1
|
Carter JAC, Swack N, Isselbacher E, Donelan K, Thorndike A. Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial. JMIR Cardio 2024; 8:e59948. [PMID: 38959294 DOI: 10.2196/59948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. OBJECTIVE This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. METHODS Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). RESULTS A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement "If I have access to the [platform] moving forward, I will use it." Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ≥5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were "very satisfying." In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. CONCLUSIONS This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/55687.
Collapse
Affiliation(s)
- Jocelyn A Carter Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Natalia Swack
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric Isselbacher
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, United States
| | - Karen Donelan
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Anne Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
2
|
Marsall M, Hornung T, Bäuerle A, Weigl M. Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process. BMC Health Serv Res 2024; 24:576. [PMID: 38702719 PMCID: PMC11069201 DOI: 10.1186/s12913-024-11047-3] [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: 04/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.
Collapse
Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
| |
Collapse
|
3
|
Marsall M, Weigl M, Schmiedhofer M, Blum K, Rösner H, Strametz R, Gambashidze N. [Discharge management strategies in German general hospitals : A nationwide survey of professionals responsible for clinical risk management]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:587-594. [PMID: 38429575 PMCID: PMC11093802 DOI: 10.1007/s00103-024-03846-0] [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: 09/18/2023] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Transitions from inpatient care are associated with risks for the safety of patients. In 2017, the framework agreement on discharge management was legally defined. There is currently a lack of empirical data in Germany on the implementation of measures to ensure safe transitions of patients after inpatient care. The aim of this study is to provide an overview of the discharge management strategies implemented by German general hospitals. METHODS Between March and May 2022, specific discharge management strategies as well as structural and organizational characteristics were assessed in a nationwide survey of 401 general hospitals, and descriptive statistics and group comparisons were performed. RESULTS Seven of nine strategies surveyed were implemented in > 95% of all hospitals. The evaluation of discharge planning was only implemented in 61% of the hospitals, and systematic documentation, analysis, and evaluation of readmissions in 54%. Hospitals with a higher number of hospital beds reported significantly less often about "early contact with follow-up care providers" and "organization of a seamless transition to follow-up care." DISCUSSION A large part of the strategies in discharge management from inpatient treatment is implemented in German general hospitals. However, measures for evaluation and the systematic analysis of discharge processes and readmissions of patients have only been partially implemented. However, these are necessary to systematically evaluate and potentially improve the discharge processes.
Collapse
Affiliation(s)
- Matthias Marsall
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland.
| | - Matthias Weigl
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland
| | | | - Karl Blum
- Deutsches Krankenhausinstitut, Düsseldorf, Deutschland
| | - Hannah Rösner
- Wiesbaden Business School, Rhein Main University of Applied Sciences, Wiesbaden, Deutschland
| | - Reinhard Strametz
- Wiesbaden Business School, Rhein Main University of Applied Sciences, Wiesbaden, Deutschland
| | - Nikoloz Gambashidze
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland
| |
Collapse
|
4
|
Rivara MB, Prince DK, Leuther KK, Hussein WF, Mehrotra R, Edwards T, Schiller B, Patrick DL. Evaluation and Measurement Properties of a Patient-Reported Experience Measure for Home Dialysis. Clin J Am Soc Nephrol 2024; 19:602-609. [PMID: 38261328 PMCID: PMC11108240 DOI: 10.2215/cjn.0000000000000429] [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: 08/16/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND No previously validated patient-reported experience measures exist for use among patients undergoing home dialysis. We tested the Home Dialysis Care Experience survey, a newly developed 26-item experience measure, among patients from 30 dialysis facilities in the United States. METHODS Using mail and telephone survey modalities, we approached 1372 patients treated with peritoneal dialysis or home hemodialysis for participation. Using the results from completed surveys, we evaluated item calibration by assessing item floor and ceiling effects. We tested three sets of composite scores and used factor analysis to assess model fit for each. We evaluated associations of composite scores with global ratings and separately with patient and dialysis facility characteristics. Finally, we measured test-retest reliability in patients who completed the survey at two separate time points. RESULTS Overall, 495 eligible patients completed at least one survey (response rate 36%). Of these, 49 completed the survey in Spanish and 61 completed a second survey within 30 days. We did not detect significant floor or ceiling effects, except for one item that demonstrated >90% responses at the top response option. Analyses supported one 12-item composite scale with high internal consistency reliability: Quality of Home Dialysis Care and Operations (Cronbach alpha=0.85). This scale strongly correlated with overall staff rating ( r =0.73) and overall center rating ( r =0.70). Patient demographic and dialysis facility characteristics were not consistently associated with composite scale scores or overall staff or center ratings. Intraclass correlation coefficients in the test-retest population were 0.74 for the Quality scale, 0.88 for overall staff rating, and 0.90 for overall center rating. CONCLUSIONS The Home Dialysis Care Experience survey is a 26-item measure that includes one composite scale and two global rating scores and is an informative tool to evaluate patient experience of care for home dialysis.
Collapse
Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - David K. Prince
- Kidney Research Institute, University of Washington, Seattle, Washington
| | | | - Wael F. Hussein
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Todd Edwards
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | - Brigitte Schiller
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Donald L. Patrick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| |
Collapse
|
5
|
Kluger AN, Mizrahi M. Defining listening: Can we get rid of the adjectives? Curr Opin Psychol 2023; 52:101639. [PMID: 37437381 DOI: 10.1016/j.copsyc.2023.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023]
Abstract
Listening is a complex construct studied in various fields, including psychology, education, marketing, management, and medicine. Despite its importance, there is no agreed definition of the construct. Therefore, we review existing definitions of listening, primarily recent, focusing on those that describe listening in interpersonal contexts. We identify 20 adjectives describing listening and found two underlying themes: unobservable versus observable behaviors and focusing on the speaker's or listener's interests. Focusing on the unobservable and the speaker's interest, we propose a novel, adjective-free listening definition: the degree of devotion to co-exploring the Other with and for the other. Adopting a dyadic view, we argue that either the listener or the speaker can generate such devotion and initiate the co-creation of a listening state. Our new definition can contribute to developing empirical measures with good discriminant validity.
Collapse
Affiliation(s)
- Avraham N Kluger
- Hebrew University Business School, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Moran Mizrahi
- The Department of Psychology, Ariel University, Israel
| |
Collapse
|
6
|
Abdalla R, Pavlova M, Groot W. Association of patient experience and the quality of hospital care. Int J Qual Health Care 2023; 35:mzad047. [PMID: 37405854 PMCID: PMC10321378 DOI: 10.1093/intqhc/mzad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/26/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
The association between patient experience and the quality of hospital care is controversial. We assess the association between clinical outcomes and patient-reported experience measures (PREMs) in hospitals in Saudi Arabia. Knowledge on this issue informs value-based health-care reforms. A retrospective observational study was conducted in 17 hospitals in Saudi Arabia during the period of 2019-22. Hospital data were collected on PREMs, mortality, readmission, length of stay (LOS), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection. Descriptive analysis was used to describe hospital characteristics. Spearman's rho correlation tests were used to assess the correlation between these measures, and multivariate generalized linear mixed model regression analysis was used to study associations while controlling for hospital characteristics and year. Our analysis showed that PREMs were negatively correlated with hospital readmission rate (r = -0.332, P ≤ .01), LOS (r = -0.299, P ≤ .01), CLABSI (r = -0.297, P ≤ .01), CAUTI (r = -0.393, P ≤ .01), and surgical site infection (r = -0.298, P ≤ .01). The results indicated that CAUTI and LOS converged negatively with PREMs (β = -0.548, P = .005; β = -0.873, P = .008, respectively) and that larger hospitals tended to have better patient experience scores (β =0.009, P = .003). Our findings suggest that better performance in clinical outcomes is associated with higher PREM scores. PREMs are not a substitute or surrogate for clinical quality. Yet, PREMs are complementary to other objective measures of patient-reported outcomes, the process of care, and clinical outcomes.
Collapse
Affiliation(s)
- Rawia Abdalla
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, P.O. Box 616, Maastricht, Limburg 6200 MD, The Netherlands
| |
Collapse
|
7
|
Hydoub YM, Fischer KM, Hanson KT, Coons TJ, Wilshusen LL, Vista TL, Colbenson GA, Burton MC, Habermann EB, Dugani SB. Multisite analysis of patient experience scores and risk of hospital admission: a retrospective cohort study. Hosp Pract (1995) 2023; 51:35-43. [PMID: 36326005 PMCID: PMC9928911 DOI: 10.1080/21548331.2022.2144055] [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: 07/12/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions. METHODS In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]). RESULTS Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; P < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for hospital rating was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; P = 0.04), medical service line (0.81 [0.70-0.94]; P = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; P = 0.003). Favorable score for recommend hospital was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; P = 0.02) but for others (e.g. cleanliness of hospital environment) showed no association. CONCLUSION In routinely collected patient experience scores, favorable hospital rating was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.
