of studies, intervention type, comparator and findings. RESULTS OF DATA SYNTHESIS Twenty-nine reviews were included for analysis. Within these reviews, 11 intervention types were examined: in-hospital medication review, discharge planning, comprehensive geriatric assessment, early recovery after surgery, transitional care, interdisciplinary team care, in-hospital nutrition therapy, acute care geriatric units, in-hospital exercise, postfall interventions for people with dementia and emergency department-based palliative care. Except for discharge planning and transitional care, none of the interventions significantly reduced readmissions among older adults. CONCLUSION There is limited evidence to support the effectiveness of existing hospital-based interventions to reduce readmissions for people aged 65 and older.
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Affiliation(s)
- Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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45
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Constantinou P, Pelletier-Fleury N, Olié V, Gastaldi-Ménager C, JuillÈre Y, Tuppin P. Patient stratification for risk of readmission due to heart failure by using nationwide administrative data. J Card Fail 2020; 27:266-276. [PMID: 32801005 DOI: 10.1016/j.cardfail.2020.07.018] [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: 01/16/2020] [Revised: 06/27/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying patients with heart failure (HF) who are most at risk of readmission permits targeting adapted interventions. The use of administrative data enables regulators to support the implementation of such interventions. METHODS AND RESULTS In a French nationwide cohort of patients aged 65 years or older, surviving an index hospitalization for HF in 2015 (N = 70,657), we studied HF readmission predictors available in administrative data, distinguishing HF severity from overall morbidity and taking into account the competing mortality risk, over a 1-year follow-up period. We also computed cumulative incidences and daily rates of HF readmission for patient groups defined according to HF severity and overall morbidity. Of the patients, 31.8% (n = 22,475) were readmitted at least once for HF, and 17.6% (n = 12,416) died without any readmission for HF. HF severity and overall morbidity were the strongest readmission predictors were the strongest readmission predictors (subdistribution hazard ratios 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45], respectively, when comparing extreme categories). Overall morbidity and age were more strongly associated with the rate of death without HF readmission (cause-specific hazard ratios). The difference in observed HF readmission between patient risk groups was approximately 40% (21.9%, n = 2144/9,786 vs 60.4%, n = 618/1023). CONCLUSIONS Segmentation of HF patients into readmission risk groups is possible by using administrative data, and it enables the targeting of preventive interventions.
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Affiliation(s)
- Panayotis Constantinou
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud; French National Health Insurance (Cnam), Paris, France.
| | - Nathalie Pelletier-Fleury
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud
| | - Valérie Olié
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | | | - Yves JuillÈre
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
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Yao SM, Zheng PP, Liang YD, Wan YH, Sun N, Luo Y, Yang JF, Wang H. Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease. BMC Geriatr 2020; 20:218. [PMID: 32571237 PMCID: PMC7309999 DOI: 10.1186/s12877-020-01606-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Methods A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06–2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60–0.71), and the AUC for men was 0.71 (95% CI: 0.63–0.78), while that for women was 0.60 (95% CI: 0.51–0.69). Conclusions Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term. Trial registration ChiCTR1800017204; date of registration: 07/18/2018.
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Affiliation(s)
- Si-Min Yao
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Pei-Pei Zheng
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yao-Dan Liang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yu-Hao Wan
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yao Luo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jie-Fu Yang
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
| | - Hua Wang
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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Understanding the large heterogeneity in hospital readmissions and mortality for acute myocardial infarction. Health Policy 2020; 124:684-694. [PMID: 32505366 DOI: 10.1016/j.healthpol.2020.04.004] [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: 08/08/2019] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Abstract
This study aims to investigate the variation in two acute myocardial infarction (AMI) outcomes across public hospitals in Portugal. In-hospital mortality and 30-day unplanned readmissions were studied using two distinct AMI cohorts of adults discharged from all acute care public hospital centers in Portugal from 2012-2015. Hierarchical generalized linear models were used to assess the association between patient and hospital characteristics and hospital variability in the two outcomes. Our findings indicate that hospitals are not performing homogeneously-the risk of adverse events tends to be consistently larger in some hospitals and consistently lower in other hospitals. While patient characteristics accounted for a larger share of the explained between-hospital variance, hospital characteristics explain an additional 8% and 10% of hospital heterogeneity in the mortality and the readmission cohorts respectively. Admissions to hospitals with low AMI caseloads or located in Alentejo/Algarve and Lisbon had a higher risk of mortality. Discharges from larger-sized hospitals were associated with increased risk of readmissions. Future health policies should incorporate these findings in order to incentivize more consistent health care outcomes across hospitals. Further investigation addressing geographical disparities, hospital caseload and practices is needed to direct actions of improvement to specific hospitals.
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48
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Alqahtani JS, Njoku CM, Bereznicki B, Wimmer BC, Peterson GM, Kinsman L, Aldabayan YS, Alrajeh AM, Aldhahir AM, Mandal S, Hurst JR. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/156/190166. [PMID: 32499306 DOI: 10.1183/16000617.0166-2019] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD. METHODS We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model. RESULTS In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)). CONCLUSIONS Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
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Affiliation(s)
- Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK .,Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Chidiamara M Njoku
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Bonnie Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Barbara C Wimmer
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, Australia
| | - Yousef S Aldabayan
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ahmed M Alrajeh
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Abdulelah M Aldhahir
- UCL Respiratory, University College London, London, UK.,Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Swapna Mandal
- UCL Respiratory, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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Li J, Dharmarajan K, Bai X, Masoudi FA, Spertus JA, Li X, Zheng X, Zhang H, Yan X, Dreyer RP, Krumholz HM. Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China. Circ Cardiovasc Qual Outcomes 2020; 12:e005628. [PMID: 31092023 DOI: 10.1161/circoutcomes.119.005628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized. Methods and Results We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52-69) years, and 76.9% were men. The index median length of stay was 11 (8-14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05-1.25), longer length of stay (HR, 1.03; 95% CI, 1.00-1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04-1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18-0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05-3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03-1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment-elevation myocardial infarction (HR, 0.60; 95% CI, 0.36-0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission. Conclusions In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624909.
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Affiliation(s)
- Jing Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Kumar Dharmarajan
- Clover Health, Jersey City, NJ (K.D.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.A.S.)
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Xiaofang Yan
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (J.L., X.B., X.L., X.Z., H.Z., X.Y.)
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (R.P.D.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., R.P.D., H.M.K.).,Section of Cardiovascular Medicine (K.D., H.M.K.), Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Abstract
BACKGROUND Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the "ideal" surgical outcome. METHODS Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates. RESULTS Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo ≥III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observed-versus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment. CONCLUSIONS TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.
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