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Thompson MP, Hou H, Likosky DS, Pagani FD, Falvey J, Bowles KH, Wadhera RK, Sterling MR. Home Health Care Use and Outcomes After Coronary Artery Bypass Grafting Among Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes 2024; 17:e010459. [PMID: 38770653 PMCID: PMC11251853 DOI: 10.1161/circoutcomes.123.010459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Home health care (HHC) has been increasingly used to improve care transitions and avoid poor outcomes, but there is limited data on its use and efficacy following coronary artery bypass grafting. The purpose of this study was to describe HHC use and its association with outcomes among Medicare beneficiaries undergoing coronary artery bypass grafting. METHODS Retrospective analysis of 100% of Medicare fee-for-service files identified 77 331 beneficiaries undergoing coronary artery bypass grafting and discharged to home between July 2016 and December 2018. The primary exposure of HHC use was defined as the presence of paid HHC claims within 30 days of discharge. Hierarchical logistic regression identified predictors of HHC use and the percentage of variation in HHC use attributed to the hospital. Propensity-matched logistic regression compared mortality, readmissions, emergency department visits, and cardiac rehabilitation enrollment at 30 and 90 days after discharge between HHC users and nonusers. RESULTS A total of 26 751 (34.6%) of beneficiaries used HHC within 30 days of discharge, which was more common among beneficiaries who were older (72.9 versus 72.5 years), male (79.4% versus 77.4%), White (90.2% versus 89.2%), and not Medicare-Medicaid dual eligible (6.7% versus 8.8%). The median hospital-level rate of HHC use was 31.0% (interquartile range, 13.7%-54.5%) and ranged from 0% to 94.2%. Nearly 30% of the interhospital variation in HHC use was attributed to the discharging hospital (intraclass correlation coefficient, 0.296 [95% CI, 0.275-0.318]). Compared with non-HHC users, those using HHC were less likely to have a readmission or emergency department visit, were more likely to enroll in cardiac rehabilitation, and had modestly higher mortality within 30 or 90 days of discharge. CONCLUSIONS A third of Medicare beneficiaries undergoing coronary artery bypass grafting used HHC within 30 days of discharge, with wide interhospital variation in use and mixed associations with clinical outcomes and health care utilization.
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Affiliation(s)
- Michael P. Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Hechuan Hou
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA
- VNS Health, New York, NY
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Wodwaski N, Webber E. Cardiovascular Assessment. Home Healthc Now 2022; 40:238-244. [PMID: 36048216 DOI: 10.1097/nhh.0000000000001097] [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: 06/15/2023]
Abstract
Cardiovascular (CV) disease affects 6.2 million people in the United States, placing many of these individuals at risk for heart failure. The number of patients with heart failure who utilize home healthcare services after hospital discharge is high. There is also a high rate of readmission following hospitalization for heart failure, contributing to morbidity and mortality, as well as creating a financial burden for healthcare systems. Home care clinicians can make a significant contribution to reducing CV morbidity and readmissions by becoming proficient at CV assessment and using this information to develop an action plan to prevent exacerbations and rehospitalizations. This article reviews the anatomy and physiology of the CV system and describes subjective and objective CV assessment.
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Sheikh MA, Ngendahimana D, Deo SV, Raza S, Altarabsheh SE, Reed GW, Kalra A, Cmolik B, Kapadia S, Eagle KA. Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction. Coron Artery Dis 2021; 32:481-488. [PMID: 33471476 DOI: 10.1097/mca.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. METHODS We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. RESULTS A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). CONCLUSION In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.