Collapse
Affiliation(s)
- Yousif M. Hydoub
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristine T. Hanson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Tafi L. Vista
- Office of Patient Experience, Mayo Clinic, Rochester, MN, United States
| | | | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth B. Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Sagar B. Dugani
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
8
|
Burke HM, Carter J. Integration of patient experience factors improves readmission prediction. Medicine (Baltimore) 2023; 102:e32632. [PMID: 36701722 PMCID: PMC9857268 DOI: 10.1097/md.0000000000032632] [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: 01/27/2023] Open
Abstract
Many readmission prediction models have marginal accuracy and are based on clinical and demographic data that exclude patient response data. The objective of this study was to evaluate the accuracy of a 30-day hospital readmission prediction model that incorporates patient response data capturing the patient experience. This was a prospective cohort study of 30-day hospital readmissions. A logistic regression model to predict readmission risk was created using patient responses obtained during interviewer-administered questionnaires as well as demographic and clinical data. Participants (N = 846) were admitted to 2 inpatient adult medicine units at Massachusetts General Hospital from 2012 to 2016. The primary outcome was the accuracy (measured by receiver operating characteristic) of a 30-day readmission risk prediction model. Secondary analyses included a readmission-focused factor analysis of individual versus collective patient experience questions. Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) had a 30-day readmission. Demographic factors had an accuracy of 0.56 (confidence interval [CI], 0.50-0.62), clinical disease factors had an accuracy of 0.59 (CI, 0.54-0.65), and the patient experience factors had an accuracy of 0.60 (CI, 0.56-0.64). Taken together, their combined accuracy of receiver operating characteristic = 0.78 (CI, 0.74-0.82) was significantly more accurate than these factors were individually. The individual accuracy of patient experience, demographic, and clinical data was relatively poor and consistent with other risk prediction models. The combination of the 3 types of data significantly improved the ability to predict 30-day readmissions. This study suggests that more accurate 30-day readmission risk prediction models can be generated by including information about the patient experience.
Collapse
Affiliation(s)
| | - Jocelyn Carter
- Harvard Medical School, Boston, United States
- Massachusetts General Hospital, Boston, United States
- * Correspondence: Jocelyn Carter, Massachusetts General Hospital, 55 Fruit Street, Blake 15, Boston, MA 02114, United States (e-mail: )
| |
Collapse
|
9
|
Patel V, Lindenmeyer A, Gao F, Yeung J. A qualitative study exploring the lived experiences of patients living with mild, moderate and severe frailty, following hip fracture surgery and hospitalisation. PLoS One 2023; 18:e0285980. [PMID: 37200345 DOI: 10.1371/journal.pone.0285980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
It is well recognised that hip fracture surgery is associated with a negative impact on short and long-term post-operative physical health and emotional well-being for patients. Furthermore, these patients are known to be frail with multiple co-morbidities. This study explores how frailty shapes the lived experiences of rehabilitation and recovery for patients who have undergone hip fracture surgery. Semi-structured interviews were conducted with sixteen participants, recently discharged from hospital following hip fracture surgery. Interpretative phenomenological analysis was applied to explore the lived experiences of frail patients and ascertain important themes. Patient experiences were captured in seven overarching themes: 1) the hospital as a place of "safety", 2) placing trust in others, 3) the slow recovery journey impeded by attitude and support, 4) maintaining autonomy and dignity whilst feeling vulnerable, 5) seeking a new normal, 6) loneliness and social isolation and 7) the ageing body. Based on our study findings, we have been able to suggest a number of opportunities to improve support for frailer patients in finding a new routine to their everyday lives, these include on-going physical and psychological support, information and education and a robust pathway for transition of care into the community. A conceptual thematic diagram is presented which helps to understand the experience and the complex needs of frail older people undergoing hip fracture surgery.
Collapse
Affiliation(s)
- Vanisha Patel
- Department of Anaesthetics, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antje Lindenmeyer
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Fang Gao
- Birmingham Acute Care Research Centre, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Birmingham, United Kingdom
| | - Joyce Yeung
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Warwick, United Kingdom
| |
Collapse
|
10
|
Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, Won P, Yu EJ, Toomey SL. Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience. Pediatrics 2022; 150:189912. [PMID: 36336649 DOI: 10.1542/peds.2021-056001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. METHODS We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. RESULTS Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. CONCLUSIONS Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.
Collapse
Affiliation(s)
- Donna Luff
- Simulator Program (SIMPeds).,Harvard Medical School, Boston, Massachusetts
| | | | - Valerie L Ward
- Office of Health Equity and Inclusion, Department of Radiology.,Harvard Medical School, Boston, Massachusetts
| | - Sonia A Ballal
- Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Sara L Toomey
- Division of General Pediatrics.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Chen HC, Cates T, Taylor M. The effect of patient quality measurements and HCAHPS patient satisfaction on hospital reimbursements. HUMAN SYSTEMS MANAGEMENT 2022. [DOI: 10.3233/hsm-220042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The Centers of Medicare & Medicaid Services (CMS) links hospital reimbursements to quality metrics. Likewise, the Hospital Value-Based Purchasing (VBP) program offers financial incentives to acute-care hospitals based on performance improvements on several quality measures included in the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. A research gap exists with regard to assessing the effectiveness of VBP incentives on improving the patient’s quality of care. OBJECTIVE: This study is to determine whether hospitals which reported better patient quality metrics and lower frequency of pressure sores received higher reimbursements. METHODS: The data were retrieved from the CMS Care Compare website utilizing matched data from 2297 US hospitals. Information on HCAHPS, the VBP Program in Patient Safety Index, and Reimbursements was obtained for this study. Partial Least Square (PLS) was utilized thru SmartPLS 3.0 to test the hypotheses. RESULTS: The results did not reveal any financial penalties when hospitals reported lower patient quality outcomes and increased numbers of pressure sores. However, lower patient quality measures were associated with lower patient satisfaction. Controversially, lower patient satisfaction scores were associated with higher reimbursement rates overall. CONCLUSIONS: The main contribution of this study reveals that the effectiveness of value-based reimbursements and the concept of continuous improvement is constrained due to the lack of unified measurement objectives across US healthcare institutions.
Collapse
Affiliation(s)
- Hui-Chuan Chen
- College of Business and Global Affairs, University of Tennessee at Martin, Martin, TN, USA
| | - Tommy Cates
- College of Business and Global Affairs, University of Tennessee at Martin, Martin, TN, USA
| | - Monty Taylor
- College of Business and Global Affairs, University of Tennessee at Martin, Martin, TN, USA
| |
Collapse
|
12
|
Olson EM, Falde SD, Wegehaupt AK, Polley E, Halvorsen AJ, Lawson DK, Ratelle JT. Dismissal disagreement and discharge delays: Associations of patient-clinician plan of care agreement with discharge outcomes. J Hosp Med 2022; 17:710-718. [PMID: 35942985 DOI: 10.1002/jhm.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many hospitalized patients do not understand or agree with their clinicians about their discharge plan. However, the effect of disagreement on discharge outcomes is unknown. OBJECTIVE To measure the correlation between patient-clinician care agreement and discharge outcomes. DESIGN A prospective cohort study was performed from September 2019 to March 2020 (Rochester, MN, USA). SETTING AND PARTICIPANTS Internal medicine patients and their primary clinician (resident, advanced practice clinician or attending) hospitalized from September 2019-March 2020 at Mayo Clinic Hospital. Participants were independently surveyed following hospital day #3 ward rounds regarding the goals of the hospitalization and discharge planning. MAIN OUTCOME AND MEASURES Patient-clinician agreement for main diagnosis, patient's main concern, and four domains of discharge planning was assessed. Readiness for hospital discharge, delayed discharge, and 30-day readmission was measured. Then, associations between patient-clinician agreement, delayed discharge, and 30-day readmissions were analyzed using multivariable logistic regression. RESULTS Of the 436 patients and clinicians, 17.7% completely agreed about what needs to be accomplished before dismissal, 40.8% agreed regarding discharge date, and 71.1% agreed regarding discharge location. In the multivariable model, patient-clinician agreement scores were not significantly correlated with discharge outcomes. Patient-clinician agreement on discharge location was higher for those discharged to home (81.5%) versus skilled nursing facility (48.5%) or assisted living (42.9%) (p < .0001). The agreement on the expected length of stay was highest for home-goers (45.9%) compared to skilled nursing (32.0%) or assisted living (21.4%) (p = .004). CONCLUSIONS Patients and their clinicians frequently disagree about when and where a patient will go after hospitalization, particularly for those discharged to a skilled nursing facility. While disagreement did not predict discharge outcomes, our findings suggest opportunities to improve effective communication and promote shared mental models regarding discharge earlier in the hospital stay.
