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Chou A, Beach SR, Lutz BJ, Rodakowski J, Terhorst L, Freburger JK. Moderating Effects of Informal Care on the Relationship Between ADL Limitations and Adverse Outcomes in Stroke Survivors. Stroke 2024. [PMID: 38660796 DOI: 10.1161/strokeaha.123.045427] [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: 10/06/2023] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Stroke survivors with limitations in activities of daily living (ADL) have a greater risk of experiencing falls, hospitalizations, or physical function decline. We examined how informal caregiving received in hours per week by stroke survivors moderated the relationship between ADL limitations and adverse outcomes. METHODS In this retrospective cohort, community-dwelling participants were extracted from the National Health and Aging Trends Study (2011-2020; n=277) and included if they had at least 1 formal or informal caregiver and reported an incident stroke in the prior year. Participants reported the amount of informal caregiving received in the month prior (low [<5.8], moderate [5.8-27.1], and high [27.2-350.4] hours per week) and their number of ADL limitations (ranging from 0 to 7). Participants were surveyed 1 year later to determine the number of adverse outcomes (ie, falls, hospitalizations, and physical function decline) experienced over the year. Poisson regression coefficients were converted to average marginal effects and estimated the moderating effects of informal caregiving hours per week on the relationship between ADL limitations and adverse outcomes. RESULTS Stroke survivors were 69.7% White, 54.5% female, with an average age of 80.5 (SD, 7.6) years and 1.2 adverse outcomes at 2 years after the incident stroke. The relationships between informal caregiving hours and adverse outcomes and between ADL limitations and adverse outcomes were positive. The interaction between informal caregiving hours per week and ADL limitations indicated that those who received the lowest amount of informal caregiving had a rate of 0.12 more adverse outcomes per ADL (average marginal effect, 0.12 [95% CI, 0.005-0.23]; P=0.041) than those who received the highest amounts. CONCLUSIONS Informal caregiving hours moderated the relationship between ADL limitations and adverse outcomes in this sample of community-based stroke survivors. Higher amounts relative to lower amounts of informal caregiving hours per week may be protective by decreasing the rate of adverse outcomes per ADL limitation.
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Affiliation(s)
- Aileen Chou
- Department of Physical Therapy, University of Pittsburgh, PA. (A.C., J.K.F.)
| | - Scott R Beach
- Department of Psychology, University of Pittsburgh, PA. (S.R.B.)
| | - Barbara J Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina-Wilmington, NC (B.J.L.)
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, PA. (J.R., L.T.)
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, PA. (J.R., L.T.)
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, PA. (A.C., J.K.F.)
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Salimian S, Virani SA, Roston TM, Yao RJR, Turgeon RD, Ezekowitz J, Hawkins NM. Impact of the method of calculating 30-day readmission rate after hospitalization for heart failure. Data from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. Eur Heart J Qual Care Clin Outcomes 2024:qcae026. [PMID: 38609346 DOI: 10.1093/ehjqcco/qcae026] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Thirty-day readmission rate after heart failure (HF) hospitalization is widely used to evaluate healthcare quality. Methodology may substantially influence estimated rates. We assessed the impact of different definitions on HF and all-cause readmission rates. METHODS Readmission rates were examined in 1,835 patients discharged following HF hospitalization using 64 unique definitions derived from five methodological factors: (1) ICD-10 codes (broad vs narrow), (2) index admission selection (single admission only first-in-year vs. random sample; or multiple admissions in year with vs. without 30-day blanking period), (3) variable denominator (number alive at discharge vs. number alive at 30-days), (4) follow-up period start (discharge date vs day following discharge), and (5) annual reference-period (calendar vs fiscal). The impact of different factors was assessed using linear-regression. RESULTS The calculated 30-day readmission rate for HF varied more than 2-fold depending solely on the methodological approach (6.5% to 15.0%). All-cause admission rates exhibited similar variation (18.8% to 29.9%). The highest rates included all consecutive index admissions (HF 11.1-15.0%, all-cause 24.0-29.9%), and lowest only one index admission per patient per year (HF 6.5-11.3%, all-cause 18.8-22.7%). When including multiple index admissions and compared to blanking the 30-days post-discharge, not blanking was associated with 2.3% higher readmission rates. Selecting a single admission per year with a first-in-year approach lowered readmission rates by 1.5%, while random-sampling admissions lowered estimates further by 5.2% (p<0.001). CONCLUSION Calculated 30-day readmission rates varied more than 2-fold by altering methods. Transparent and consistent methods are needed to ensure reproducible and comparable reporting.
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Affiliation(s)
- Samaneh Salimian
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Sean A Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Thomas M Roston
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Ren Jie Robert Yao
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Ricky D Turgeon
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Justin Ezekowitz
- Canadian Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
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Lin C, King PH, Richman JS, Davis LL. Association of Posttraumatic Stress Disorder and Race on Readmissions After Stroke. Stroke 2024; 55:983-989. [PMID: 38482715 PMCID: PMC10994194 DOI: 10.1161/strokeaha.123.044795] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND There is limited research on outcomes of patients with posttraumatic stress disorder (PTSD) who also develop stroke, particularly regarding racial disparities. Our goal was to determine whether PTSD is associated with the risk of hospital readmission after stroke and whether racial disparities existed. METHODS The analytical sample consisted of all veterans receiving care in the Veterans Health Administration who were identified as having a new stroke requiring inpatient admission based on the International Classification of Diseases codes. PTSD and comorbidities were identified using the International Classification of Diseases codes and given the date of first occurrence. The retrospective cohort data were obtained from the Veterans Affairs Corporate Data Warehouse. The main outcome was any readmission to Veterans Health Administration with a stroke diagnosis. The hypothesis that PTSD is associated with readmission after stroke was tested using Cox regression adjusted for patient characteristics including age, sex, race, PTSD, smoking status, alcohol use, and comorbidities treated as time-varying covariates. RESULTS Our final cohort consisted of 93 651 patients with inpatient stroke diagnosis and no prior Veterans Health Administration codes for stroke starting from 1999 with follow-up through August 6, 2022. Of these patients, 12 916 (13.8%) had comorbid PTSD. Of the final cohort, 16 896 patients (18.0%) with stroke were readmitted. Our fully adjusted model for readmission found an interaction between African American veterans and PTSD with a hazard ratio of 1.09 ([95% CI, 1.00-1.20] P=0.047). In stratified models, PTSD has a significant hazard ratio of 1.10 ([95% CI, 1.02-1.18] P=0.01) for African American but not White veterans (1.05 [95% CI, 0.99-1.11]; P=0.10). CONCLUSIONS Among African American veterans who experienced stroke, preexisting PTSD was associated with increased risk of readmission, which was not significant among White veterans. This study highlights the need to focus on high-risk groups to reduce readmissions after stroke.
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Affiliation(s)
- Chen Lin
- Departments of Neurology (C.L., P.H.K.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Peter H King
- Departments of Neurology (C.L., P.H.K.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Joshua S Richman
- Surgery (J.S.R.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Lori L Davis
- Psychiatry (L.L.D.), University of Alabama at Birmingham
- Tuscaloosa VA Medical Center, AL (L.L.D.)
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Impact of the COVID-19 pandemic on outcomes of cholecystectomy for acute cholecystitis: a national cohort study. ANZ J Surg 2024; 94:674-683. [PMID: 38426369 DOI: 10.1111/ans.18830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The COVID-19 pandemic was associated with significant disruptions to healthcare provision globally and in Aotearoa New Zealand. It remains unclear how this disruption affected the surgical management of acute cholecystitis and whether there are ongoing impacts. METHODS We conducted a secondary analysis of two multicentre cohort studies (CHOLECOVID and CHOLENZ) on patients who underwent cholecystectomy for acute cholecystitis. Participants were categorized into pre-pandemic (September-November 2019), pandemic (March-May 2020), and late-pandemic (August-October 2021) phases. Baseline demographics, clinical management, and 30-day postoperative complications were assessed between phases. Multivariable logistic regression was used to explore the impact of timing of operation on rates of hospital readmission and postoperative complications. RESULTS 517 participants were included, of whom 85 (16%) were in the pre-pandemic-phase, 52 (10%) were in the pandemic phase, and 380 (73%) were in the late-pandemic phase. Pandemic and late-pandemic phase participants were more comorbid and had higher rates of obesity and deranged blood results than pre-pandemic. After multivariable adjustment, there were no differences in rates of hospital readmission or postoperative complications at 30-day follow-up across phases. CONCLUSION The COVID-19 pandemic had minimal impacts on the provision of cholecystectomy for acute cholecystitis in Aotearoa New Zealand. However, patients managed during the COVID-19 pandemic were more comorbid and had higher rates of obesity and elevated inflammatory markers.
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Martens P, Tang WHW. Defining Iron Deficiency in Heart Failure: Importance of Transferrin Saturation. Circ Heart Fail 2024; 17:e011440. [PMID: 38567517 DOI: 10.1161/circheartfailure.123.011440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Pieter Martens
- Kauffman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (P.M., W.H.W.T.)
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Genk, Belgium (P.M.)
| | - W H Wilson Tang
- Kauffman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (P.M., W.H.W.T.)
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Grayburn PA, Mack MJ, Manandhar P, Kosinski AS, Sannino A, Smith RL, Szerlip M, Vemulapalli S. Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair. Circ Cardiovasc Interv 2024; 17:e013581. [PMID: 38436084 DOI: 10.1161/circinterventions.123.013581] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. METHODS We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). RESULTS The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. CONCLUSIONS TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.