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Affiliation(s)
- Muhammad A Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Ngendahimana
- Department of Population and Quantitative Health Sciences, Case Western Reserve University
| | - Salil V Deo
- Department of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Sajjad Raza
- PRECISIONheor, Precision Value & Health, Boston, MA USA
| | | | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Cmolik
- Department of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kim A Eagle
- Department of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
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Nazir S, Ahuja KR, Ariss RW, Changal K, Khuder SA, Moukarbel GV. Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:1-6. [PMID: 34045166 DOI: 10.1016/j.carrev.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS/MATERIALS We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes. RESULTS Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC. CONCLUSIONS Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA, USA
| | - Robert W Ariss
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Khalid Changal
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
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Arundel C, Lam PH, Faselis C, Sheriff HM, Dooley DJ, Morgan C, Fonarow GC, Aronow WS, Allman RM, Ahmed A. Length of stay and readmission in older adults hospitalized for heart failure. Arch Med Sci 2021; 17:891-899. [PMID: 34336017 PMCID: PMC8314416 DOI: 10.5114/aoms.2019.89702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hospital length of stay (LoS) and hospital readmissions are metrics of healthcare performance. We examined the association between these two metrics in older patients hospitalized with decompensated heart failure (HF). MATERIAL AND METHODS Eight thousand and forty-nine patients hospitalized for HF in 106 U.S. hospitals had a median LoS of 5 days; among them, 3777 had a LoS > 5 days. Using propensity scores for LoS > 5 days, we assembled 2723 pairs of patients with LoS 1-5 vs. > 5 days. The matched cohort of 5446 patients was balanced on 40 baseline characteristics. We repeated the above process in 7045 patients after excluding those with LoS > 10 days, thus assembling a second matched cohort of 2399 pairs of patients with LoS 1-5 vs. 6-10 days. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with longer LoS were estimated in matched cohorts. RESULTS In the primary matched cohort (n = 5446), LoS > 5 days was associated with a higher risk of all-cause readmission at 30 days (HR = 1.16; 95% CI: 1.04-1.31; p = 0.010), but not during longer follow-up. A longer LoS was also associated with a higher risk of mortality during 8.8 years of follow-up (HR = 1.13; 95% CI: 1.06-1.21; p < 0.001). LoS had no association with HF readmission. Similar associations were observed among the matched sensitivity cohort (n = 4798) that excluded patients with LoS > 10 days. CONCLUSIONS In propensity score-matched balanced cohorts of patients with HF, a longer LoS was independently associated with poor outcomes, which persisted when LoS > 10 days were excluded.
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Affiliation(s)
- Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Helen M. Sheriff
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Daniel. J. Dooley
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charity Morgan
- Veterans Affairs Medical Center, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wilbert S. Aronow
- Weschester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Richard M. Allman
- George Washington University, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
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Kang Y, Mondesir FL, Young D, Norris E, Hernandez JM, Nativi-Nicolau J, Stehlik J. Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge: A Quality-Improvement Pilot Project. Home Healthc Now 2021; 39:25-31. [PMID: 33417359 PMCID: PMC9910483 DOI: 10.1097/nhh.0000000000000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and high cost. Homebound patients with HF qualify for home healthcare after hospital discharge. It is not known if nonhomebound patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home. The purpose of this quality-improvement pilot study was to assess the impact of HHN visits provided to nonhomebound HF patients after hospital discharge on 30-day rehospitalization rates. We included patients with HF who were ineligible for home healthcare services due to their nonhomebound status. Home healthcare nurses followed a modified version of the discharge checklist from the American Heart Association's Rise Above Heart Failure materials, and provided education as appropriate based on patients' responses. We enrolled 68 patients in the study. The mean age was 60.2 years; 61.8% were male and 77.9% were White. Based on patient responses to the checklist, key areas addressed during HHN visits were medication management and HF self-care. In the HHN visit group, 15% of the patients experienced rehospitalization within 30 days, compared with 23% in the non-HHN visit group among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHN visits for nonhomebound patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach.
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Kang Y, Sheng X, Stehlik J, Mooney K. Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain. Home Healthc Now 2020; 38:24-30. [PMID: 31895894 PMCID: PMC7678889 DOI: 10.1097/nhh.0000000000000830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.