Collapse
Affiliation(s)
- Emily M Olson
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel D Falde
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Eric Polley
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Donna K Lawson
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John T Ratelle
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
13
|
Paolini D, Bonaccorsi G, Lorini C, Forni S, Tanzini M, Toccafondi G, D'Arienzo S, Dannaoui B, Niccolini F, Tomaiuolo M, Bussotti A, Petrioli A, Morettini A. Careggi Re-Engineered Discharge (CaRED) Project: Standardize Discharge and Improve Care Coordination Between Healthcare Professionals. Int J Qual Health Care 2022; 34:6650607. [PMID: 35894611 DOI: 10.1093/intqhc/mzac060] [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: 08/25/2021] [Revised: 05/12/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The hospital discharge process plays a key role for patient care. CaRED (Careggi Re-Engineered Discharge) aimed at establishing a meaningful relationship among General Practitioners (GPs) and patients, throughout the discharge process. In this paper we describe the activities and results in the period 2014 - 2017. METHODS CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad-hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy of effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction. RESULTS A total of 1,549 hospitalizations were included, respectively 717 in the pre and 832 in the post intervention period. The 30-day hospital readmission rate decreased significantly in the post intervention period (14.4% vs 19.4%, χ2(1)=8.03, P<0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post- survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1)=0.56, P=0.03) and on what to do if conditions change (χ2(31)=19.0 P <0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3)=19.6, P <0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post- survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P <0.01). CONCLUSIONS CaRED significantly improved the discharge process, and became a benchmark for local improvements in communication patterns with GPs.
Collapse
Affiliation(s)
- Diana Paolini
- Hospital Health Management, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, Viale G.B. Morgagni 48, Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Viale G.B. Morgagni 48, Florence, Italy
| | - Silvia Forni
- Quality and Equity Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, Florence, Italy
| | - Michela Tanzini
- Clinical Risk Management and Patient Safety Center - GRC, Via Pietro Dazzi, 1, Florence, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center - GRC, Via Pietro Dazzi, 1, Florence, Italy
| | - Sara D'Arienzo
- Quality and Equity Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, Florence, Italy
| | - Bassam Dannaoui
- Technological Innovation in Clinical-Assistance Activities Unit, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| | - Fabrizio Niccolini
- Hospital Health Management, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| | - Matteo Tomaiuolo
- Hospital Health Management, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| | | | - Alessandra Petrioli
- Internal Medicine, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| | - Alessandro Morettini
- Internal Medicine, Careggi Teaching Hospital, Largo Brambilla 3, Florence, Italy
| |
Collapse
|
14
|
Wong ELY, Poon CM, Cheung AWL, Chen FY, Yeoh EK. Relationship between patient experience and hospital readmission: system-level survey with deterministic data linkage method. BMC Med Res Methodol 2022; 22:197. [PMID: 35864472 PMCID: PMC9306034 DOI: 10.1186/s12874-022-01677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Linkage of public healthcare data provides powerful resources for studying from a comprehensive view of quality of care than information for a single administrative database. It is believed that positive patient experiences reflect good quality of health care and may reduce patient readmission. This study aimed to determine the relationship between patient experience and hospital readmission at a system level by linking anonymous experience survey data with de-identified longitudinal hospital administrative admissions data. Methods Data were obtained by linking two datasets with anonymised individual-level records from seven largest-scale acute public hospitals over seven geographical clusters in Hong Kong. Selected records in the two datasets involving patient experience survey (PES) (2013 survey dataset) and healthcare utilization (admissions dataset) were used. Following data cleaning and standardization, a deterministic data linkage algorithm was used to identify pairs of records uniquely matched for a list of identifiers (10 selected variables) between two datasets. If patient’s record from the survey dataset matched with the hospitalization records in the admissions dataset, they were included in the subsequent analyses. Bivariate analyses and multivariable logistic regression models were performed to evaluate the associations between hospital readmission in the next calendar month and patient experience. Results The overall matching rate was 62.1% (1746/2811) for PES participants aged 45 or above from the survey dataset. The average score for overall inpatient experience was 8.10 (SD = 1.53). There was no significant difference between matched patients and unmatched patients in terms of their score for the perception of overall quality of care received during hospitalization (X2 = 6.931, p-value = 0.14) and score for overall inpatient experience (X2 = 7.853, p-value = 0.25). In the multivariable model, readmission through the outpatient department (planned admission) in the next calendar month was significantly associated with a higher score given to the overall quality of care received (adjusted OR = 1.54, 95%CI = 1.09–2.17), while such association was absent for readmission through Accident and Emergency department (adjusted OR = 0.75, 95%CI = 0.50–1.12). Conclusions This study demonstrated the feasibility of routine record linkage, with the limited intrusion of patients’ confidentiality, for evaluating health care quality. It also highlights the significant association between readmission through planned readmission and a higher score for overall quality of care received. A possible explanation might be the perceived better co-ordination between outpatient departments and inpatient service and the well-informed discharge plan given to this group of patients.
Collapse
Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Chin-Man Poon
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Frank Youhua Chen
- Department of Management Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
15
|
Nijhawan AE, Zhang S, Chansard M, Gao A, Jain MK, Halm EA. A Multicomponent Intervention to Reduce Readmissions Among People With HIV. J Acquir Immune Defic Syndr 2022; 90:161-169. [PMID: 35135975 PMCID: PMC9203879 DOI: 10.1097/qai.0000000000002938] [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: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH. METHODS Demographic, socioeconomic, and clinical variables were collected from the electronic health records of PWH or those with cellulitis (control group) hospitalized at an urban safety-net hospital before and after (from September 2012 to December 2016) the implementation of a multidisciplinary HIV transitional care team. After October 2014, hospitalized PWH could receive a medical HIV consultation ± a transitional care nurse intervention. The primary outcome was readmission to any hospital within 30 days of discharge. Multivariate logistic regression and propensity score analyses were conducted to compare readmissions before and after intervention implementation in PWH and people with cellulitis. RESULTS Overall, among PWH, 329 of the 2049 (16.1%) readmissions occurred before and 329 of the 2023 (16.3%) occurred after the transitional care team intervention. After including clinical and social predictors, the adjusted odds ratio of 30-day readmissions for postintervention for PWH was 0.81 (95% confidence interval: 0.66 to 0.99, P= 0.04), whereas little reduction was identified for those with cellulitis (adjusted odds ratio 0.91 (95% confidence interval: 0.81 to 1.02, P= 0.10). A dose-response effect was not observed for receipt of different HIV intervention components. CONCLUSIONS A multicomponent intervention reduced the adjusted risk of 30-day readmissions in PWH, although no dose-response effect was detected. Additional efforts are needed to reduce overall hospitalizations and readmissions among PWH including increasing HIV prevention, early diagnosis and engagement in care, and expanding the availability and spectrum of transitional care services.
Collapse
Affiliation(s)
- Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital Systems, Dallas, TX
- Departments of Population and Data Sciences
| | - Song Zhang
- Departments of Population and Data Sciences
| | - Matthieu Chansard
- Anesthesia and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX; and
| | - Ang Gao
- Departments of Population and Data Sciences
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital Systems, Dallas, TX
| | - Ethan A Halm
- Departments of Population and Data Sciences
- Department of Internal Medicine, Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
16
|
Lee ZY, Uitvlugt EB, Karapinar-Çarkit F. Medication-Related Readmissions: Documentation of the Medication Involved and Communication in the Care Continuum. Front Pharmacol 2022; 13:824892. [PMID: 35387329 PMCID: PMC8978797 DOI: 10.3389/fphar.2022.824892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Of all readmissions, 21% are medication-related readmissions (MRRs). However, it is unknown whether MRRs are recognized at the time of readmission and are communicated in the care continuum. Objectives: To identify the prevalence of MRRs that contain a documentation on the medication involved (and therefore are regarded as recognized), and the proportion of communicated MRRs. Setting: The study was performed in a teaching hospital. Methods: In a previous study, a multidisciplinary team of physicians and pharmacists assessed the medication-relatedness, the medication involved and preventability of unplanned readmissions from seven departments. In the current cross-sectional study, two pharmacy team members evaluated the patient records independently. An MRR was regarded as recognized when the medication involved was documented in patient records. An MRR was regarded as communicated to the patient and/or the next healthcare provider when the medication involved or a description was mentioned in discharge letters or discharge prescriptions. The relationship between documented MRRs and whether the MRR was preventable as well as the relationship between (un)documented MRRs and the length of stay (LOS) were assessed. Descriptive data analysis was used. Results: Of 181 included MRRs, 72 (40%) were deemed preventable by the multidisciplinary team. For 159 of 181 MRRs (88%), a documentation on the medication involved was present. Of 159 documented MRRs, 93 (58%) were communicated to patients and/or caregivers, 137 (86%) to the general practitioner, and 4 (3%) to the community pharmacy. The medication involved was documented less often for potentially preventable MRRs than for non-preventable MRRs (78 vs. 95%; p = 0.002). The LOS was longer for MRRs where the medication involved was undocumented (median 8 vs. 5 days; p = 0.062). Conclusion: The results of this study imply that MRRs are not always recognized, which could impact patients’ well-being. In this study an increased LOS was observed with unrecognized MRRs. Communication of MRRs to the patients and/or the next healthcare providers should be improved.