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Affiliation(s)
- Paul A Grayburn
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Michael J Mack
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | | | | | - Anna Sannino
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Robert L Smith
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Molly Szerlip
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
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Lee SW, Elsakr C, Holt J, Ayutyanont N. Characteristics and Hospital Outcomes of 1403 Patients Hospitalized at Community Hospitals With Ankylosing Spondylitis. HCA Healthc J Med 2024; 5:11-18. [PMID: 38560394 PMCID: PMC10939093 DOI: 10.36518/2689-0216.1600] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS). Methods We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home discharge and readmission. Results The mean age for all AS patients was 56.06 ± 17.01 years, which was younger in the favorable outcome group, and 82.47% of patients were discharged to home after the average length of stay of 3.72 ± 4.09 days, also shorter in the favorable outcome group. Of 1403 patients, 37.56% were readmitted within 3 months of discharge, at a lower rate in the group with home discharge. Opioids were the most commonly used medication during hospitalization (67.07%), prescribed at a lower rate in the favorable outcome group. Medical coverage by Medicare and Medicaid, fall at admission, hospital-acquired anemia, steroid, acetaminophen, muscle relaxant use, and an increased dose of morphine milligram equivalent at discharge were significantly associated with decreased odds of home discharge. Surgical procedures during admission, gastrointestinal complications, discharge to inpatient rehabilitation units, and use of benzodiazepine were associated with an increased risk of readmission within 3 months. Conclusion Recognizing factors that put patients with AS at risk of unfavorable outcomes is useful information to improve patient care during hospitalization.
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Lv Q, Zhang X, Wang Y, Xu X, He Y, Liu J, Chang H, Zang X, Zhao Y. Multi-Trajectories of Symptoms and their Associations with Unplanned 30-day Hospital Readmission among Patients with Heart Failure: A longitudinal study. Eur J Cardiovasc Nurs 2024:zvae038. [PMID: 38507650 DOI: 10.1093/eurjcn/zvae038] [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: 12/04/2023] [Revised: 03/03/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024]
Abstract
AIMS This study aimed to uncover hidden patterns and predictors of symptom multi-trajectories within 30 days after discharge in patients with heart failure and assess the risk of unplanned 30-day hospital readmission in different patterns. METHODS AND RESULTS The study was conducted from September 2022 to September 2023 in four third-class hospitals in Tianjin, China. A total of 301 patients with heart failure were enrolled in the cohort, and 248 patients completed a 30-day follow-up after discharge. Three multi-trajectory groups were identified: mild symptom status (24.19%), moderate symptom status (57.26%), and severe symptom status (18.55%). With the mild symptom status group as a reference, physical frailty, psychological frailty, and comorbid renal dysfunction were predictors of the moderate symptom status group. Physical frailty, psychological frailty, resilience, taking diuretics, and comorbid renal dysfunction were predictors of the severe symptom status group. Compared with the mild symptom status group, the severe symptom status group was significantly associated with high unplanned 30-day hospital readmission risks. CONCLUSIONS This study identified three distinct multi-trajectory groups among patients with heart failure within 30 days after discharge. The severe symptom status group was associated with a significantly increased risk of unplanned 30-day hospital readmission. Common and different factors predicted different symptom multi-trajectories. Healthcare providers should assess the physical and psychological frailty and renal dysfunction of patients with heart failure before discharge. Inpatient care aimed at alleviating physical and psychological frailty and enhancing resilience may be important to improve patients' symptom development post-discharge.
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Affiliation(s)
- Qingyun Lv
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Xiaonan Zhang
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Yaqi Wang
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Xueying Xu
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Yuan He
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Jingwen Liu
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Hairong Chang
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Xiaoying Zang
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
| | - Yue Zhao
- Tianjin Medical University, School of Nursing, Tianjin, Peoples R China
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Vaeli Zadeh A, Dinparastisaleh R, Vaezi A, Bandyopadhyay D, Rubinstein I, Baig HZ, Calderon-Candelario R, Hashemi Shahraki A, Kawasaki T, Magnusson JM, Larsson LO, Sharafkhaneh A, Herazo-Maya JD, Lee AS, Mirsaeidi M. Risk of 30-Day All-Cause Readmission in Interstitial Lung Disease Patients after COVID-19: National-Level Data. Ann Am Thorac Soc 2024; 21:428-437. [PMID: 38134434 PMCID: PMC10913765 DOI: 10.1513/annalsats.202305-491oc] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Rationale: Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset. Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital. Methods: This study is a nested cohort study that used the PearlDiver patient records database. Adult patients (age ⩾18 yr) who were admitted to hospitals in 28 states in the United States with COVID-19 or ILD diagnoses were included. We defined and analyzed two separate cohorts in this study. The first cohort consisted of patients with COVID-19 and was later divided into two groups with or without a history of ILD. The second cohort consisted of patients with ILD and was later divided into groups with COVID-19 or with a non-COVID-19 pneumonia diagnosis at admission. We also studied two other subcohorts of patients with and without idiopathic pulmonary fibrosis within the second cohort. Propensity score matching was employed to match confounders between groups. The Kaplan-Meier log rank test was applied to compare the probabilities of outcomes. Results: We assessed the data of 2,286,775 patients with COVID-19 and 118,892 patients with ILD. We found that patients with COVID-19 with preexisting ILD had an odds ratio of 1.6 for 30-day all-cause readmission. Similarly, an odds ratio of 2.42 in readmission rates was observed among hospitalized individuals with ILD who contracted COVID-19 compared with those who were hospitalized for non-COVID-19 pneumonia. Our study also found a significantly higher probability of intensive care admission among patients in both cohorts. Conclusions: Patients with ILD face heightened rates of hospital readmissions, particularly when ILD is combined with COVID-19, resulting in adverse outcomes such as decreased quality of life and increased healthcare expenses. It is imperative to prioritize preventive measures against COVID-19 and establish effective postdischarge care strategies for patients with ILD.
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Affiliation(s)
- Ali Vaeli Zadeh
- University of Miami at Holy Cross Health, Fort Lauderdale, Florida
| | - Roshan Dinparastisaleh
- Division of Pulmonary, Critical Care, and Sleep, College of Medicine – Jacksonville, University of Florida, Jacksonville, Florida
| | - Atefeh Vaezi
- Division of Pulmonary, Critical Care, and Sleep, College of Medicine – Jacksonville, University of Florida, Jacksonville, Florida
| | | | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Illinois
| | - Hassan Z. Baig
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Abdolrazagh Hashemi Shahraki
- Division of Pulmonary, Critical Care, and Sleep, College of Medicine – Jacksonville, University of Florida, Jacksonville, Florida
| | | | - Jesper M. Magnusson
- Department of Pulmonology, Institute of Medicine, Shagreens Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars-Olof Larsson
- Division of Respiratory Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden; and
| | - Amir Sharafkhaneh
- Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | - Jose D. Herazo-Maya
- Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Augustine S. Lee
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, and Sleep, College of Medicine – Jacksonville, University of Florida, Jacksonville, Florida
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Borja AJ, Gallagher RS, Karsalia R, Chauhan D, Malhotra EG, Punchak MA, Na J, McClintock SD, Schuster JM, Malhotra NR. Racial disparities in short-term spinal fusion outcomes across 4263 consecutive patients. J Neurosurg Spine 2024:1-6. [PMID: 38394654 DOI: 10.3171/2023.12.spine23700] [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: 06/22/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Race plays a salient role in access to surgical care. However, few investigations have assessed the impact of race within surgical populations after care has been delivered. The objective of this study was to employ an exact matching protocol to a homogenous population of spine surgery patients in order to isolate the relationships between race and short-term postoperative outcomes. METHODS In total, 4263 consecutive patients who underwent single-level, posterior-only lumbar fusion at a single multihospital academic medical center were retrospectively enrolled. Of these patients, 3406 patients self-identified as White and 857 patients self-identified as non-White. Outcomes were initially compared across all patients via logistic regression. Subsequently, White patients and non-White patients were exactly matched on the basis of key demographic and health characteristics (1520 matched patients). Outcome disparities were evaluated between the exact-matched cohorts. Primary outcomes were readmissions, emergency department (ED) visits, reoperations, mortality, intraoperative complications, and discharge disposition. RESULTS Before matching, non-White patients were less likely to be discharged home and more likely to be readmitted, evaluated in the ED, and undergo reoperation. After matching, non-White patients experienced higher rates of nonhome discharge, readmissions, and ED visits. Non-White patients did not have more surgical complications either before or after matching. CONCLUSIONS Between otherwise similar cohorts of spinal fusion cases, non-White patients experienced unfavorable discharge disposition and higher risk of multiple adverse postoperative outcomes. However, these findings were not accounted for by differences in surgical complications, suggesting that structural factors underlie the observed disparities.
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Affiliation(s)
- Austin J Borja
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ryan S Gallagher
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ritesh Karsalia
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daksh Chauhan
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emelia G Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Maria A Punchak
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jianbo Na
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
| | - Scott D McClintock
- 3West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - James M Schuster
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
| | - Neil R Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- 2McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
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Rachmawaty R, Wahyudin E, Bukhari A, Sinrang AW, Satar GL, Juhran A. Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals. J Holist Nurs 2024:8980101241229481. [PMID: 38311909 DOI: 10.1177/08980101241229481] [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] [Indexed: 02/06/2024]
Abstract
Background: Hospitals are required to improve the quality of health services provided to patients. Purpose: Evaluating and comparing the healthcare quality received by insured patients hospitalized in two Indonesian regional public hospitals. Methods: Secondary data analysis used the 2019 and 2020 Indonesian National Health Insurance e-claim databases of Hospital A and Hospital B. Descriptive and crosstabs analyses were used to determine INA-CBGs diagnoses that were categorized as high volume, high risk, and high cost. Results: The admissions that caused financial loss at the Hospital A were 21.1% in 2019 and 19.8% in 2020, while 30.3% in 2019 and 27.5% at the Hospital B. More than 60% of these admissions were placed in the 3rd class of inpatient wards of the two hospitals. Of these admissions, < 5% at the Hospital A and >5% at the Hospital B were readmitted within 30 days, although more than 90% were previously discharged based on physicians' approval. Conclusions: Inadequate healthcare quality received by insured patients. Hence, an integrated clinical pathways based professional nursing practice model is highly recommended to increase patient outcomes and decrease 30 days hospital readmission rates.
