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Amjad W, Schiano T, Segovia MC, Malik A, Weiner J, Horslen S, Jafri SM. An analysis of the outcomes of Clostridioides difficile occurring in intestinal transplant recipients requiring hospitalization. Transpl Infect Dis 2023; 25:e13951. [PMID: 36621893 DOI: 10.1111/tid.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Organ transplantation is a known risk factor for Clostridioides difficile infection (CDI). There is limited published data on the impact of CDI in the intestinal transplant population. METHODS We utilized the National Readmission Database (2010-2017) to study the outcomes of CDI in patients having a history of intestinal transplantation. Association of CDI with readmission and hospital resource utilization was computed in multivariable models adjusted for demographics and comorbidities. RESULTS During 2010-2017, 8442 hospitalizations with the history of intestinal transplantation had indexed hospital admissions. Of these, 320 (3.8%) had CDI. CDI hospitalization in intestine transplant patients was associated with higher median cost $54 430 (IQR: 27 231, 109 980) as compared to patients who did not have CDI $48 888 (IQR: 22 578, 112 777), (β: 71 814 95% confidence intervals [CI]: 676-142 953, p = .048). The median length of stay was also longer for patients with CDI 7 (IQR: 4, 13) days as compared to 5 (IQR: 3, 11) days in non-CDI (β: 5.51 95% CI: 0.73-10.29, p = .02). The mortality rate, intestinal transplant complications, presence of malnutrition, acute kidney injury, ICU admissions, and sepsis were similar in both groups. CDI was the top cause of 30-day readmission in the intestinal transplant recipients with CDI during the index admission; the number of 30-day readmissions also increased from 2010 to 2017. CONCLUSION CDI hospitalization in post-intestine transplant patients occurs commonly and is associated with a longer length of stay and higher costs during hospitalization. The CDI was the most common cause of readmission after the index admission of CDI in these patients.
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Affiliation(s)
- Waseem Amjad
- Clinical Investigation, Harvard Medical School, Boston, Massachusetts, USA.,Research fellow, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thomas Schiano
- Recanati-Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Maria C Segovia
- Gastroenterology and Liver Transplant, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adnan Malik
- Internal Medicine, Loyola School of Medicine, Chicago, Illinois, USA
| | - Joshua Weiner
- Abdominal Organ Transplant, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Simon Horslen
- Pediatric Gastroenterology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Syed-Mohammed Jafri
- Gastroenterology and Transplant Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
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Williams C, Bagwell MT, DeDeo M, Lutz AB, Deal MJ, Richey BP, Zeini IM, Service B, Youmans DH, Osbahr DC. Demographics and surgery-related complications lead to 30-day readmission rates among knee arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc 2022; 30:2408-2418. [PMID: 35199185 DOI: 10.1007/s00167-022-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The study objectives were (1) to evaluate risk factors related to 30-day hospital readmissions after arthroscopic knee surgeries and (2) to determine the complications that may arise from surgery. METHODS The American College of Surgeons National Surgical Quality Improvement Program database data from 2012 to 2017 were researched. Patients were identified using Current Procedural Terminology codes for knee arthroscopic procedures. Ordinal logistic fit regression and decision tree analysis were used to examine study objectives. RESULTS There were 83,083 knee arthroscopic procedures between 2012 and 2017 obtained from the National Surgical Quality Improvement Program database. The overall readmission rate was 0.87%. The complication rates were highest for synovectomy and cartilage procedures, 1.6% and 1.3% respectively. A majority of readmissions were related to the procedure (71.1%) with wound complications being the primary reason (28.2%) followed by pulmonary embolism and deep vein thrombosis, 12.7% and 10.6%, respectively. Gender and body mass index were not significant factors and age over 65 years was an independent risk factor. Wound infection, deep vein thrombosis, and pulmonary embolism were the most prevalent complications. CONCLUSION Healthcare professionals have a unique opportunity to modify treatment plans based on patient risk factors. For patients who are at higher risk of inferior surgical outcomes, clinicians should carefully weigh risk factors when considering surgical and non-surgical approaches. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cynthia Williams
- Department of Health Administration, Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224-2646, USA
| | - Matt T Bagwell
- Department of Public Administration, School of Criminology, Criminal Justice and Public Administration, College of Liberal and Fine Arts, Tarleton State University, 10850 Texan Rider Dr., Rm # 336, Fort Worth, TX, 76036-9414, USA.