Collapse
Affiliation(s)
- Ze-Yun Lee
- Department of Clinical Pharmacy, OLVG, Amsterdam, Netherlands
| | | | | |
Collapse
|
17
|
Greisman JD, Olmsted ZT, Crorkin PJ, Dallimore CA, Zhigin V, Shlifer A, Bedi AD, Kim JK, Nelson P, Sy HL, Patel KV, Ellis JA, Boockvar J, Langer DJ, D'Amico RS. Enhanced Recovery After Surgery (ERAS) for Cranial Tumor Resection: A Review. World Neurosurg 2022; 163:104-122.e2. [PMID: 35381381 DOI: 10.1016/j.wneu.2022.03.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols describe a standardized method of preoperative, perioperative, and postoperative care to enhance outcomes and minimize complication risks surrounding elective surgical intervention. A growing body of evidence is being generated as we learn to apply principles of ERAS standardization to neurosurgical patients. First applied in spinal surgery, ERAS protocols have been extended to cranial neuro-oncological procedures. This review synthesizes recent findings to generate evidence-based guidelines to manage neurosurgical oncology patients with standardized systems and assess ability of these systems to coordinate multidisciplinary, patient-centric care efforts. Furthermore, we highlight the potential utility of multimedia, app-based communication platforms to facilitate patient education, autonomy, and team communication within each of the three settings.
Collapse
Affiliation(s)
- Jacob D Greisman
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY.
| | - Zachary T Olmsted
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Patrick J Crorkin
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Colin A Dallimore
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Vadim Zhigin
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Artur Shlifer
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Anupama D Bedi
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Jane K Kim
- Department of Anesthesiology, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Priscilla Nelson
- Department of Anesthesiology, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Heustein L Sy
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Kiran V Patel
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - John Boockvar
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| |
Collapse
|
18
|
Combs CA, Goffman D, Pettker CM, Pettker C. Society for Maternal-Fetal Medicine Special Statement: A critique of postpartum readmission rate as a quality metric. Am J Obstet Gynecol 2022; 226:B2-B9. [PMID: 34838802 DOI: 10.1016/j.ajog.2021.11.1355] [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] [Indexed: 11/01/2022]
Abstract
Hospital readmission is considered a core measure of quality in healthcare. Readmission soon after hospital discharge can result from suboptimal care during the index hospitalization or from inadequate systems for postdischarge care. For many conditions, readmission is associated with a high rate of serious morbidity and potentially avoidable costs. In obstetrics, for postpartum care specifically, hospitals and payers can easily track the rate of maternal readmission after childbirth and may seek to incentivize obstetricians, maternal-fetal medicine specialists, or provider groups to reduce the rate of readmission. However, this practice has not been shown to improve outcomes or reduce harm. There are major concerns with incentivizing providers to reduce postpartum readmissions, including the lack of a standardized metric, a baseline rate of 1% to 2% that is too low to accurately discriminate between random variation and controllable factors, the need for risk adjustment that greatly complicates rate calculations, the potential for bias depending on the duration of the follow-up interval, the potential for the "gaming" of the metric, the lack of evidence that obstetrical providers can influence the rate, and the potential for unintended harm in the vulnerable postpartum population. Until these problems are adequately addressed, maternal readmission rate after a childbirth hospitalization currently has limited utility as a metric for quality or performance improvement or as a factor to adjust provider reimbursement.
Collapse
|
19
|
Thevelin S, Pétein C, Metry B, Adam L, van Herksen A, Murphy K, Knol W, O'Mahony D, Rodondi N, Spinewine A, Dalleur O. Experience of hospital-initiated medication changes in older people with multimorbidity: a multicentre mixed-methods study embedded in the OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial. BMJ Qual Saf 2022; 31:888-898. [PMID: 35351779 DOI: 10.1136/bmjqs-2021-014372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND A patient-centred approach to medicines optimisation is considered essential. The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial evaluated the effectiveness of medication review with shared decision-making (SDM) in older people with multimorbidity. Beyond evaluating the clinical effectiveness, exploring the patient experience facilitates a better understanding of contextual factors and mechanisms affecting medication review effectiveness. OBJECTIVE To explore experiences of hospital-initiated medication changes in older people with multimorbidity. METHODS We conducted a multicentre mixed-methods study, embedded in the OPERAM trial, combining semi-structured interviews and the Beliefs about Medicines Questionnaire (BMQ) with a purposive sample of 48 patients (70-94 years) from four European countries. Interviews were analysed using the Framework approach. Trial implementation data on SDM were collected and the 9-item SDM questionnaire was conducted with 17 clinicians. RESULTS Patients generally displayed positive attitudes towards medication review, yet emphasised the importance of long-term, trusting relationships such as with their general practitioners for medication review. Many patients reported a lack of information and communication about medication changes and predominantly experienced paternalistic decision-making. Patients' beliefs that 'doctors know best', 'blind trust', having limited opportunities for questions, use of jargon terms by clinicians, 'feeling too ill', dismissive clinicians, etc highlight the powerlessness some patients felt during hospitalisation, all representing barriers to SDM. Conversely, involvement of companions, health literacy, empathetic and trusting patient-doctor relationships, facilitated SDM. Paradoxical to patients' experiential accounts, clinicians reported high levels of SDM. The BMQ showed that most patients had high necessity and low concern beliefs about medicines. Beliefs about medicines, experiencing benefits or harms from medication changes, illness perception, trust and balancing advice between different healthcare professionals all affected acceptance of medication changes. CONCLUSION To meet patients' needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings.
Collapse
Affiliation(s)
- Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Beatrice Metry
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anniek van Herksen
- Department of Geriatric Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital and Department of Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
20
|
Clinical characteristics and risk factors of preventable hospital readmissions within 30 days. Sci Rep 2021; 11:20172. [PMID: 34635681 PMCID: PMC8505517 DOI: 10.1038/s41598-021-99250-8] [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: 04/12/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Knowledge regarding preventable hospital readmissions is scarce. Our aim was to compare the clinical characteristics of potentially preventable readmissions (PPRs) with non-PPRs. Additionally, we aimed to identify risk factors for PPRs. Our study included readmissions within 30 days after discharge from 1 of 7 hospital departments. Preventability was assessed by multidisciplinary meetings. Characteristics of the readmissions were collected and 23 risk factors were analyzed. Of the 1120 readmissions, 125 (11%) were PPRs. PPRs occurred equally among different departments (p = 0.21). 29.6% of PPRs were readmitted by a practitioner of a different medical specialty than the initial admission (IA) specialist. The PPR group had more readmissions within 7 days (PPR 54% vs. non-PPR 44%, p = 0.03). The median LOS was 1 day longer for PPRs (p = 0.16). Factors associated with PPR were higher age (p = 0.004), higher socio-economic status (p = 0.049), fewer prior hospital admissions (p = 0.004), and no outpatient visit prior to readmission (p = 0.025). This study found that PPRs can occur at any department in the hospital. There is not a single type of patient that can easily be pinpointed to be at risk of a PPR, probably due to the multifactorial nature of PPRs.