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Savitz ST, Inselman S, Nyman MA, Lee M. Evaluation of the Predictive Value of Routinely Collected Health-Related Social Needs Measures. Popul Health Manag 2024; 27:34-43. [PMID: 37903241 DOI: 10.1089/pop.2023.0129] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
The objective was to assess the value of routinely collected patient-reported health-related social needs (HRSNs) measures for predicting utilization and health outcomes. The authors identified Mayo Clinic patients with cancer, diabetes, or heart failure. The HRSN measures were collected as part of patient-reported screenings from June to December 2019 and outcomes (hospitalization, 30-day readmission, and death) were ascertained in 2020. For each outcome and disease combination, 4 models were used: gradient boosting machine (GBM), random forest (RF), generalized linear model (GLM), and elastic net (EN). Other predictors included clinical factors, demographics, and area-based HRSN measures-area deprivation index (ADI) and rurality. Predictive performance for models was evaluated with and without the routinely collected HRSN measures as change in area under the curve (AUC). Variable importance was also assessed. The differences in AUC were mixed. Significant improvements existed in 3 models of death for cancer (GBM: 0.0421, RF: 0.0496, EN: 0.0428), 3 models of hospitalization (GBM: 0.0372, RF: 0.0640, EN: 0.0441), and 1 of death (RF: 0.0754) for diabetes, and 1 model of readmissions (GBM: 0.1817), and 3 models of death (GBM: 0.0333, RF: 0.0519, GLM: 0.0489) for heart failure. Age, ADI, and the Charlson comorbidity index were the top 3 in variable importance and were consistently more important than routinely collected HRSN measures. The addition of routinely collected HRSN measures resulted in mixed improvement in the predictive performance of the models. These findings suggest that existing factors and the ADI are more important for prediction in these contexts. More work is needed to identify predictors that consistently improve model performance.
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Affiliation(s)
- Samuel T Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Shealeigh Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Nyman
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Minji Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Ketabi M, Andishgar A, Fereidouni Z, Sani MM, Abdollahi A, Vali M, Alkamel A, Tabrizi R. Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach. Clin Cardiol 2024; 47:e24239. [PMID: 38402566 PMCID: PMC10894620 DOI: 10.1002/clc.24239] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HF patients by using The Fasa Registry on Systolic HF (FaRSH) database. HYPOTHESIS ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data. METHODS Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC). RESULTS Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI. CONCLUSIONS The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.
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Affiliation(s)
- Marzieh Ketabi
- Student Research CommitteeFasa University of Medical SciencesFasaIran
| | | | - Zhila Fereidouni
- Department of Medical Surgical NursingFasa University of Medical ScienceFarsIran
| | | | - Ashkan Abdollahi
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohebat Vali
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Abdulhakim Alkamel
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
| | - Reza Tabrizi
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
- Clinical Research Development UnitFasa University of Medical SciencesFasaIran
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Snyder S, Butala N, Williams AM, Kneebusch J. Pharmacist-Driven Alcohol Use Disorder Screening May Increase Inpatient Utilization of Extended-Release Naltrexone: A Single Center Pilot Study. Pharmacy (Basel) 2024; 12:26. [PMID: 38392933 PMCID: PMC10892525 DOI: 10.3390/pharmacy12010026] [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: 11/27/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Individuals with mental illness have a high incidence of comorbid substance use, with one of the most prevalent being alcohol use disorder (AUD). Naltrexone, FDA-approved for AUD, decreases reward associated with alcohol-related social cues. This study aimed to determine if a pharmacist-driven screening tool would increase the use of extended-release naltrexone (XR-NTX) in patients with AUD and a comorbid psychiatric condition. Pharmacists screened and recommended XR-NTX for adults admitted to the inpatient psychiatric unit, who had a DSM-5 diagnosis of AUD, a negative urine drug screen for opioids, and were hospitalized for at least 1 day. Endpoints evaluated included the number of XR-NTX doses administered during the screening period to the prescreening period, 30-day readmission rates, recommendation acceptance rates, and reasons for not administering XR-NTX. Pharmacists identified 66 of 641 screened patients who met the inclusion criteria and were candidates for XR-NTX. Compared to the preintervention period, more patients received XR-NTX for AUD (2 vs. 8). Readmission rates were similar between those with AUD who received XR-NTX and those who did not. Pharmacist-driven screening for AUD led to greater administration of XR-NTX when compared to the same 4-month period the year prior to initiating the study.
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Affiliation(s)
- Sabrina Snyder
- Department of Pharmacy, Arlington Campus, Riverside University Health System, Riverside, CA 92503, USA; (S.S.); (N.B.); (A.M.W.)
| | - Niyati Butala
- Department of Pharmacy, Arlington Campus, Riverside University Health System, Riverside, CA 92503, USA; (S.S.); (N.B.); (A.M.W.)
| | - Andrew M. Williams
- Department of Pharmacy, Arlington Campus, Riverside University Health System, Riverside, CA 92503, USA; (S.S.); (N.B.); (A.M.W.)
| | - Jamie Kneebusch
- Department of Pharmacy, Arlington Campus, Riverside University Health System, Riverside, CA 92503, USA; (S.S.); (N.B.); (A.M.W.)
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA 92093, USA
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Tomita M, Murata K, Suzuki H, Osaki C, Matuki E, Komatuzaki K, Ishihara Y, Yoshihara S, Sakai S. Multiple risk factors for unplanned readmissions within 1 month of hospital discharge in acute care hospitals in Japan. Int J Nurs Pract 2024:e13235. [PMID: 38217463 DOI: 10.1111/ijn.13235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024]
Abstract
AIM The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. BACKGROUND With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. DESIGN This is a single-centre retrospective descriptive study. METHODS Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April-September 2017 as risk factors. RESULTS Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04-4.77), malignancy (OR: 2.16, 95% CI: 1.44-3.24), non-surgical admission (OR: 1.76, 95% CI: 1.07-2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14-2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06-2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non-malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. CONCLUSIONS Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care.
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Affiliation(s)
- Masako Tomita
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Kanako Murata
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Hiroko Suzuki
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Chieko Osaki
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Eri Matuki
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Kiiko Komatuzaki
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Yukie Ishihara
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Shoko Yoshihara
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Shima Sakai
- Faculty of Human Sciences, Sophia University, Tokyo, Japan
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Daus M, McHugh MD, Kutney-Lee A, Brooks Carthon JM. Effect of the Nurse Work Environment on Older Hispanic Surgical Patient Readmissions. Nurs Res 2024; 73:E1-E10. [PMID: 37768958 PMCID: PMC10840851 DOI: 10.1097/nnr.0000000000000698] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Readmissions following hospitalization for common surgical procedures are prevalent among older adults and are disproportionally experienced by Hispanic patients. One potential explanation for these disparities is that Hispanic patients may receive care in hospitals with lower-quality nursing care. OBJECTIVES The objective of this study was to evaluate the relationship between the hospital-level work environment of nurses and hospital readmissions among older Hispanic patients. METHODS Using linked data sources from 2014 to 2016, we conducted a cross-sectional analysis of 522 hospitals and 732,035 general, orthopedic, and vascular surgical patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) in four states. Multivariable logistic regression models were employed to determine the relationship between the work environment and older Hispanic patient readmissions at multiple time periods (7, 30, and 90 days). RESULTS In final adjusted models that included an interaction between work environment and ethnicity, an increase in the quality of the work environment resulted in a decrease in the odds of readmission that was greater for older Hispanic surgical patients at all time periods. Specifically, an increase in three of the five work environment subscales (Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy) was associated with a reduction in the odds of readmission that was greater for Hispanic patients than their non-Hispanic White counterparts. DISCUSSION System-level investments in the work environment may reduce Hispanic patient readmission disparities. This study's findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients.
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Affiliation(s)
- Marguerite Daus
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, Aurora, CO
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Ann Kutney-Lee
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - J. Margo Brooks Carthon
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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Liu C, Luo L, He X, Wang T, Liu X, Liu Y. Patient Readmission for Ischemic Stroke: Risk Factors and Impact on Mortality. Inquiry 2024; 61:469580241241271. [PMID: 38529892 DOI: 10.1177/00469580241241271] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Patient readmission for ischemic stroke significantly strains the healthcare and medical insurance systems. Current understanding of the risk factors associated with these readmissions, as well as their subsequent impact on mortality within China, remains insufficient. This is particularly evident in the context of comprehensive, contemporary population studies. This 4-year retrospective cohort study included 125 397 hospital admissions for ischemic stroke from 838 hospitals located in 22 regions (13 urban and 9 rural) of a major city in western China, between January 1, 2015 and December 31, 2018. The Chi-square tests were used in univariate analysis. Accounting for intra-subject correlations of patients' readmissions, accelerated failure time (AFT) shared frailty models were used to examine readmission events and pure AFT models for mortality. Risk factors for patient readmission after ischemic stroke include frequent admission history, male gender, employee's insurance, advanced age, residence in urban areas, index hospitalization in low-level hospitals, extended length of stay (LOS) during index hospitalization, specific comorbidities and subtypes of ischemic stroke. Furthermore, our findings indicated that an additional admission for ischemic stroke increased patient mortality by 16.4% (P < .001). Stroke readmission contributed to an increased risk of hospital mortality. Policymakers can establish more effective and targeted policies to reduce readmissions for stroke by controlling these risk factors.
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Affiliation(s)
- Chuang Liu
- Chengdu Vocational & Technical College of Industry, Chengdu, Sichuan, China
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Xiaozhou He
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wang
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Xiaofei Liu
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Yiyou Liu
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
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18
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Achanta A, Wasfy JH, Moss CT, Cherukara A, Ho D, Boxer R, Schmieding M, Phadke NA, Thompson R, Levine DM, Weiner RB. Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care. Circ Cardiovasc Qual Outcomes 2024; 17:e010031. [PMID: 38054286 DOI: 10.1161/circoutcomes.123.010031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. METHODS Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. RESULTS We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. CONCLUSIONS About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.