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Affiliation(s)
- Youjeong Kang
- Youjeong Kang, PhD, MPH, CCRN, is an Assistant Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Xiaoming Sheng, PhD, is a Research Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Josef Stehlik, MD, is a Professor, University of Utah School of Medicine, Salt Lake City, Utah. Kathi Mooney, PhD, RN, FAAN, is a Distinguished Professor, University of Utah College of Nursing, Salt Lake City, Utah
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Ariss RW, Nazir S, Ahuja KR, Moukarbel GV. Predictors of Home Health Care Utilization and Its Relationship With Early Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair. Am J Cardiol 2020; 131:136-138. [PMID: 32713652 DOI: 10.1016/j.amjcard.2020.06.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
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Understanding the Workflow of Home Health Care for Patients with Heart Failure: Challenges and Opportunities. J Gen Intern Med 2020; 35:1721-1729. [PMID: 32026253 PMCID: PMC7280407 DOI: 10.1007/s11606-020-05675-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal. OBJECTIVE We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist. DESIGN AND PARTICIPANTS In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018. APPROACH Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image. KEY RESULTS Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step. CONCLUSIONS Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.
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Cho J, Lee S, Uh Y, Lee JH. Usefulness of mean platelet volume to platelet count ratio for predicting the risk of mortality in community-acquired pneumonia. Arch Med Sci 2020; 16:1327-1335. [PMID: 33224331 PMCID: PMC7667432 DOI: 10.5114/aoms.2020.92404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/27/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The association between mean platelet volume (MPV) to platelet count (PC) ratio and prognosis has been demonstrated in some diseases but not in community-acquired pneumonia (CAP). In this study, we evaluated the ability of MPV to PC ratio (MPR) to predict short-term mortality in CAP patients. MATERIAL AND METHODS We retrospectively analysed data archived over 10 years and stratified MPR values into quartiles. Relations between MPR (femtoliters/number of thousand platelets per microlitre) quartiles and 60-day mortality were examined. Logistic regression was performed to adjust for confounders, and the Kaplan-Meier method was used for survival analysis. RESULTS After adjusting for confounding factors, the odds ratios of 60-day mortality for CAP were 2.66 (95% CI: 2.04-3.46) for the fourth MPR quartile (range ≥ 5.19; p < 0.001) versus the first MPR quartile (range ≤ 2.45). Kaplan-Meier curves indicated that a higher MPR was associated with a higher risk of mortality among CAP patients, and this was confirmed by the log-rank test (p < 0.001). CONCLUSIONS Mean platelet volume to PC ratio was found to be positively correlated with short-term mortality. Our data indicate that MPR might be a significant predictive marker of the mortality in CAP. Further prospective studies are required to establish the exact role of MPR in CAP and other diseases.
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Affiliation(s)
- Jooyoung Cho
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Saejin Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Zalewska-Adamiec M, Malyszko J, Bachórzewska-Gajewska H, Tomaszuk-Kazberuk A, Dobrzycki SJ. Takotsubo syndrome - fatal prognosis of patients with low body mass index in 5-year follow-up. Arch Med Sci 2020; 16:282-288. [PMID: 32190137 PMCID: PMC7069448 DOI: 10.5114/aoms.2019.87082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/02/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS. MATERIAL AND METHODS Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m2), normal body mass (18.5 ≥ BMI < 25 kg/m2) and excessive body mass (BMI ≥ 25 kg/m2). RESULTS Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m2. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; p < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m2) was 8.3%, and in obese people (BMI ≥ 30 kg/m2) 1 out 5 patients died during follow-up. CONCLUSIONS The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up.