Collapse
|
21
|
Sadda P, Huang B, Taha B. Online Reviews of Hemodialysis Centers Correlate With Medicare and Medicaid Survey Measures of Patient Experience. Qual Manag Health Care 2021; 30:213-218. [PMID: 34326289 DOI: 10.1097/qmh.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient experience in outpatient hemodialysis has been shown to be significantly correlated with health outcomes. The current gold standard for assessing patient experience in outpatient hemodialysis is the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS). Online reviews of outpatient hemodialysis centers could potentially serve as an additional source of information regarding patient experience, but they have not been well validated. This study aims to determine whether overall scores and subscores from patient-authored online reviews of outpatient dialysis centers are correlated with current gold standard survey-based measures of patient experience in outpatient hemodialysis. METHODS All reviews of hemodialysis centers posted to the online review site CiteHealth.com between March 2008 and October 2019 were collected (1081 reviews of 762 centers). Publicly-available ICH-CAHPS survey summary data and End Stage Renal Disease Quality Incentive Program (ESRD QIP) summary data from May 2016 to October 2019 were obtained from the Dialysis Facility Compare website. Spearman correlation coefficients were calculated between facilities' mean online review overall scores and subscores within a given year and their ICH-CAHPS ratings from the same year. Statistical significance was assessed with a 2-tailed permutation test. A Bonferroni correction for multiple hypothesis testing was applied. RESULTS The mean "Overall" score from CiteHealth.com had a significant positive correlation with the "Center Care Quality," "Staff," and "Facility" scores from ICH-CAHPS surveys. No significant correlation could be found between the mean "Overall" CiteHealth.com score and any other ICH-CAHPS patient satisfaction metric. There was a significant positive correlation between the mean CiteHealth.com "Center" score and the ICH-CAHPS "Center Care Quality" score, the mean CiteHealth.com "Facility" score and the ICH-CAHPS "Facility" score, and the mean CiteHealth.com "Staff" score and the ICH-CAHPS "Staff" score. No significant correlation was found between the mean CiteHealth.com "Nephrologist" score and the ICH-CAHPS "Nephrologist" score. No significant correlation was found between online review scores and ESRD QIP health outcome measures. CONCLUSION Certain components of online reviews are significantly correlated with ICH-CAHPS measures of patient experience. Additionally, online reviews come with narrative comments that can offer specific insights into positive and negative aspects of patient care that cannot always be elucidated by numeric survey questions. Online reviews may have utility as an adjunctive source of information to patient experience surveys such as the ICH-CAHPS.
Collapse
Affiliation(s)
- Praneeth Sadda
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana (Dr Sadda and Mr Huang); and Department of Surgery, University of Minnesota School of Medicine, Minneapolis (Dr Taha)
| | | | | |
Collapse
|
22
|
Del Palacio-Gonzalez A, Hesse M, Thylstrup B, Pedersen MU, Pedersen MM. Effects of contingency management and use of reminders for drug use treatment on readmission and criminality among young people: A linkage study of a randomized trial. J Subst Abuse Treat 2021; 133:108617. [PMID: 34544626 DOI: 10.1016/j.jsat.2021.108617] [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: 03/21/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION An increasing number of adolescents and emerging adults are entering treatment for drug use disorders in high-income countries. This fact points not only to a need to evaluate treatment outcomes related to drug use reduction, but also to evaluate other indicators of treatment success. The aim of this study was to examine treatment effects on predicting readmission to drug use treatment and being convicted for a criminal offence among youth. A second aim was to examine whether a psychiatric history had an impact on these outcomes. METHODS Participants were 460 youth aged 15-25 who took part in the YouthDAT, a randomized pragmatic clinical trial for outpatient drug use treatment. The trial compared four treatment conditions consisting of 12 sessions of a manualized treatment based on cognitive behavioral therapy and motivational interviewing. Condition one was the standard (only the manual); condition two consisted of standard treatment and contingency management (CM) (Vouchers); condition three included standard treatment, text reminders, and low-intensity aftercare (Reminders+LIA); and condition four combined the standard treatment, CM, text reminders, and low-intensity aftercare (Combined+LIA). The study linked participants to register data on psychiatric history, drug use treatment history, and criminal convictions. RESULTS Treatment conditions Reminders+LIA (aB = 0.42, p = .026) and Combined+LIA (aB = 0.69, p = .000) predicted longer time to readmission compared to standard treatment. The Vouchers condition predicted a lower risk for criminal convictions (aIRR = 0.26, p = .001). Half of the participants had a psychiatric history. The treatments with additional strategies were useful in delaying readmission and reducing convictions for these youth. The results remained significant in the adjusted models accounting for relevant participant characteristics. CONCLUSIONS Additional treatment strategies in outpatient drug use treatment, such as CM, text reminders, and low-intensity aftercare, predicted delayed readmission to treatment and fewer legal problems. Mental health problems were common among youth. However, the treatments with additional strategies were effective with youth with a psychiatric history. Overall, while the additional strategies may be resource demanding for clinical settings, they support treatment success and may also help to decrease other public costs. TRIAL REGISTRATION ISRCTN registry ISRCTN27473213.
Collapse
Affiliation(s)
- Adriana Del Palacio-Gonzalez
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Michael Mulbjerg Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| |
Collapse
|
23
|
Carter J, Hassan S, Walton A, Yu L, Donelan K, Thorndike AN. Effect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2110936. [PMID: 34014324 PMCID: PMC8138690 DOI: 10.1001/jamanetworkopen.2021.10936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. OBJECTIVE To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. INTERVENTION CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. RESULTS A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03085264.
Collapse
Affiliation(s)
- Jocelyn Carter
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Susan Hassan
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne Walton
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Boston
- Brandeis University, Waltham, Massachusetts
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
24
|
Meyer MA. Qualifications and Skills Required for Patient Experience Positions. J Patient Exp 2020; 7:1535-1542. [PMID: 33457611 PMCID: PMC7786781 DOI: 10.1177/2374373519895091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The need to provide patient-centered care has been recognized by major players in the health-care field. As such, attention has been placed on patients' experience of the health care they receive, and health-care organizations have been investing in patient experience initiatives and staffing to implement those initiatives. Given this, the objective for this study was to investigate the qualifications and skills US health-care organizations seek for patient experience positions through a content analysis of job postings. Results show that patient experience positions are largely found in health systems and hospitals. These positions include coordinators, directors, managers, specialists, and advisors. Five key skills were identified: collaborating with stakeholders; coordinating, planning, and executing service excellence programs; handling complaints and grievances; educating and training leadership and frontline employees; and providing excellent customer service. The skills vary depending on the position. The overall goal for patient experience positions is to ensure a complete and positive patient experience. As these patient experience positions are relatively new, requirements will likely evolve over time as organizations adapt patient experience strategies.
Collapse
Affiliation(s)
- Melanie A Meyer
- Department of Public Health, University of Massachusetts, Lowell, MA, USA
| |
Collapse
|
25
|
King B, Bodden J, Steege L, Brown CJ. Older adults experiences with ambulation during a hospital stay: A qualitative study. Geriatr Nurs 2020; 42:225-232. [PMID: 32861430 DOI: 10.1016/j.gerinurse.2020.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
Abstract
Older adults often lose their ability to independently ambulate during a hospital stay. Few studies have investigated older adults' experiences with ambulation during hospitalization. The purpose of this study was to understand older adults' perceptions of and experiences with ambulation during a hospital admission. A qualitative study using Inductive Content Analysis was conducted. Community-dwelling older adults (N = 11) were recruited to participant in five focus group meetings each lasting 90 min. All individuals participated in each focus group. Participants described high complexity in deciding whether or not they could ambulate. Six categories were identified: Uncertainty, Restriction Messaging, Non-Welcoming Space, Caring for Nurse and Self, Feeling Isolated, and Presenting Self. This study provides a detailed understanding of older adults' experiences and perceptions of a hospital stay. Findings from this study can serve as a foundation for future interventions to improve older adult patient ambulation during hospitalization.
Collapse
Affiliation(s)
- Barbara King
- APRN-BC University of Wisconsin- Madison, School of Nursing.
| | - Jillian Bodden
- UW Health, Department of Geriatrics, University of Wisconsin- Madison, School of Nursing
| | | | - Cynthia J Brown
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, University of Alabama at Birmingham
| |
Collapse
|
26
|
Shah N, Konchak C, Chertok D, Au L, Kozlov A, Ravichandran U, McNulty P, Liao L, Steele K, Kharasch M, Boyle C, Hensing T, Lovinger D, Birnberg J, Solomonides A, Halasyamani L. Clinical Analytics Prediction Engine (CAPE): Development, electronic health record integration and prospective validation of hospital mortality, 180-day mortality and 30-day readmission risk prediction models. PLoS One 2020; 15:e0238065. [PMID: 32853223 PMCID: PMC7451512 DOI: 10.1371/journal.pone.0238065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous predictive models in the literature stratify patients by risk of mortality and readmission. Few prediction models have been developed to optimize impact while sustaining sufficient performance. OBJECTIVE We aimed to derive models for hospital mortality, 180-day mortality and 30-day readmission, implement these models within our electronic health record and prospectively validate these models for use across an entire health system. MATERIALS & METHODS We developed, integrated into our electronic health record and prospectively validated three predictive models using logistic regression from data collected from patients 18 to 99 years old who had an inpatient or observation admission at NorthShore University HealthSystem, a four-hospital integrated system in the United States, from January 2012 to September 2018. We analyzed the area under the receiver operating characteristic curve (AUC) for model performance. RESULTS Models were derived and validated at three time points: retrospective, prospective at discharge, and prospective at 4 hours after presentation. AUCs of hospital mortality were 0.91, 0.89 and 0.77, respectively. AUCs for 30-day readmission were 0.71, 0.71 and 0.69, respectively. 180-day mortality models were only retrospectively validated with an AUC of 0.85. DISCUSSION We were able to retain good model performance while optimizing potential model impact by also valuing model derivation efficiency, usability, sensitivity, generalizability and ability to prescribe timely interventions to reduce underlying risk. Measuring model impact by tying prediction models to interventions that are then rapidly tested will establish a path for meaningful clinical improvement and implementation.