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Affiliation(s)
- Aditya Achanta
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Jason H Wasfy
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - David Ho
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Malte Schmieding
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Neelam Ameya Phadke
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Allergy and Immunology Division (N.P.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ryan Thompson
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Michael Levine
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Rory B Weiner
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
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Chartrand J, Shea B, Hutton B, Dingwall O, Kakkar A, Chartrand M, Poulin A, Backman C. Patient- and family-centred care transition interventions for adults: a systematic review and meta-analysis of RCTs. Int J Qual Health Care 2023; 35:mzad102. [PMID: 38147502 PMCID: PMC10750974 DOI: 10.1093/intqhc/mzad102] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023] Open
Abstract
Although patient centredness is part of providing high-quality health care, little is known about the effectiveness of care transition interventions that involve patients and their families on readmissions to the hospital or emergency visits post-discharge. This systematic review (SR) aimed to examine the evidence on patient- and family-centred (PFC) care transition interventions and evaluate their effectiveness on adults' hospital readmissions and emergency department (ED) visits after discharge. Searches of Medline, CINAHL, and Embase databases were conducted from the earliest available online year of indexing up to and including 14 March 2021. The studies included: (i) were about care transitions (hospital to home) of ≥18-year-old patients; (ii) had components of patient-centred care and care transition frameworks; (iii) reported on one or more outcomes were among hospital readmissions and ED visits after discharge; and (iv) were cluster-, pilot- or randomized-controlled trials published in English or French. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers. A narrative synthesis was performed, and pooled odd ratios, standardized mean differences, and mean differences were calculated using a random-effects meta-analysis. Of the 10,021 citations screened, 50 trials were included in the SR and 44 were included in the meta-analyses. Care transition intervention types included health assessment, symptom and disease management, medication reconciliation, discharge planning, risk management, complication detection, and emotional support. Results showed that PFC care transition interventions significantly reduced the risk of hospital readmission rates compared to usual care [incident rate ratio (IRR), 0.86; 95% confidence interval (CI), 0.75-0.98; I2 = 73%] regardless of time elapsed since discharge. However, these same interventions had minimal impact on the risk of ED visit rates compared to usual care group regardless of time passed after discharge (IRR, 1.00; 95% CI, 0.85-1.18; I2 = 29%). PFC care transition interventions containing a greater number of patient-centred care (IRR, 0.73; 95% CI, 0.57-0.94; I2 = 59%) and care transition components (IRR, 0.76; 95% CI, 0.64-0.91; I2 = 4%) significantly decreased the risk of patients being readmitted. However, these interventions did not significantly increase the risk of patients visiting the ED after discharge (IRR, 1.54; CI 95%, 0.91-2.61). Future interventions should focus on patients' and families' values, beliefs, needs, preferences, race, age, gender, and social determinants of health to improve the quality of adults' care transitions.
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Affiliation(s)
- Julie Chartrand
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
| | - Beverley Shea
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Moran Crescent, Ottawa, Ontario K1G 5Z3, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
- Bruyère Research Institute, Bruyère Continuing Care, 85 Primerose Avenue, Ottawa, Ontario K1R 6M1, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Moran Crescent, Ottawa, Ontario K1G 5Z3, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Orvie Dingwall
- Neil John Maclean Health Sciences Library, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Anupriya Kakkar
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Mariève Chartrand
- Collège La Cité, 801 Aviation Parkway, Ottawa, Ontario K1K 4R3, Canada
| | - Ariane Poulin
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
| | - Chantal Backman
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
- Care of the Elderly, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
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Palacios-Ariza MA, Morales-Mendoza E, Murcia J, Arias-Duarte R, Lara-Castellanos G, Cely-Jiménez A, Rincón-Acuña JC, Araúzo-Bravo MJ, McDouall J. Prediction of patient admission and readmission in adults from a Colombian cohort with bipolar disorder using artificial intelligence. Front Psychiatry 2023; 14:1266548. [PMID: 38179255 PMCID: PMC10764573 DOI: 10.3389/fpsyt.2023.1266548] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Bipolar disorder (BD) is a chronically progressive mental condition, associated with a reduced quality of life and greater disability. Patient admissions are preventable events with a considerable impact on global functioning and social adjustment. While machine learning (ML) approaches have proven prediction ability in other diseases, little is known about their utility to predict patient admissions in this pathology. Aim To develop prediction models for hospital admission/readmission within 5 years of diagnosis in patients with BD using ML techniques. Methods The study utilized data from patients diagnosed with BD in a major healthcare organization in Colombia. Candidate predictors were selected from Electronic Health Records (EHRs) and included sociodemographic and clinical variables. ML algorithms, including Decision Trees, Random Forests, Logistic Regressions, and Support Vector Machines, were used to predict patient admission or readmission. Survival models, including a penalized Cox Model and Random Survival Forest, were used to predict time to admission and first readmission. Model performance was evaluated using accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC) and concordance index. Results The admission dataset included 2,726 BD patients, with 354 admissions, while the readmission dataset included 352 patients, with almost half being readmitted. The best-performing model for predicting admission was the Random Forest, with an accuracy score of 0.951 and an AUC of 0.98. The variables with the greatest predictive power in the Recursive Feature Elimination (RFE) importance analysis were the number of psychiatric emergency visits, the number of outpatient follow-up appointments and age. Survival models showed similar results, with the Random Survival Forest performing best, achieving an AUC of 0.95. However, the prediction models for patient readmission had poorer performance, with the Random Forest model being again the best performer but with an AUC below 0.70. Conclusion ML models, particularly the Random Forest model, outperformed traditional statistical techniques for admission prediction. However, readmission prediction models had poorer performance. This study demonstrates the potential of ML techniques in improving prediction accuracy for BD patient admissions.
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Affiliation(s)
| | - Esteban Morales-Mendoza
- Fundación Universitaria Sanitas, Gerencia y Gestión Sanitaria Research Group, Instituto de Gerencia y Gestión Sanitaria (IGGS), Bogotá, Colombia
| | - Jossie Murcia
- Fundación Universitaria Sanitas, Gerencia y Gestión Sanitaria Research Group, Instituto de Gerencia y Gestión Sanitaria (IGGS), Bogotá, Colombia
| | - Rafael Arias-Duarte
- Psicopatología y Sociedad Research Group, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Germán Lara-Castellanos
- Psicopatología y Sociedad Research Group, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia
| | | | | | - Marcos J. Araúzo-Bravo
- Keralty, Bogotá, Colombia
- Computational Biology and Systems Biomedicine, Biodonostia Health Research Institute, San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, Faculty of Medicine and Nursing, University of Basque Country (UPV/EHU), Leioa, Spain
| | - Jorge McDouall
- Sanitas Crea Research Group, Fundación Universitaria Sanitas, Bogotá, Colombia
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Kurniawan T, Nilmanat K, Boonyasopun U, Ganefianty A. Experiences of discharge planning practices among Indonesian nurses: A qualitative study. Belitung Nurs J 2023; 9:520-529. [PMID: 38130678 PMCID: PMC10731435 DOI: 10.33546/bnj.2980] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Background Discharge planning is vital to preventing hospital readmission, and nurses play a key role. The COVID-19 pandemic has posed challenges to hospital services that may persist or recur. Therefore, exploring nurses' experiences with discharge planning practices before and during this pandemic is crucial. Objective This study aimed to describe the experiences of discharge planning practices among nurses at an Indonesian tertiary hospital before and during the COVID-19 pandemic. Methods A qualitative descriptive study design was used. Telephone interviews were conducted to collect data among ten nurses from March 2019 and continued between December 2020 and August 2021. Content analysis was done for data analysis. Results Two main themes emerged: 1) Challenges in discharge planning practices and 2) Perceived discharge planning as a professional responsibility. Implementing the inpatient ward fusion policy as part of the hospital's pandemic response presented greater challenges to nurses in coordinating care and performing discharge planning. Fear of COVID-19 infection, social distancing measures, and using personal protective equipment also affected how nurses delivered discharge education during the pandemic. However, the nurses sensed a greater responsibility to ensure the maintenance of essential components of discharge planning procedures to guarantee the patient's capability to perform self-care at home. Conclusion Nurses viewed discharge planning practices as their responsibility and continued them during the pandemic despite facing various challenges. In addition to recognizing the significance of nurses' roles in discharge planning practices and overall patient care, it is crucial to anticipate and address the diverse working patterns and styles among healthcare professionals in unified wards, ensuring effective coordination.
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Affiliation(s)
- Titis Kurniawan
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
- Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | | | | | - Amelia Ganefianty
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
- Department of Nursing, Dr. Hasan Sadikin Hospital, West Java, Indonesia
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Zoham MH, Mohammadpour M, Yaghmaie B, Hadizadeh A, Eskandarizadeh Z, Beigi EH. Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission. J Pediatr Intensive Care 2023; 12:312-318. [PMID: 37970145 PMCID: PMC10631837 DOI: 10.1055/s-0041-1735297] [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: 02/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022] Open
Abstract
Despite the fact that unscheduled readmission to pediatric intensive care units (PICUs) has significant adverse consequences, there is a need for a predictive tool appropriate for use in the clinical setting. The aim of this study was to assess the ability of the modified Brighton pediatric early warning score (PEWS) to identify children at high risk for early unplanned readmission. In this retrospective cohort study, all patients aged 1 month to 18 years of age discharged from PICUs of two tertiary children's hospitals during the study interval were enrolled. Apart from demographic data, the association between PEWS and early readmission, defined as readmission within 48 hours of discharge, was analyzed by multivariable logistic regression. From 416 patients, 27 patients had early PICU readmission. Patients who experienced readmission were significantly younger than the controls. (≤12 months, 70.4 vs. 39.1%, p = 0.001) Patients who were admitted from the emergency room (66.7 and 33.3% for emergency department (ED) and floor, respectively, p = 0.012) had higher risk of early unplanned readmission. PEWS at discharge was significantly higher in patients who experienced readmission (3.07 vs. 0.8, p < 0.001). A cut-off PEWS of 2, with sensitivity 85.2% and specificity 78.1%, determined the risk of unplanned readmission. Each 1-point increase in the PEWS at discharge significantly increases the risk of readmission (odds ratio [OR] = 3.58, 95% confidence interval [CI]: [2.42-5.31], p < 0.001). PEWS can be utilized as a useful predictive tool regarding predicting unscheduled readmission in PICU. Further large-scale studies are needed to determine its benefits in clinical practice.