| | - Michelle DeDeo
- Department of Mathematics and Statistics, College of Arts and Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224-2646, USA
| | - Alexandra Baker Lutz
- Department of Orthopedic Surgery, University of Maryland, 110 S Paca St, Baltimore, MD, 21201, USA
| | - M Jordan Deal
- Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, 3577 W.13 Mile Rd., Suite 402, Royal Oak, MI, 48073, USA
| | - Bradley P Richey
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd 32827, Orlando, FL, USA
| | - Ibrahim M Zeini
- AdventHealth Research Institute
- Orthopedic Institute, 301 E Princeton St, Orlando, FL, 32804, USA
| | - Benjamin Service
- Orlando Health Jewett Orthopedic Institute, 7243 Della Drive, Floor 2, Suite I, Orlando, FL, 32819, USA
| | - D Harrison Youmans
- Rothman Orthopaedic Institute Florida, 410 Lionel Way Suite 201, Davenport, FL, 33837, USA
| | - Daryl C Osbahr
- Rothman Orthopaedic Institute Florida, 410 Lionel Way Suite 201, Davenport, FL, 33837, USA
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Powers JS, Abraham L, Parker R, Azubike N, Habermann R. The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly. Geriatrics (Basel) 2021; 6:4. [PMID: 33418873 DOI: 10.3390/geriatrics6010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient centered medical home is a promising model, which improves care coordination and may reduce hospital readmissions. Methods: This is a quality improvement report, the geriatric patient-aligned care team (GeriPACT) at Tennessee Valley Healthcare System (TVHS) participated in ongoing quality improvement (Plan, Do, Study, Act (PDSA)) cycles during teamlet meetings. Post home discharge follow-up for GeriPACT patients was provided by proactive telehealth communication by the Registered Nurse (RN) care manager and nurse practitioner. Periodic operations data obtained from the Data and Statistical Services (DSS) coordinator informed the PDSA cycles and teamlet meetings. Results: at baseline (July 2018–June 2019) the 30-day all-cause readmission for GeriPACT was 21%. From July to December 2019, 30-day all-cause readmissions were 13%. From January to June 2020, 30-day all-cause readmissions were 15%. Conclusion: PDSA cycles with sharing of operations data during GeriPACT teamlet meetings and fostering a shared responsibility for managing high-risk patients contributes to improved outcomes in 30-day all-cause readmissions.
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Hopkins BS, Yamaguchi JT, Garcia R, Kesavabhotla K, Weiss H, Hsu WK, Smith ZA, Dahdaleh NS. Using machine learning to predict 30-day readmissions after posterior lumbar fusion: an NSQIP study involving 23,264 patients. J Neurosurg Spine 2019; 32:1-8. [PMID: 31783353 DOI: 10.3171/2019.9.spine19860] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unplanned preventable hospital readmissions within 30 days are a great burden to patients and the healthcare system. With an estimated $41.3 billion spent yearly, reducing such readmission rates is of the utmost importance. With the widespread adoption of big data and machine learning, clinicians can use these analytical tools to understand these complex relationships and find predictive factors that can be generalized to future patients. The object of this study was to assess the efficacy of a machine learning algorithm in the prediction of 30-day hospital readmission after posterior spinal fusion surgery. METHODS The authors analyzed the distribution of National Surgical Quality Improvement Program (NSQIP) posterior lumbar fusions from 2011 to 2016 by using machine learning techniques to create a model predictive of hospital readmissions. A deep neural network was trained using 177 unique input variables. The model was trained and tested using cross-validation, in which the data were randomly partitioned into training (n = 17,448 [75%]) and testing (n = 5816 [25%]) data sets. In training, the 17,448 training cases were fed through a series of 7 layers, each with varying degrees of forward and backward communicating nodes (neurons). RESULTS Mean and median positive predictive values were 78.5% and 78.0%, respectively. Mean and median negative predictive values were both 97%, respectively. Mean and median areas under the curve for the model were 0.812 and 0.810, respectively. The five most heavily weighted inputs were (in order of importance) return to the operating room, septic shock, superficial surgical site infection, sepsis, and being on a ventilator for > 48 hours. CONCLUSIONS Machine learning and artificial intelligence are powerful tools with the ability to improve understanding of predictive metrics in clinical spine surgery. The authors' model was able to predict those patients who would not require readmission. Similarly, the majority of predicted readmissions (up to 60%) were predicted by the model while retaining a 0% false-positive rate. Such findings suggest a possible need for reevaluation of the current Hospital Readmissions Reduction Program penalties in spine surgery.
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Affiliation(s)
- Benjamin S Hopkins
- 2Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Hannah Weiss
- 2Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Gai Y, Pachamanova D. Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Serv Res 2019; 19:837. [PMID: 31727168 PMCID: PMC6857270 DOI: 10.1186/s12913-019-4645-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy's overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. METHODS Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010-2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. RESULTS There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. CONCLUSIONS The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital's patients and neighborhood.
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Affiliation(s)
- Yunwei Gai
- Associate Professor, Economics Division, Babson College, 231 Forest Street, Babson Park, MA, 02457, USA.
| | - Dessislava Pachamanova
- Professor, Mathematics and Sciences Division, Babson College, 231 Forest Street, Babson Park, MA, 02457, USA
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Kohn R, Harhay MO, Bayes B, Mikkelsen ME, Ratcliffe SJ, Halpern SD, Kerlin MP. Ward Capacity Strain: A Novel Predictor of 30-Day Hospital Readmissions. J Gen Intern Med 2018; 33:1851-1853. [PMID: 30022410 PMCID: PMC6206345 DOI: 10.1007/s11606-018-4564-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rachel Kohn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA. .,Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Michael O Harhay
- Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Bayes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark E Mikkelsen
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sarah J Ratcliffe
- Department of Public Health Sciences and Division of Biostatistics at the University of Virginia, Charlottesville, VA, USA
| | - Scott D Halpern
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Meeta Prasad Kerlin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
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