Collapse
Affiliation(s)
- Nirav Shah
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - Chad Konchak
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Daniel Chertok
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Loretta Au
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Alex Kozlov
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Urmila Ravichandran
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Patrick McNulty
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Linning Liao
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Kate Steele
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Maureen Kharasch
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Chris Boyle
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - Tom Hensing
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - David Lovinger
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - Jonathan Birnberg
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - Anthony Solomonides
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Lakshmi Halasyamani
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| |
Collapse
|
27
|
Thomas Craig KJ, McKillop MM, Huang HT, George J, Punwani ES, Rhee KB. U.S. hospital performance methodologies: a scoping review to identify opportunities for crossing the quality chasm. BMC Health Serv Res 2020; 20:640. [PMID: 32650759 PMCID: PMC7350649 DOI: 10.1186/s12913-020-05503-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Hospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions. These assessments have been developed by government, private and non-profit organizations, and academic institutions. Given the number and variability in available assessments, a knowledge gap exists regarding what assessments are available and how each assessment measures quality to identify top performing hospitals. This study aims to: (a) comprehensively identify current hospital performance assessments, (b) compare quality measures from each methodology in the context of the Institute of Medicine’s (IOM) six domains of STEEEP (safety, timeliness, effectiveness, efficiency, equitable, and patient-centeredness), and (c) formulate policy recommendations that improve value-based, patient-centered care to address identified gaps. Methods A scoping review was conducted using a systematic search of MEDLINE and the grey literature along with handsearching to identify studies that provide assessments of US-based hospital performance whereby the study cohort examined a minimum of 250 hospitals in the last two years (2017–2019). Results From 3058 unique records screened, 19 hospital performance assessments met inclusion criteria. Methodologies were analyzed across each assessment and measures were mapped to STEEEP. While safety and effectiveness were commonly identified measures across assessments, efficiency, and patient-centeredness were less frequently represented. Equity measures were also limited to risk- and severity-adjustment methods to balance patient characteristics across populations, rather than stand-alone indicators to evaluate health disparities that may contribute to community-level inequities. Conclusions To further improve health and healthcare value-based decision-making, there remains a need for methodological transparency across assessments and the standardization of consensus-based measures that reflect the IOM’s quality framework. Additionally, a large opportunity exists to improve the assessment of health equity in the communities that hospitals serve.
Collapse
Affiliation(s)
- Kelly J Thomas Craig
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA.
| | - Mollie M McKillop
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Hu T Huang
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Judy George
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Ekta S Punwani
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Kyu B Rhee
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| |
Collapse
|
28
|
Chen HC, Cates T, Taylor M, Cates C. Improving the US hospital reimbursement: how patient satisfaction in HCAHPS reflects lower readmission. Int J Health Care Qual Assur 2020; ahead-of-print. [PMID: 32633907 DOI: 10.1108/ijhcqa-03-2019-0066] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine whether patient readmission rates are associated with patient satisfaction and Medicare reimbursement rates in the US hospitals. DESIGN/METHODOLOGY/APPROACH The Hospital Compare database was obtained from the Centers for Medicare and Medicaid Services (CMS) in the US. A total of 2,711 acute care hospitals were analyzed for this present study. The data included patient satisfaction surveys, hospital 30-days readmission ratios for heart failure and pneumonia patients and related payments. Exploratory factor analysis was applied in the first stage to operationalize constructs for scale development. Partial least squares (PLS) modeling analysis via Smart-PLS was utilized for testing the hypotheses. FINDINGS Results indicated that data provided from the Hospital Compare database for the acute care hospitals accurately reflect quality outcomes. Nevertheless, the Medicare Hospital Readmissions Reduction Program (HRRP) did not penalize the hospitals when patients reported lower satisfaction via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. ORIGINALITY/VALUE The findings suggest that a high-readmission rate is not associated with lower payment. Such results appear to conflict with the goals of value-based purchasing programs, which seek to penalize hospitals financially for higher readmission rates.
Collapse
Affiliation(s)
- Hui-Chuan Chen
- Department of MMIS, University of Tennessee at Martin, Martin, Tennessee, USA
| | - Tommy Cates
- Department of MMIS, University of Tennessee at Martin, Martin, Tennessee, USA
| | - Monty Taylor
- Department of MMIS, University of Tennessee at Martin, Martin, Tennessee, USA
| | | |
Collapse
|
29
|
Association of Patient-reported Experiences and Surgical Outcomes Among Group Practices: Retrospective Cohort Study. Ann Surg 2020; 271:475-483. [PMID: 30188401 DOI: 10.1097/sla.0000000000003034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices. BACKGROUND The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined. METHODS Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix. RESULTS Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions. CONCLUSIONS In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.
Collapse
|
30
|
Romanova AL, Carter-Brooks C, Ruppert KM, Zyczynski HM. 30-Day unanticipated healthcare encounters after prolapse surgery: impact of same day discharge. Am J Obstet Gynecol 2020; 222:482.e1-482.e8. [PMID: 31733206 DOI: 10.1016/j.ajog.2019.11.1249] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Same-day discharge is becoming increasingly common in gynecologic surgery; however, data are limited for frequency, setting, and severity of unanticipated healthcare visits for women who are discharged on the day of surgery after major prolapse repair. OBJECTIVE The purpose of this study was to evaluate whether discharge on the day of surgery is associated with increased 30-day unanticipated healthcare encounters after major pelvic organ prolapse surgery compared with discharge on or after postoperative day 1. STUDY DESIGN This is a retrospective analysis of women who underwent pelvic organ prolapse surgery by 8 female pelvic medicine and reconstructive surgery surgeons from January 2016 to October 2017. Unanticipated healthcare encounter was a composite variable of any visit to the office, emergency department, or hospital readmission. Number of visits, visit diagnoses, and complication severity (Clavien-Dindo classification) were compared by day of discharge with the use of χ2 tests. Multivariable analyses were performed. RESULTS Of 405 women, 258 (63.7%) were discharged on the day of surgery, and 147 (36.3%) were discharged on postoperative day 1 or later. Mean age was 66±11 years, body mass index was 27.9±4.8 kg/m2. Most had stage III prolapse (n=273; 67.4%). Procedures included laparoscopic or robotic sacrocolpopexy, (n=163; 40.2%), vaginal apical suspensions (n=115; 28.4%), obliterative (n=105; 25.9%), and concomitant hysterectomy (n=229; 56.5%). There was no increase in the number of women with at least 1 unanticipated healthcare encounter within 30 days of surgery, based on discharge on the day of surgery compared with postoperative day 1 (24.0% vs 26.5%; P=.572). The majority of visits occurred in the office (17.8% vs 19.0%; P=.760). There was no increase in 30-day readmissions (3.5% vs 4.8%; P=.527). The most common visit diagnosis was pain and accounted for 31.5% of all visits, followed by urologic and gastrointestinal symptoms. Diagnoses and complication severity did not vary by day of discharge, except that women who were discharged on the day of surgery were more likely to have a superficial wound separation (11.3% vs 0%; P=.011) and less likely to experience grade II complications (7.4% vs 15.6%, P=.009). Few women had >1 unscheduled visit, and rates were similar between the 2 groups (6.2% vs 6.8%; P=.810). On multivariable regression, younger women (adjusted odds ratio, 1.03; 95% confidence interval, 1.001-1.05), those with lower body mass index (adjusted odds ratio, 1.07; 95% confidence interval, 1.13-1.01), and higher initial postanesthesia recovery unit pain scores (adjusted odds ratio, 1.11; 95% confidence interval, 1.02-1.21) were more likely to have an unanticipated healthcare encounter. Pain complaints were evaluated most often in the office compared with the emergency department (41.1% vs 13.0%); medical complications such as cardiac (15.6% vs 0%) and respiratory (6.5% vs 0%) were more likely to be evaluated in the emergency department. Higher grade complications (II/III) were more likely to visit the emergence department (78.2% vs 27.1%; P<.0001). CONCLUSION Same-day discharge after prolapse surgery did not result in an increase in 30-day unanticipated healthcare encounters.