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Affiliation(s)
- Mojdeh Habibi Zoham
- Division of Pediatric Intensive Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Division of Pediatric Intensive Care, Children's Medical Center Hospital (Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaie
- Division of Pediatric Intensive Care, Children's Medical Center Hospital (Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Amere Hadizadeh
- Division of Pediatric Intensive Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Eskandarizadeh
- Division of Pediatric Intensive Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat H. Beigi
- Division of Pediatric Intensive Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Low JK, Crawford K, Lai J, Manias E. Factors associated with readmission in chronic kidney disease: Systematic review and meta-analysis. J Ren Care 2023; 49:229-242. [PMID: 35809061 DOI: 10.1111/jorc.12437] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk factors associated with all-cause hospital readmission are poorly characterised in patients with chronic kidney disease. OBJECTIVE A systematic review and meta-analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease. DESIGN, PARTICIPANTS & MEASUREMENTS Studies involving adult patients were identified from four databases from inception to 31/03/2020. Random-effects meta-analyses were conducted to determine factors associated with all-cause 30-day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups. RESULTS Eighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta-analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30-day readmission. Other risk factors identified included increasing body mass index (kg/m2 ) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow-up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist. CONCLUSION Risk-reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jerry Lai
- eSolution, Deakin University, Geelong, Victoria, Australia
- Intersect Australia, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
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Gesner T, Fogel J, Bryson L. Blood pressure medication use and postpartum hospital readmission among preeclampsia patients. Hypertens Pregnancy 2023; 42:2226210. [PMID: 37358058 DOI: 10.1080/10641955.2023.2226210] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Blood pressure medication is often prescribed to patients with preeclampsia. We are not aware of any study on readmission of those with preeclampsia to the hospital that considers blood pressure medication use or dose. METHODS This was a retrospective study of 440 preeclampsia patients diagnosed during the antepartum, intrapartum, or immediate postpartum period prior to discharge from the hospital. The outcome was hospital readmission. One analysis compared blood pressure medication (oral labetalol and oral extended release nifedipine) use and nonuse. Another analysis compared low-dose and high-dose blood pressure medication use. RESULTS Blood pressure medication use was not significantly associated with readmission (OR: 0.79, 95% CI: 0.39, 1.63, p = 0.53). Low dose of blood pressure medication was significantly associated with increased odds for readmission (OR: 2.29, 95% CI: 1.00, 5.25, p = 0.05). CONCLUSION We found that low dose of blood pressure medication was associated with increased odds for readmission within 6 weeks among those with preeclampsia. We recommend that clinicians balance the preference to reduce a blood pressure medication dose with the possible concern that too low a dose may place certain patients on track for hospital readmission after discharge.
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Affiliation(s)
- Timothy Gesner
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA
| | - Joshua Fogel
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA
- Department of Business Management, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - Lennox Bryson
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, NY, USA
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Dixit NM, Parikh NU, Ziaeian B, Fonarow GC. Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients. Circ Heart Fail 2023; 16:e011218. [PMID: 37929591 PMCID: PMC10872946 DOI: 10.1161/circheartfailure.123.011218] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown. METHODS Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines-HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled. RESULTS An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively. CONCLUSIONS An intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.
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Affiliation(s)
- Neal M. Dixit
- Division of Cardiovascular Medicine, Department of Medicine, University of California, Davis, Sacramento, California
| | - Neil U. Parikh
- School of Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Pagnesi M, Ghiraldin D, Vizzardi E, Chiarito M, Stolfo D, Baldetti L, Adamo M, Lombardi CM, Inciardi RM, Tomasoni D, Loiacono F, Maccallini M, Villaschi A, Gasparini G, Montella M, Contessi S, Cocianni D, Perotto M, Barone G, Sartori S, Davison BA, Merlo M, Cappelletti AM, Sinagra G, Pini D, Metra M. Detailed Assessment of the "I Need Help" Criteria in Patients With Heart Failure: Insights From the HELP-HF Registry. Circ Heart Fail 2023; 16:e011003. [PMID: 37909222 DOI: 10.1161/circheartfailure.123.011003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The "I Need Help" markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these markers on clinical outcomes in a real-world, contemporary, multicenter HF population. METHODS We included consecutive patients with HF and at least 1 high-risk "I Need Help" marker from 4 centers. The impact of the cumulative number of "I Need Help" criteria and that of each individual "I Need Help" criterion was evaluated. The primary end point was the composite of all-cause mortality or first HF hospitalization. RESULTS Among 1149 patients enrolled, the majority had 2 (30.9%) or 3 (22.6%) "I Need Help" criteria. A higher cumulative number of "I Need Help" criteria was independently associated with a higher risk of the primary end point (adjusted hazard ratio for each criterion increase, 1.19 [95% CI, 1.11-1.27]; P<0.001), and patients with >5 criteria had the worst prognosis. Need of inotropes, persistently high New York Heart Association classes III and IV or natriuretic peptides, end-organ dysfunction, >1 HF hospitalization in the last year, persisting fluid overload or escalating diuretics, and low blood pressure were the individual criteria independently associated with a higher risk of the primary end point. CONCLUSIONS In our HF population, a higher number of "I Need Help" criteria was associated with a worse prognosis. The individual criteria with an independent impact on mortality or HF hospitalization were need of inotropes, New York Heart Association class or natriuretic peptides, end-organ dysfunction, multiple HF hospitalizations, persisting edema or escalating diuretics, and low blood pressure.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Daniele Ghiraldin
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Enrico Vizzardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Mauro Chiarito
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella)
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.B., A.M.C.)
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Carlo Mario Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Riccardo Maria Inciardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
| | - Ferdinando Loiacono
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
| | - Marta Maccallini
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella)
| | - Alessandro Villaschi
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella)
| | - Gaia Gasparini
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella)
| | - Marco Montella
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., M. Maccallini, A.V., G.G., M. Montella)
| | - Stefano Contessi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Daniele Cocianni
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Maria Perotto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Giuseppe Barone
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.B., A.M.C.)
| | | | | | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Alberto Maria Cappelletti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.B., A.M.C.)
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Italy (D.S., S.C., D.C., M. Perotto, M. Merlo, G.S.)
| | - Daniela Pini
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.C., F.L., M. Maccallini, A.V., G.G., M. Montella, D.P.)
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Pagnesi, D.G., E.V., M.A., C.M.L., R.M.I., D.T., M. Metra)
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Gomes L, Pereira S, Sousa-Pinto B, Rodrigues C. Performance of risk scores in patients with acute exacerbations of COPD. J Bras Pneumol 2023; 49:e20230032. [PMID: 37909549 PMCID: PMC10759966 DOI: 10.36416/1806-3756/e20230032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/05/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Acute exacerbations of COPD (AECOPD) are common causes of hospitalization. Various scoring systems have been proposed to classify the risk of clinical deterioration or mortality in hospitalized patients with AECOPD. We sought to investigate whether clinical deterioration and mortality scores at admission can predict adverse events occurring during hospitalization and after discharge of patients with AECOPD. METHODS We performed a retrospective study of patients admitted with AECOPD. The National Early Warning Score 2 (NEWS2), the NEWS288-92%, the Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF) score, and the modified DECAF (mDECAF) score were calculated at admission. We assessed the sensitivity, specificity, and overall performance of the scores for the following outcomes: in-hospital mortality; need for invasive mechanical ventilation or noninvasive ventilation (NIV); long hospital stays; hospital readmissions; and future AECOPD. RESULTS We included 119 patients admitted with AECOPD. The median age was 75 years, and 87.9% were male. The NEWS288-92% was associated with an 8.9% reduction in the number of individuals classified as requiring close, continuous observation, without an increased risk of death in the group of individuals classified as being low-risk patients. The NEWS288-92% and NEWS2 scores were found to be adequate in predicting the need for acute NIV and longer hospital stays. The DECAF and mDECAF scores were found to be better at predicting in-hospital mortality than the NEWS2 and NEWS288-92%. CONCLUSIONS The NEWS288-92% safely reduces the need for clinical monitoring in patients with AECOPD when compared with the NEWS2. The NEWS2 and NEWS288-92% appear to be good predictors of the length of hospital stay and need for NIV, but they do not replace the DECAF and mDECAF scores as predictors of mortality.
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Affiliation(s)
- Lídia Gomes
- . Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Samuel Pereira
- . Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bernardo Sousa-Pinto
- . Centro de Investigação em Tecnologias e Serviços de Saúde - CINTESIS - Universidade do Porto, Porto, Portugal
| | - Cidália Rodrigues
- . Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Berghetti L, Danielle MBA, Winter VDB, Petersen AGP, Lorenzini E, Kolankiewicz ACB. Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics. Rev Lat Am Enfermagem 2023; 31:e4013. [PMID: 37820218 PMCID: PMC10561803 DOI: 10.1590/1518-8345.6594.4013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/19/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. METHOD cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. RESULTS the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. CONCLUSION in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days. (1) Brazilian study that evaluated the transition of care of patients with CNCDs. (2) Women had a higher average in the understanding about medications factor. (3) Whites and residents in the urban area better evaluated the care plan. (4) Better preparation for self-management reduces length of stay and readmissions. (5) Better preparation for understanding about medications reduces hospitalization time.