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Affiliation(s)
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | | | | | - Sławomir J. Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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Ochman M, Urlik M, Tatoj Z, Zawadzki F, Wajda-Pokrontka M, Latos M, Przybyłowski P, Zembala M. Retrospective cohort study of patients qualified for lung transplantation due to idiopathic pulmonary fibrosis - single-centre experience. Arch Med Sci 2020; 16:621-626. [PMID: 32399111 PMCID: PMC7212221 DOI: 10.5114/aoms.2019.82662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/14/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease. Pharmacological treatment can only slow its progression. However, lung transplantation (LTx) is the only treatment for patients with its end-stage form. This study analysed the long-term results of the qualification process of patients with IPF recruited for LTx in a single centre. MATERIAL AND METHODS Retrospective analysis of 84 patients (56 patients who died while on the waiting list and 28 patients who underwent LTx) with end-stage IPF who were qualified for LTx between 2006 and 2017 at the Silesian Centre for Heart Diseases (Zabrze, Poland). RESULTS Cox proportional hazard analysis showed that the only parameter was 6-minute walk test (6MWT) distance, which statistically significantly impacted the probability of receiving a graft (parameter assessment, 0.00523; p = 0.006; 95% confidence interval (CI): 0.0015-0.009; hazard ratio (HR) = 1.005) as well as that of death while on the waiting list (parameter assessment, -0.0054; p = 0.003; 95% CI: -0.009- (-0.0017); HR = 0.995). Patients with a 253-350-m 6MWT distance had 3 times greater risk of dying while on the waiting list than those who walked more than 350 m. Other factors, such as height, sex, and blood group, also influenced the outcome. CONCLUSIONS The 6-minute walk test distance is an independent predictor of mortality on the lung transplant waiting list. Blood type and height also play a significant role in becoming a lung recipient.
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Affiliation(s)
- Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Maciej Urlik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Zofia Tatoj
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Marta Wajda-Pokrontka
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Magdalena Latos
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Piotr Przybyłowski
- 1 Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Silesian Center for Heart Diseases, Zabrze, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Poland
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13
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Jones CD, Boxer RS. Home care after elective vascular surgery: still more questions than answers. BMJ Qual Saf 2019; 29:968-970. [PMID: 31796575 DOI: 10.1136/bmjqs-2019-009754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
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14
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Weerahandi H, Bao H, Herrin J, Dharmarajan K, Ross JS, Jones S, Horwitz LI. Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization. J Am Geriatr Soc 2019; 68:96-102. [PMID: 31603248 DOI: 10.1111/jgs.16179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVE Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. Here, we examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization. DESIGN Retrospective cohort study. SETTING Fee-for-service Medicare data, 2012 to 2015. PARTICIPANTS Beneficiaries, aged 65 years and older, hospitalized with HF who were subsequently discharged to SNF and then discharged home. MEASUREMENTS The primary outcome was unplanned readmission within 30 days of discharge to home from SNF. We compared time to readmission between those with and without HHC services using a Cox model. RESULTS Of 67 585 HF hospitalizations discharged to SNFs and subsequently discharged home, 13 257 (19.6%) were discharged with HHC, and 54 328 (80.4%) were discharged without HHC. Patients discharged home from SNFs with HHC had lower 30-day readmission rates than patients discharged without HHC (22.8% vs 24.5%; P < .0001) and a longer time to readmission. In an adjusted model, the hazard for readmission was 0.91 (0.86-0.95) with receipt of HHC. CONCLUSIONS Recipients of HHC were less likely to be readmitted within 30 days vs those discharged home without HHC. This is unexpected, as patients discharged with HHC likely have more functional impairments. Since patients requiring a SNF stay after hospital discharge may have additional needs, they may particularly benefit from restorative therapy through HHC; however, only approximately 20% received such services. J Am Geriatr Soc 68:96-102, 2019.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.,Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Haikun Bao
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Simon Jones
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Leora I Horwitz
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.,Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
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15
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Knapik P, Knapik M, Trejnowska E, Kłaczek B, Śmietanka K, Cieśla D, Krzych ŁJ, Kucewicz EM. Should we admit more patients not requiring invasive ventilation to reduce excess mortality in Polish intensive care units? Data from the Silesian ICU Registry. Arch Med Sci 2019; 15:1313-1320. [PMID: 31572479 PMCID: PMC6764313 DOI: 10.5114/aoms.2019.84401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/03/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Mortality in Polish intensive care units (ICU) is excessively high. Only a few patients do not require intubation and invasive ventilation throughout the whole ICU treatment period. We aimed to define this population, as pre-emptive admissions of such patients may increase the population which benefits from ICU admission and reduce excessive mortality in Polish ICUs. MATERIAL AND METHODS Data on 20 651 patients from the Silesian Registry of Intensive Care Units were analysed. Patients who did not require intubation and invasive ventilation (referred to as non-ventilated patients) were identified and compared to the remaining ICU population. Independent variables that influence being non-intubated in the ICU were identified. RESULTS Among 20 368 analyzed adult patients, only 1233 (6.1%) were in the non-ventilated group. Non-ventilated patients were younger, with fewer comorbidities and a lower APACHE II score at admission (13.0 ±7.1 vs. 23.7 ±8.6 points, p < 0.001). Patients with cardiac arrest prior to admission were particularly rare in this group (2.6% vs. 26.8%, p < 0.001). The ICU mortality among non-ventilated patients was 6 to 7 times lower (7.0% vs. 46.7%, p < 0.001). Independent variables that influenced the ICU stay in non-ventilated patients were: obstetric complications as the primary cause of ICU admission, presence of a systemic autoimmune disease, invasive monitoring as the primary cause of ICU admission, ICU readmission and the presence of cancer. CONCLUSIONS Non-ventilated patients have a high potential for a favourable outcome. Pre‑emptive ICU admissions have a potential to reduce mortality in Polish ICUs.