Collapse
Affiliation(s)
- Anna L Romanova
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center.
| | - Charelle Carter-Brooks
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center
| | | | - Halina M Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center
| |
Collapse
|
31
|
Collins TL, Yong KW, Marchetti MT, Miller KL, Booths B, Falvey JR. The Value of Home Health Physical Therapy. Home Healthc Now 2019; 37:145-151. [PMID: 31058732 DOI: 10.1097/nhh.0000000000000760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of the Triple Aim is to improve population health, reduce healthcare costs, and improve the patient experience. These goals-to reduce cost while improving health outcomes and patient experiences have shifted utilization of services from other postacute care settings to the home. The purpose of this perspective article is to discuss how home healthcare services, and home physical therapy (PT) specifically, provide value to patients, caregivers, and payers to meet the goals of the Triple Aim. This article will substantiate the value of home PT and provide healthcare professionals with evidence-based information on the value of home PT.
Collapse
Affiliation(s)
- Tracey L Collins
- Tracey L. Collins, PT, PhD, MBA, is a Geriatric Certified Specialist, and Assistant Professor, Department of Physical Therapy, University of Scranton, Scranton, Pennsylvania. Karen W. Yong, PT, MPT, is a Physical Therapist, ANX Home Healthcare, Daly City, and Home Rehab Services, Pacifica, California. Mary T. Marchetti, PT, PhD, is a Geriatric Certified Specialist, and Assistant Professor, Duquesne University, Pittsburgh, Pennsylvania. Kenneth L. Miller, PT, DPT, CEEAA, is an Assistant Professor, UNT Health Science Center, Fort Worth, Texas. Brian Booths, DPT, ATC, is a Market Manager, Select Medical, Mechanicsburg, Pennsylvania. Jason R. Falvey, PT, DPT, CEEAA, is a Postdoctoral Fellow, Yale University, New Haven, Connecticut
| | | | | | | | | | | |
Collapse
|
32
|
Uitvlugt EB, Janssen MJA, Siegert CEH, Leenders AJA, van den Bemt BJF, van den Bemt PMLA, Karapinar-Çarkit F. Patients' and providers' perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge. Health Expect 2019; 23:212-219. [PMID: 31733100 PMCID: PMC6978863 DOI: 10.1111/hex.12993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Hospital readmissions are increasingly used as an indicator of quality in health care. One potential risk factor of readmissions is polypharmacy. No studies have explored the patients’ perspectives on the medication relatedness and potential preventability of their readmissions. Objective To compare the patients’ perspectives on the medication relatedness and potential preventability of their readmissions with the providers’ perspectives. Methods Patients unplanned readmitted within 30 days after discharge at one of the participating departments of OLVG Hospital in Amsterdam were interviewed during their readmission. Patients’ perspectives regarding medication relatedness of their readmissions, the potential preventability, possible preventable interventions, and satisfaction with medication information were examined. Health‐care providers also reviewed files of these readmitted patients. Primary outcome was the percentage of medication‐related and potentially preventable readmissions according to the patient vs the provider. Descriptive data analysis was used. Results According to patients, 36 of 172 (21%) readmissions were medication‐related, and of these, 21 (58%) were potentially preventable. According to providers, 26 (15%) readmissions were medication‐related and 6 (23%) of these were potentially preventable. Patients and providers agreed on the medication relatedness in 11 of the 172 readmissions, and in two of these, agreement on the potential preventability existed. According to patients, preventive interventions belonged mostly to the hospital level, followed by the primary care level and patient level. Conclusion Patients and providers differ substantially on their perspectives regarding the medication relatedness and preventability of readmissions. Patients were more likely to view medication‐related readmissions as preventable.
Collapse
Affiliation(s)
- Elien B Uitvlugt
- Department of Hospital Pharmacy, OLVG, Amsterdam, The Netherlands
| | | | - Carl E H Siegert
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | |
Collapse
|
33
|
Custer A, Rein L, Nguyen D, Wentworth K, Dhamoon A. Development of a real-time physician-patient communication data collection tool. BMJ Open Qual 2019; 8:e000599. [PMID: 31799445 PMCID: PMC6863660 DOI: 10.1136/bmjoq-2018-000599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 08/22/2019] [Accepted: 10/20/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives To design a tool to assess and improve physician communication, provide physicians with personalised feedback in real time, and relate specific communication behaviours to patient experience measures. It was hypothesised that performance of fundamental communication behaviours would correlate with individual patient experience scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Design Prospective observational study. Setting Single-centre study at a mid-sized academic tertiary medical centre. Participants Thirteen hospitalists across 305 patient interactions were assessed in this study. Participants were recruited from three geographically cohorted adult general medicine-teaching teams on two inpatient units. Participants with cognitive impairment or who were unable to speak English were excluded from the study. Main outcome measures Frequency of performance of 10 fundamental communication behaviours. Results The communication behaviours of 13 hospitalists were assessed by 305 surveys: 146 observations, 106 patient reports and 52 excluded interactions. During rounds, 50% of physicians introduced themselves, 40% explained their role, 44% introduced other members of the team, 59% addressed patients by name, 58% addressed friends/family, 59% attempted to be at eye level, 41% asked permission before performing a physical examination, 40% asked if patients had questions and 20% asked if patients understood the plan of care. Several variables correlated with higher HCAHPS scores; however, addressing patients by name (r=0.60482, p=0.0492) and introducing other members of the team (r=0.87239, p=0.0234) were statistically significant. Conclusion This study highlights the importance of effective physician–patient communication and presents a unique data collection tool to assess and improve physician communication in real time. This tool can provide physicians with personalised feedback and relate specific communication behaviours to patient experience measures to provide high-quality care and improve the patient experience.
Collapse
Affiliation(s)
- Adam Custer
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura Rein
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Daniel Nguyen
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Karen Wentworth
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amit Dhamoon
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| |
Collapse
|
34
|
Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. Associations between patient experiences and clinical outcomes: a cross-sectional data linkage study of the Australian private healthcare sector. BMJ Open Qual 2019; 8:e000637. [PMID: 31523739 PMCID: PMC6711428 DOI: 10.1136/bmjoq-2019-000637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/29/2019] [Accepted: 07/31/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
35
|
Holden C, Marshall-Aiyelawo K, Frazier C, Dorris J, Fowler T, Mismash M, Meno J, Nishimura K. Prevalence Of Unplanned Readmissions Among Patients Of Military Treatment Facilities. Health Aff (Millwood) 2019; 38:1321-1326. [DOI: 10.1377/hlthaff.2019.00271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Craig Holden
- Craig Holden is a senior researcher in the Center for Military and Veterans Health, Altarum, in Washington, D.C
| | - Kimberley Marshall-Aiyelawo
- Kimberley Marshall-Aiyelawo is director of healthcare management studies in the Decision Support Division, Defense Health Agency, in Falls Church, Virginia
| | - Chantell Frazier
- Chantell Frazier is a senior researcher in the Center for Military and Veterans Health, Altarum, in Washington
| | - Joseph Dorris
- Joseph Dorris is an applied economist in the Center for Military and Veterans Health, Altarum, in Ann Arbor, Michigan
| | - Tara Fowler
- Tara Fowler is deputy director of the Center for Military and Veterans Health, Altarum, in Washington
| | - Mitchell Mismash
- Mitchell Mismash is a healthcare analyst in the Center for Military and Veterans Health, Altarum, in Washington
| | - Jenifer Meno
- Jenifer Meno is deputy assistant director of the Strategy, Planning, and Functional Integration Directorate, Defense Health Agency
| | - Koji Nishimura
- Koji Nishimura is chief of the Integrated Clinical Operations Policy Support Branch in Medical Affairs, Defense Health Agency
| |
Collapse
|
36
|
Rayan-Gharra N, Balicer RD, Tadmor B, Shadmi E. Association between cultural factors and readmissions: the mediating effect of hospital discharge practices and care-transition preparedness. BMJ Qual Saf 2019; 28:866-874. [PMID: 31113835 DOI: 10.1136/bmjqs-2019-009317] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The study examines whether hospital discharge practices and care-transition preparedness mediate the association between patients' cultural factors and readmissions. METHODS A prospective study of internal medicine patients (n=599) examining a culturally diverse cohort, at a tertiary medical centre in Israel. The in-hospital baseline questionnaire included sociodemographic, cultural factors (Multidimensional Health Locus of Control, family collectivism, health literacy and minority status) and physical, mental and functional health status. A follow-up telephone survey assessed hospital discharge practices: use of the teach-back method, providers' cultural competence, at-discharge language concordance and caregiver presence and care-transition preparedness using the care transition measure (CTM). Clinical and administrative data, including 30-day readmissions to any hospital, were retrieved from the healthcare organisation's data warehouse. Multiple mediation was tested using Hayes's PROCESS procedure, model 80. RESULTS A total of 101 patients (17%) were readmitted within 30 days. Multiple logistic regressions indicated that all cultural factors, except for minority status, were associated with 30-day readmission when no mediators were included (p<0.05). Multiple mediation analysis indicated significant indirect effects of the cultural factors on readmission through the hospital discharge practices and CTM. Finally, when the mediators were included, strong direct and indirect effects between minority status and readmission were found (B coefficient=-0.95; p=0.021). CONCLUSIONS The results show that the association between patients' cultural factors and 30-day readmission is mediated by the hospital discharge practices and care transition. Providing high-quality discharge planning tailored to patients' cultural characteristics is associated with better care-transition preparedness, which, in turn, is associated with reduced 30-day readmissions.