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Affiliation(s)
- Larissa Berghetti
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brasil
| | | | | | | | - Elisiane Lorenzini
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
- Becaria del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
| | - Adriane Cristina Bernat Kolankiewicz
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brasil
- Becaria del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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Shashikumar SA, Zheng J, Orav EJ, Epstein AM, Joynt Maddox KE. Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement - Advanced. Circulation 2023; 148:1074-1083. [PMID: 37681315 PMCID: PMC10540757 DOI: 10.1161/circulationaha.123.065109] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bundled Payments for Care Improvement - Advanced (BPCI-A) is a Medicare initiative that aims to incentivize reductions in spending for episodes of care that start with a hospitalization and end 90 days after discharge. Cardiovascular disease, an important driver of Medicare spending, is one of the areas of focus BPCI-A. It is unknown whether BPCI-A is associated with spending reductions or quality improvements for the 3 cardiovascular medical events or 5 cardiovascular procedures in the model. METHODS In this retrospective cohort study, we conducted difference-in-differences analyses using Medicare claims for patients discharged between January 1, 2017, and September 30, 2019, to assess differences between BPCI-A hospitals and matched nonparticipating control hospitals. Our primary outcomes were the differential changes in spending, before versus after implementation of BPCI-A, for cardiac medical and procedural conditions at BPCI-A hospitals compared with controls. Secondary outcomes included changes in patient complexity, care utilization, healthy days at home, readmissions, and mortality. RESULTS Baseline spending for cardiac medical episodes at BPCI-A hospitals was $25 606. The differential change in spending for cardiac medical episodes at BPCI-A versus control hospitals was $16 (95% CI, -$228 to $261; P=0.90). Baseline spending for cardiac procedural episodes at BPCI-A hospitals was $37 961. The differential change in spending for cardiac procedural episodes was $171 (95% CI, -$429 to $772; P=0.58). There were minimal differential changes in physicians' care patterns such as the complexity of treated patients or in their care utilization. At BPCI-A versus control hospitals, there were no significant differential changes in rates of 90-day readmissions (differential change, 0.27% [95% CI, -0.25% to 0.80%] for medical episodes; differential change, 0.31% [95% CI, -0.98% to 1.60%] for procedural episodes) or mortality (differential change, -0.14% [95% CI, -0.50% to 0.23%] for medical episodes; differential change, -0.36% [95% CI, -1.25% to 0.54%] for procedural episodes). CONCLUSIONS Participation in BPCI-A was not associated with spending reductions, changes in care utilization, or quality improvements for the cardiovascular medical events or procedures offered in the model.
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Affiliation(s)
- Sukruth A. Shashikumar
- Department of Medicine (S.A.S.), Brigham and Women’s Hospital, Boston, MA
- Center for Advancing Health Services, Policy & Economics Research, Washington University, St. Louis, MO (S.A.S., K.E.J.M.)
| | - Jie Zheng
- Department of Health Policy and Management (J.Z., A.M.E.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - E. John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine (E.J.O., A.M.E.), Brigham and Women’s Hospital, Boston, MA
- Department of Biostatistics (E.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Arnold M. Epstein
- Division of General Internal Medicine and Primary Care, Department of Medicine (E.J.O., A.M.E.), Brigham and Women’s Hospital, Boston, MA
- Department of Health Policy and Management (J.Z., A.M.E.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karen E. Joynt Maddox
- Center for Advancing Health Services, Policy & Economics Research, Washington University, St. Louis, MO (S.A.S., K.E.J.M.)
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.)
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Roldán-Chicano MT, García-López MM, Martínez-Pacheco MC, Rodríguez-Tello J. Prognostic value of defining characteristics in frail elderly syndrome: Hospital readmission and mortality outcomes. Int J Nurs Knowl 2023. [PMID: 37700456 DOI: 10.1111/2047-3095.12445] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To identify the most relevant clinical characteristics of the nursing diagnosis frail elderly syndrome (FES) in hospitalized patients aged 65 or older and analyze their impact on 9-month mortality and hospital readmission. METHODS A prospective and prognostic accuracy study was conducted in patients aged 65 or older, who were admitted to hospital more than 24 h. A consecutive convenience sampling process was used. Assessment included defining characteristics (DCs) of FES, clinical fraility scale (CFS), frail scale (FS), and 9-month mortality and hospital readmission. Statistical tests were used to verify associations between variables. Binary logistic regression analysis and area under the curve were used, to identify significant predictors for the outcomes and evaluate the prognostic accuracy of the DCs. FINDINGS This study involved 150 patients. CFS scored 65 patients (43.3%, confidence interval 95% 35.2% a 51.6) as frail and proved a prognostic value of mortality at 9 month from pre-frail state (p = 0.020). The mean number of DCs for FES nursing diagnosis was 6.35 (SD = 3.14). Validated tools for measuring frailty were associated with all DCs, excepting nutritional imbalance: below body needs. The hospital readmission during the following 9 months was only statistically related to memory impairment (p = 0.07). CONCLUSION Clinical frailty scale showed good results as a predictor of mortality. The study suggests exploring including it, in clinical manifestations of elderly frail syndrome. This study found that only memory impairment defining characteristic was predictive of hospital readmission. Further research should identify other relevant and prognostic clinical manifestations. IMPLICATION FOR NURSING PRACTICE These findings highlight the importance of being vigilant on cognitive decline during hospital admissions. The most prevalent and determinant DCs identified in this study indicate that clinical should focus on preserving functional and mental abilities as well as mobility.
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Affiliation(s)
- María T Roldán-Chicano
- Santa Lucía General University Hospital, Cartagena, Spain
- Cartagena School of Nursing, University of Murcia, Murcia, Spain
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Rao V, DeLeon G, Thamba A, Flanagan M, Nickel K, Gerue M, Gray D. A Retrospective Review of 30-Day Hospital Readmission Risk After Open Heart Surgery in Patients With Atrial Fibrillation. Cureus 2023; 15:e45755. [PMID: 37745753 PMCID: PMC10515093 DOI: 10.7759/cureus.45755] [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] [Accepted: 09/22/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Readmission rates after open heart surgery (OHS) remain an important clinical issue. The causes are varied, with identifying risk factors potentially providing valuable information to reduce healthcare costs and the rate of post-operative complications. This study aimed to characterize the reasons for 30-day hospital readmission rates of patients after open heart surgery. Methods All patients over 18 years of age undergoing OHS at a community hospital from January 2020 through December 2020 were identified. Demographic data, medical history, operative reports, post-operative complications, and telehealth interventions were obtained through chart review. Descriptive statistics and readmission rates were calculated, along with a logistic regression model, to understand the effects of medical history on readmission. Results A total of 357 OHS patients met the inclusion criteria for the study. Within the population, 8.68% of patients experienced readmission, 10.08% had an emergency department (ED) visit, and 95.80% had an outpatient office visit. A history of atrial fibrillation (AFib) significantly predicted 30-day hospital readmissions but not ED or outpatient office visits. Telehealth education was delivered to 66.11% of patients. Conclusion The study investigated factors associated with 30-day readmission following OHS. AFib patients were more likely to be readmitted than patients without atrial fibrillation. No other predictors of readmission, ED visits, or outpatient office visits were found. Patients reporting symptoms of tachycardia, pain, dyspnea, or "other" could be at increased risk for readmission.
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Affiliation(s)
- Varun Rao
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Genaro DeLeon
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Aish Thamba
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Mindy Flanagan
- Department of Research and Innovation, Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, USA
| | - Kathleen Nickel
- Department of Research and Innovation, Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, USA
| | - Michael Gerue
- Department of Cardiovascular Surgery, Parkview Heart Institute, Parkview Health, Fort Wayne, USA
| | - Douglas Gray
- Department of Cardiovascular Surgery, Parkview Heart Institute, Parkview Health, Fort Wayne, USA
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Juanes A, Ruíz J, Puig M, Blázquez M, Gilabert A, López L, Baena MI, Guiu JM, Antònia Mangues M. The Effect of the Drug-Related Problems Prevention Bundle on Early Readmissions in Patients From the Emergency Department: A Randomized Clinical Trial. Ann Pharmacother 2023; 57:1025-1035. [PMID: 36539949 DOI: 10.1177/10600280221143237] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized. OBJECTIVE To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems. METHODS A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause. RESULTS Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed. CONCLUSION AND RELEVANCE In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT03607097).
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Affiliation(s)
- Ana Juanes
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Jesús Ruíz
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Mireia Puig
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Blázquez
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Gilabert
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Laia López
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - M Isabel Baena
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Josep M Guiu
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Maria Antònia Mangues
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
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Al Sabei SD, Ross AM. The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review. Can J Nurs Res 2023; 55:267-278. [PMID: 36734052 DOI: 10.1177/08445621231152959] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes. PURPOSE This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates. METHODS A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed. FINDINGS The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates. CONCLUSIONS The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.
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Affiliation(s)
- Sulaiman Dawood Al Sabei
- Fundamentals and Nursing Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Amy M Ross
- Systems & Organizational Leadership Program, Oregon Health and Science University, School of Nursing, Portland, OR, USA
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Goto J, Shono M, Abe Y, Fujita Y, Ueda K, Yoshida B, Nabeshima Y. Preventive effect of aripiprazole once monthly on rehospitalization for bipolar disorder: A multicenter 1-year retrospective mirror image study. Neuropsychopharmacol Rep 2023; 43:425-433. [PMID: 37560818 PMCID: PMC10496053 DOI: 10.1002/npr2.12371] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
AIM We conducted a 1-year retrospective mirror-image study to investigate the effect of aripiprazole once monthly (AOM) on rehospitalization for bipolar disorder. METHODS Participants were recruited from psychiatric emergency and acute care hospitals in western Japan. We included 39 participants with bipolar disorder who had been administered AOM for at least 1 year with no missing medical records during the observational period. The primary outcomes were rehospitalization rate, number of rehospitalizations, total hospitalization days, and time to rehospitalization in the context of overall psychiatric readmissions. The significance level was set at p < 0.05. RESULTS AOM significantly reduced the rehospitalization rate from 23/39 (59%) to 7/39 (18%) (p = 0.001). The number of rehospitalizations decreased significantly from a mean of 0.85 per person-year to 0.41 per person-year (p = 0.048). The total hospitalization days significantly decreased from a mean of 34.9 days to 14.4 days (p = 0.008). AOM significantly prolonged the time to rehospitalization (p < 0.001). CONCLUSION This study found that AOM reduces overall psychiatric rehospitalization for bipolar disorder based on data from 1 year before and after AOM administration in the real-world setting. Future studies should examine the robustness and persistence of the rehospitalization preventive effect of AOM with larger sample sizes and longer observation periods beyond 1 year.