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Affiliation(s)
- Piotr Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Małgorzata Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Ewa Trejnowska
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Bogumiła Kłaczek
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Konstanty Śmietanka
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Daniel Cieśla
- Department of Science, Education and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Ewa M. Kucewicz
- Department of Anaesthesiology and Intensive Care, School of Medicine, Medical University of Silesia, Katowice, Poland
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16
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Simpson M, Macias Tejada J, Driscoll A, Singh M, Klein M, Malone M. The Bundled Hospital Elder Life Program-HELP and HELP in Home Care-and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare. J Am Geriatr Soc 2019; 67:1730-1736. [PMID: 31220334 DOI: 10.1111/jgs.15979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN Matched case-control study. SETTING Two medical-surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS The primary study outcome was 30-day all-cause unplanned hospital readmission. Additional outcomes measured were 30-day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS Fewer cases (16.8%) than controls (28.4%) had a 30-day all-cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30-day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22-0.77; P < .01). The difference between case (10.8%) and control (15.5%) 30-day ED visit was not significant (P = .23). A lower LOS for the case group was shown (P < .01), while the number of skilled home care visits was not significantly different between groups (P = .28). CONCLUSION HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home. J Am Geriatr Soc 67:1730-1736, 2019.
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Affiliation(s)
- Michelle Simpson
- Aurora Research Institute, Ed Howe Center for Health Care Transformation, Aurora Health Care, Milwaukee, Wisconsin
| | | | - Amy Driscoll
- Aurora at Home, Aurora Health Care, Milwaukee, Wisconsin
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Matthew Klein
- Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Michael Malone
- Senior Services, Aurora Health Care, Milwaukee, Wisconsin.,Department of Senior Services, Aurora Health Care, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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17
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de Mestral C, Kayssi A, Al-Omran M, Salata K, Hussain MA, Roche-Nagle G. Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission. BMJ Qual Saf 2019; 28:901-907. [DOI: 10.1136/bmjqs-2018-009161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/27/2023]
Abstract
BackgroundEvents occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.ObjectiveTo quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.MethodsPatients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.ResultsThe cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.ConclusionHome care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.
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18
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Wang J, Dietrich MS, Bell SP, Maxwell CA, Simmons SF, Kripalani S. Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study. BMJ Open 2019; 9:e024766. [PMID: 30700484 PMCID: PMC6352778 DOI: 10.1136/bmjopen-2018-024766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES (1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period. DESIGN Secondary analysis of longitudinal data from a cohort study. PARTICIPANTS AND SETTING 834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121). OUTCOME Vulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching. RESULTS Overall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=-1.34(-2.07, -0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%-16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year. CONCLUSION After adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.
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Affiliation(s)
- Jinjiao Wang
- University of Rochester Medical Center, School of Nursing, Rochester, New York, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cathy A Maxwell
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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