Collapse
Affiliation(s)
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Boaz Tadmor
- The Rabin Medical Center Research Authority, Clalit Health Services, Petah Tikva, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| |
Collapse
|
37
|
Carter J, Ward C, Thorndike A, Donelan K, Wexler DJ. Social Factors and Patient Perceptions Associated With Preventable Hospital Readmissions. J Patient Exp 2019; 7:19-26. [PMID: 32128367 PMCID: PMC7036679 DOI: 10.1177/2374373518825143] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Preventable hospital readmissions are costly and erode the quality of care delivery.
Few efforts to incorporate the patient perspectives and social factors associated with
readmission preventability exist. Objective: To identify patient perceptions and social barriers to care related to readmission. Methods: Prospective cohort study of 202 respondents readmitted within 30 days of hospital
discharge from 2 inpatient adult medicine units at Massachusetts General Hospital,
Boston, Massachusetts between January 2012 and January 2016. Results: Few participants indicated that their readmission was due to unattainable health care
after discharge. Almost half indicated that they needed more general assistance to stay
well outside the hospital. Those reporting a barrier related to at least 2 measures of
social determinants of health were more likely to have preventable readmissions (34% vs
17%, P = .006). Participants with a history of homelessness or
substance use disorder were more likely to have preventable readmissions (44% vs 20%,
P = .04 and 32% vs 18%, P = .03, respectively). Conclusion: Strengthening nonmedical support systems and general social policy may be required to
reduce preventable readmissions.
Collapse
Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Charlotte Ward
- Center for Healthcare Studies, Northwestern University, Chicago, IL, USA.,Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Anne Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Karen Donelan
- Harvard Medical School, Boston, MA, USA.,Mongan Institute for Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Wexler
- Harvard Medical School, Boston, MA, USA.,MGH Diabetes Center, Boston, MA, USA
| |
Collapse
|
38
|
Wang W, Loban EK, Dionne E. Public Hospitals in China: Is There a Variation in Patient Experience with Inpatient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E193. [PMID: 30641915 PMCID: PMC6352089 DOI: 10.3390/ijerph16020193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
Abstract
In China, public hospitals are the main provider of inpatient service. The Chinese public hospital reform has recently shifted towards health care organizations and delivery to improve health care quality. This study analyzes the variation of one of the dimensions of health care quality, patient-centeredness, among inpatients with different socioeconomic status and geographical residency in China. 1471 respondents who received inpatient care in public hospitals were included in our analysis. Patient-centeredness performance was assessed on the dimensions of Communication, Autonomy, Dignity, and Confidentiality. Variations of inpatient experience were estimated using binary logistic regression models according to: residency, region, age, gender, education, income quintile, self-rated health, and number of hospital admissions. Our results indicate that older patients, and patients living in rural areas and Eastern China are more likely to report positive experience of their public hospital stay according to the care aspects of Dignity, Communication, Confidentiality and Autonomy. However, there remains a gap between China and other countries in relation to inpatient experience. Noticeable disparities in inpatient experience also persist between different geographical regions in China. These variations of patient experience pose a challenge that China's health policy makers would need to consider in their future reform efforts.
Collapse
Affiliation(s)
- Wenhua Wang
- Department of Family Medicine, McGill University, Montreal, Quebec H3T 1M5, Canada.
| | | | - Emilie Dionne
- Department of Family Medicine, McGill University, Montreal, Quebec H3T 1M5, Canada.
| |
Collapse
|
39
|
Rawal S, Kwan JL, Razak F, Detsky AS, Guo Y, Lapointe-Shaw L, Tang T, Weinerman A, Laupacis A, Subramanian SV, Verma AA. Association of the Trauma of Hospitalization With 30-Day Readmission or Emergency Department Visit. JAMA Intern Med 2019; 179:38-45. [PMID: 30508018 PMCID: PMC6583419 DOI: 10.1001/jamainternmed.2018.5100] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Trauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge. OBJECTIVES To characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled participants between September 1, 2016, and September 1, 2017, at 2 academic hospitals in Toronto, Canada. Participants were adults admitted to the internal medicine ward for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Responses for each domain were dichotomized as disturbance or no disturbance. Disturbance in 3 or 4 domains (the upper tertile) was considered high trauma of hospitalization, and disturbance in 0 to 2 domains (the lower 2 tertiles) was considered low trauma. MAIN OUTCOME AND MEASURES The primary outcome was readmission or emergency department visit within 30 days of discharge. The association between trauma of hospitalization and the primary outcome was examined using logistic regression, adjusted for age; sex; length of stay; Charlson Comorbidity Index Score; Laboratory-Based Acute Physiology Score; and baseline disturbances in sleep, mobility, nutrition, and mood. RESULTS A total of 207 patients participated, of whom 82 (39.6%) were women and 125 (60.4%) were men, with a mean (SD) age of 60.3 (16.8) years. Among the 207 participants, 75 (36.2%) reported sleep disturbance, 162 (78.3%) reported mobility disturbance, 114 (55.1%) reported nutrition disturbance, and 48 (23.2%) reported mood disturbance. Nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. A statistically significant 15.8% greater absolute risk of readmission or emergency department visit was found in participants with high trauma (37.7%; 95% CI, 25.9%-51.1%) compared with those with low trauma (21.9%; 95% CI, 15.7%-29.7%), which remained statistically significant after adjusting for baseline characteristics (adjusted odds ratio, 2.52; 95% CI, 1.24-5.17; P = .01) and propensity score matching (odds ratio, 2.47; 95% CI, 1.11-5.73; P = .03). CONCLUSIONS AND RELEVANCE Disturbances in sleep, mobility, nutrition, and mood were common in medical inpatients; such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.
Collapse
Affiliation(s)
- Shail Rawal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Janice L Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yishan Guo
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Terence Tang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Trillium Health Partners, Mississauga, Ontario, Canada
| | - Adina Weinerman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amol A Verma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
40
|
Kshirsagar AV, Tabriz AA, Bang H, Lee SYD. Patient Satisfaction Is Associated With Dialysis Facility Quality and Star Ratings. Am J Med Qual 2018; 34:243-250. [PMID: 30223675 DOI: 10.1177/1062860618796310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Dialysis Facility Compare Star Rating and the Quality Incentive Program (QIP) generate separate performance scores from clinical measures, and the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey evaluates patient satisfaction across 6 separate domains related to nephrologists, dialysis facility, and information transmission. This study examined the relationship of the 3 measures for US clinics, modeling the 6 ICH-CAHPS domains as independent variables and QIP and star ratings as dependent variables. Among 3176 dialysis clinics, domains assessing dialysis facility and information transmission had a consistently stronger relationship with QIP and star ratings than the domains assessing nephrologists: QIP, β (95% CI) = 1.62 (1.26-1.97) for dialysis facility staff rating, 0.70 (0.35-1.05) for nephrologists; star rating, odds ratio (95% CI) = 1.38 (1.29-1.49) for dialysis facility staff rating, 1.17 (1.09-1.25) for nephrologists. Patient satisfaction is associated with dialysis care quality, with surprising differences between nephrologists and dialysis facilities.
Collapse
|
41
|
Affiliation(s)
- Paul T Rosenau
- Department of Pediatrics, Larner College of Medicine, University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont;
| | - Brian K Alverson
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island; and.,Division of Hospital Medicine, Hasbro Children's Hospital, Providence Rhode Island
| |
Collapse
|
42
|
Boozary AS, Shojania KG. Pathology of poverty: the need for quality improvement efforts to address social determinants of health. BMJ Qual Saf 2018; 27:421-424. [PMID: 29511090 DOI: 10.1136/bmjqs-2017-007552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew S Boozary
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Kaveh G Shojania
- Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|