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Amato LA, Kalolo R, Yu W, Simmons D. Provision of continuous subcutaneous insulin infusion to type 1 diabetes 'frequent flyers'. Intern Med J 2023; 53:1706-1711. [PMID: 37665715 DOI: 10.1111/imj.16213] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/27/2023] [Indexed: 09/06/2023]
Abstract
A few people with type 1 diabetes undergo multiple hospital admissions for acute glycaemic events. We report on a series of five such 'frequent flyers' who were provided with continuous subcutaneous insulin infusion (CSII) therapy. Mean HbA1c decreased from 9.7 ± 2.5% (83 ± 27 mmol/mol) to 7.9 ± 0.4% (63 ± 4.7 mmol/mol) after 2-4 months. Frequency of admissions for acute glycaemic events reduced in three but increased in two patients within 6 months. Total insulin dose and body mass index decreased in some patients and satisfaction was anecdotally higher. Some, but not all, 'frequent flyers' benefited from a trial of CSII.
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Affiliation(s)
- Lisa A Amato
- Macarthur Diabetes Service, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Romana Kalolo
- Macarthur Diabetes Service, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - William Yu
- Macarthur Diabetes Service, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - David Simmons
- Macarthur Diabetes Service, Campbelltown Hospital, Sydney, New South Wales, Australia
- Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
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Coatsworth-Puspoky R, Dahlke S, Duggleby W, Hunter KF. Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review. J Clin Nurs 2023; 32:5793-5815. [PMID: 37095609 DOI: 10.1111/jocn.16705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. DESIGN Mixed methods systematic review. DATA SOURCES Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). REVIEW METHODS Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. RESULTS Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. CONCLUSIONS Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. RELEVANCE TO CLINICAL PRACTICE Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. REPORTING METHOD PRISMA guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution due to design.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Ali H, Inayat F, Malik TF, Patel P, Nawaz G, Taj S, Rehman AU, Afzal A, Ishtiaq R, Afzal MS, Advani R, Watson RR. Operator-specific outcomes in endoscopic sleeve gastroplasty: a propensity-matched analysis of the US population using a multicenter database. Proc AMIA Symp 2023; 36:592-599. [PMID: 37614858 PMCID: PMC10443959 DOI: 10.1080/08998280.2023.2228180] [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: 04/27/2023] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 08/25/2023] Open
Abstract
Background Endoscopic sleeve gastroplasty (ESG) has emerged as an effective endoscopic bariatric procedure over the past decade. Data comparing short-term outcomes of ESG based on operator specialty is scarce. We aimed to assess the impact of operator specialization on patient outcomes using a large bariatric-specific database. Methods We identified a retrospective cohort of patients who underwent ESG by gastroenterologists using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database (2020-2021). A matched comparison cohort of patients who underwent ESG by surgeons was identified and underwent 1:1 propensity score matching based on age, race, gender, American Society of Anesthesiologists physical status classification, and preoperative body mass index. Results After matching, 154 patients were included in the final analysis. Of these, 77 patients underwent ESG by surgeons and 77 by gastroenterologists. In the matched cohort, the median operation time was lower in ESG by surgeons compared to gastroenterologists (P < 0.001). The median percent body mass index decrease was higher in the gastroenterologist cohort compared to the surgeon cohort (4.9% vs 3.8%, P = 0.04). The median percent weight loss after ESG was 4.8% in the surgeon cohort and 5.9% in the gastroenterologist cohort (P = 0.09). There was no statistically significant difference in postoperative emergency department visits (P = 0.65), reoperations (P = 0.15), or reinterventions within 30 days (P = 0.87) between the cohorts. There was no difference in major adverse effects between the groups (0% each). Conclusions Operator choice does not affect ESG-related adverse events or 30-day outcomes in patients undergoing ESG.
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Affiliation(s)
- Hassam Ali
- East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | | | - Talia F. Malik
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Pratik Patel
- Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, New York, USA
| | - Gul Nawaz
- Allama Iqbal Medical College, Lahore, Pakistan
| | - Sobaan Taj
- Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | | | - Arslan Afzal
- Woodhull Medical Center, Brooklyn, New York, USA
| | - Rizwan Ishtiaq
- Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | | | - Rashmi Advani
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Valbuena Valecillos AD, Gober J, Palermo AE, Johnson-Greene D, Shapiro LT. Comparison of Patients Discharged to Skilled Nursing and Inpatient Rehabilitation Facilities After Hospitalization for COVID-19: A Retrospective Study. Am J Phys Med Rehabil 2023; 102:605-610. [PMID: 36729893 PMCID: PMC10259171 DOI: 10.1097/phm.0000000000002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the study is to identify differences in demographics, severity of disease, and rates of hospital readmission among adults discharged to skilled nursing facilities and inpatient rehabilitation facilities after hospitalization for coronavirus 2019. DESIGN This is a retrospective cohort study of adults hospitalized with coronavirus 2019 infection at academic medical centers participating in the Vizient Clinical Data Base between April 1, 2020, and June 30, 2021, who were discharged to skilled nursing facilities or inpatient rehabilitation facilities ( N = 39,882). Data from the Clinical Data Base are used with permission of Vizient, Inc. All rights reserved. RESULTS Among adults hospitalized with coronavirus 2019 infection, those discharged to skilled nursing facilities were 1.4 times more likely to require hospital readmission than those discharged to inpatient rehabilitation facilities. They were, on average, older (73 vs. 61 yrs, P < 0.001) and had shorter hospital lengths of stay (15 vs. 26 days, P < 0.0001) than the patients discharged to inpatient rehabilitation facilities. Persons discharged to inpatient rehabilitation facilities were more likely to have received intensive care and mechanical ventilation while hospitalized ( P < 0.001). CONCLUSIONS Individuals discharged to inpatient rehabilitation facilities after hospitalization for coronavirus 2019 differ from those discharged to skilled nursing facilities on a number of key variables, including age, hospital length of stay, having received intensive care, and odds of hospital readmission.
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Gallo LC, Fortmann AL, Clark TL, Roesch SC, Bravin JI, Spierling Bagsic SR, Sandoval H, Savin KL, Gilmer T, Talavera GA, Philis-Tsimikas A. Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2098-2106. [PMID: 36697929 PMCID: PMC9876654 DOI: 10.1007/s11606-022-08006-1] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs. OBJECTIVE We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. DESIGN Randomized, controlled, single-blind parallel-groups. PARTICIPANTS Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population. INTERVENTIONS Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs. MAIN MEASURES The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined. KEY RESULTS In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses. CONCLUSIONS In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.
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Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- South Bay Latino Research Center, San Diego State University, 780 Bay Blvd. Suite 200, Chula Vista, CA, 91910, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Julia I Bravin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Kimberly L Savin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Todd Gilmer
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Rajkumar E, Nguyen K, Radic S, Paa J, Geng Q. Machine Learning and Causal Approaches to Predict Readmissions and Its Economic Consequences Among Canadian Patients With Heart Disease: Retrospective Study. JMIR Form Res 2023; 7:e41725. [PMID: 37234042 DOI: 10.2196/41725] [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: 08/06/2022] [Revised: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Unplanned patient readmissions within 30 days of discharge pose a substantial challenge in Canadian health care economics. To address this issue, risk stratification, machine learning, and linear regression paradigms have been proposed as potential predictive solutions. Ensemble machine learning methods, such as stacked ensemble models with boosted tree algorithms, have shown promise for early risk identification in specific patient groups. OBJECTIVE This study aims to implement an ensemble model with submodels for structured data, compare metrics, evaluate the impact of optimized data manipulation with principal component analysis on shorter readmissions, and quantitatively verify the causal relationship between expected length of stay (ELOS) and resource intensity weight (RIW) value for a comprehensive economic perspective. METHODS This retrospective study used Python 3.9 and streamlined libraries to analyze data obtained from the Discharge Abstract Database covering 2016 to 2021. The study used 2 sub-data sets, clinical and geographical data sets, to predict patient readmission and analyze its economic implications, respectively. A stacking classifier ensemble model was used after principal component analysis to predict patient readmission. Linear regression was performed to determine the relationship between RIW and ELOS. RESULTS The ensemble model achieved precision and slightly higher recall (0.49 and 0.68), indicating a higher instance of false positives. The model was able to predict cases better than other models in the literature. Per the ensemble model, readmitted women and men aged 40 to 44 and 35 to 39 years, respectively, were more likely to use resources. The regression tables verified the causality of the model and confirmed the trend that patient readmission is much more costly than continued hospital stay without discharge for both the patient and health care system. CONCLUSIONS This study validates the use of hybrid ensemble models for predicting economic cost models in health care with the goal of reducing the bureaucratic and utility costs associated with hospital readmissions. The availability of robust and efficient predictive models, as demonstrated in this study, can help hospitals focus more on patient care while maintaining low economic costs. This study predicts the relationship between ELOS and RIW, which can indirectly impact patient outcomes by reducing administrative tasks and physicians' burden, thereby reducing the cost burdens placed on patients. It is recommended that changes to the general ensemble model and linear regressions be made to analyze new numerical data for predicting hospital costs. Ultimately, the proposed work hopes to emphasize the advantages of implementing hybrid ensemble models in forecasting health care economic cost models, empowering hospitals to prioritize patient care while simultaneously decreasing administrative and bureaucratic expenses.
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Affiliation(s)
- Ethan Rajkumar
- Department of Chemistry, Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Kevin Nguyen
- Department of Computer Science, Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Sandra Radic
- Department of Computer Science, Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Jubelle Paa
- Department of Computer Science, Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Qiyang Geng
- School of Biomedical Engineering, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC, Canada
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Lewis LK, Jupiter DC, Panchbhavi VK, Chen J. Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty. Foot Ankle Spec 2023:19386400231169368. [PMID: 37148165 DOI: 10.1177/19386400231169368] [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] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Ankle arthritis adversely affects patients' function and quality of life. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). A 5-item modified frailty index (mFI-5) has predicted adverse outcomes following multiple orthopaedic procedures; this study evaluated its suitability as a risk-stratification tool in patients undergoing TAA. METHODS The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed for patients undergoing TAA between 2011 and 2017. Bivariate and multivariate statistical analyses were performed to investigate frailty as a possible predictor of postoperative complications. RESULTS In total, 1035 patients were identified. When comparing patients with an mFI-5 score of 0 versus ≥2, overall complication rates significantly increased from 5.24% to 19.38%, 30-day readmission rate increased from 0.24% to 3.1%, adverse discharge rate increased from 3.81% to 15.5%, and wound complications increased from 0.24% to 1.55%. After multivariate analysis, mFI-5 score remained significantly associated with patients' risk of developing any complication (P = .03) and 30-day readmission rate (P = .005). CONCLUSIONS Frailty is associated with adverse outcomes following TAA. The mFI-5 can help identify patients who are at an elevated risk of sustaining a complication, allowing for improved decision-making and perioperative care when considering TAA. LEVELS OF EVIDENCE III, Prognostic.
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Affiliation(s)
- Lauren K Lewis
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch at Galveston, Galveston, Texas
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Brajcich BC, Johnson JK, Holl JL, Bilimoria KY, Ager MS, Chung J, Joung RHS, Iroz CB, Odell DD, Bentrem DJ, Yang AD, Franklin PD, Slota JM, Silver CM, Skolarus T, Merkow RP. Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery. J Surg Oncol 2023. [PMID: 37126379 DOI: 10.1002/jso.27292] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Emergency department (ED) utilization after gastrointestinal cancer operations is poorly characterized. Our study objectives were to determine the incidence of, reasons for, and predictors of ED treat-and-release encounters after gastrointestinal cancer operations. METHODS Patients who underwent elective esophageal, hepatobiliary, gastric, pancreatic, small intestinal, or colorectal operations for cancer were identified in the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The primary outcomes were the incidence of ED treat-and-release encounters and readmissions within 30 days of discharge. RESULTS Among 51 527 patients at 406 hospitals, 4047 (7.9%) had an ED treat-and-release encounter, and 5573 (10.8%) had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. ED treat-and-release encounters were most frequently for pain (12.0%), device/ostomy complaints (11.7%), or wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.12-1.37) and Medicare (OR 1.27, 95% CI 1.16-1.40) or Medicaid (OR 1.82, 95% CI 1.62-2.40) coverage. CONCLUSIONS ED treat-and-release encounters are common after major gastrointestinal operations, making up nearly half of postdischarge ED encounters. The reasons for ED treat-and-release encounters differ from those for ED encounters with readmissions.
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Affiliation(s)
- Brian C Brajcich
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Julie K Johnson
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Karl Y Bilimoria
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jeanette Chung
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel Hae Soo Joung
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cassandra B Iroz
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D Odell
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Surgical Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Anthony D Yang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer M Slota
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Casey M Silver
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Ted Skolarus
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Ryan P Merkow
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
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Mentias A, Peterson ED, Keshvani N, Kumbhani DJ, Yancy C, Morris A, Allen L, Girotra S, Fonarow GC, Starling R, Alvarez P, Desai M, Cram P, Pandey A. Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure. Circulation 2023; 147:1121-1133. [PMID: 37036906 PMCID: PMC10765408 DOI: 10.1161/circulationaha.122.061995] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/23/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The contemporary measures of hospital performance for heart failure hospitalization and 30-day risk-standardized readmission rate (RSRR) and risk-standardized mortality rate (RSMR) are estimated using the same risk adjustment model and overall event rate for all patients. Thus, these measures are mainly driven by the care quality and outcomes for the majority racial and ethnic group, and may not adequately represent the hospital performance for patients of Black and other races. METHODS Fee-for-service Medicare beneficiaries from January 2014 to December 2019 hospitalized with heart failure were identified. Hospital-level 30-day RSRR and RSMR were estimated using the traditional race-agnostic models and the race-specific approach. The composite race-specific performance metric was calculated as the average of the RSRR/RMSR measures derived separately for each race and ethnicity group. Correlation and concordance in hospital performance for all patients and patients of Black and other races were assessed using the composite race-specific and race-agnostic metrics. RESULTS The study included 1 903 232 patients (75.7% White [n=1 439 958]; 14.5% Black [n=276 684]; and 9.8% other races [n=186 590]) with heart failure from 1860 hospitals. There was a modest correlation between hospital-level 30-day performance metrics for patients of White versus Black race (Pearson correlation coefficient: RSRR=0.42; RSMR=0.26). Compared with the race-agnostic RSRR and RSMR, composite race-specific metrics for all patients demonstrated stronger correlation with RSRR (correlation coefficient: 0.60 versus 0.74) and RSMR (correlation coefficient: 0.44 versus 0.51) for Black patients. Concordance in hospital performance for all patients and patients of Black race was also higher with race-specific (versus race-agnostic) metrics (RSRR=64% versus 53% concordantly high-performing; 61% versus 51% concordantly low-performing). Race-specific RSRR and RSMR metrics (versus race-agnostic) led to reclassification in performance ranking of 35.8% and 39.2% of hospitals, respectively, with better 30-day and 1-year outcomes for patients of all race groups at hospitals reclassified as high-performing. CONCLUSIONS Among patients hospitalized with heart failure, race-specific 30-day RSMR and RSRR are more equitable in representing hospital performance for patients of Black and other races.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Eric D. Peterson
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Dharam J. Kumbhani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Clyde Yancy
- Division of Cardiology, Northwestern University School of Medicine, Chicago, IL
| | - Alanna Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Larry Allen
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Gregg C. Fonarow
- Ahmanson Cardiomyopathy Center, UCLA School of Medicine, Los Angeles, CA
| | - Randall Starling
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Paulino Alvarez
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Milind Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter Cram
- Department of Internal Medicine, UT Medical Branch, Galveston, TX
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Ivey-Miranda JB, Rao VS, Cox ZL, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner JM, Collins S, Wilson FP, Krumholz HM, Testani JM. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circ Heart Fail 2023; 16:e010206. [PMID: 36896716 PMCID: PMC10186250 DOI: 10.1161/circheartfailure.122.010206] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Following treatment for acute decompensated heart failure, in-hospital observation on oral diuretics (OOD) is recommended, assuming it provides actionable information on discharge diuretic dosing and thus reduces readmissions. METHODS In the Mechanisms of Diuretic Resistance (MDR) cohort, we analyzed in-hospital measures of diuretic response, provider's decisions, and diuretic response ≈30 days postdischarge. In a Yale multicenter cohort, we assessed if in-hospital OOD was associated with 30-day readmission risk. The main objective of this study was to evaluate the utility of in-hospital OOD. RESULTS Of the 468 patients in the MDR cohort, 57% (N=265) underwent in-hospital OOD. During the OOD, weight change and net fluid balance correlated poorly with each other (r=0.36). Discharge diuretic dosing was similar between patients who had increased, stable, or decreased weight (decreased discharge dose from OOD dose in 77% versus 72% versus 70%, respectively), net fluid status (decreased discharge dose from OOD dose in 100% versus 69% versus 74%, respectively), and urine output (decreased discharge dose from OOD dose in 69% versus 79% versus 72%, respectively) during the 24-hour OOD period (P>0.27 for all). In participants returning at 30 days for formal quantification of outpatient diuretic response (n=98), outpatient and inpatient OOD natriuresis was poorly correlated (r=0.26). In the Yale multicenter cohort (n=18 454 hospitalizations), OOD occurred in 55% and was not associated with 30-day hospital readmission (hazard ratio, 0.98 [95% CI, 0.93-1.05]; P=0.51). CONCLUSIONS In-hospital OOD did not provide actionable information on diuretic response, was not associated with outpatient dose selection, did not predict subsequent outpatient diuretic response, and was not associated with lower readmission rate. Additional research is needed to replicate these findings and understand if these resources could be better allocated elsewhere. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02546583.
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Affiliation(s)
- Juan B. Ivey-Miranda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
- Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Veena S. Rao
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Zachary L. Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Julieta Moreno-Villagomez
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
- Universidad Nacional Autónoma de México, México City, México
| | - Devin Mahoney
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Christopher Maulion
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Lavanya Bellumkonda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeffrey M. Turner
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven CT
| | - Sean Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - F. Perry Wilson
- Clinical and translational research accelerator, Yale University School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation. Yale-New Haven Hospital, New Haven, CT
| | - Jeffrey M. Testani
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
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Mady AF, Al-Odat MA, Alshaya R, Hussien S, Aletreby A, Hamido HM, Aletreby WT. Mortality Rates in Early versus Late Intensive Care Unit Readmission. Saudi J Med Med Sci 2023; 11:143-149. [PMID: 37252017 PMCID: PMC10211416 DOI: 10.4103/sjmms.sjmms_634_22] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/21/2023] [Accepted: 03/16/2023] [Indexed: 05/31/2023]
Abstract
Background ICU readmission is associated with poor outcomes. Few studies have directly compared the outcomes of early versus late readmissions, especially in Saudi Arabia. Objective To compare the outcomes between early and late ICU readmissions, mainly with regards to hospital mortality. Methods This retrospective study included unique patients who, within the same hospitalization, were admitted to the ICU, discharged to the general wards, and then readmitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 01, 2015, and June 30, 2022. Patients readmitted within 2 calendar days were grouped into the Early readmission group, while those readmitted after 2 calendar days were in the Late readmission group. Results A total of 997 patients were included, of which 753 (75.5%) belonged to the Late group. The mortality rate in the Late group was significantly higher than that in the Early group (37.6% vs. 29.5%, respectively; 95% CI: 1%-14.8%; P = 0.03). The readmission length of stay (LOS) and severity score of both groups were similar. The odds ratio of mortality for the Early group was 0.71 (95% CI: 0.51-0.98, P = 0.04); other significant risk factors were age (OR = 1.023, 95% CI: 1.016-1.03; P < 0.001) and readmission LOS (OR = 1.017, 95% CI: 1.009-1.026; P < 0.001). The most common reason for readmission in the Early group was high Modified Early Warning Score, while in the Late group, it was respiratory failure followed by sepsis or septic shock. Conclusion Compared with late readmission, early readmission was associated with lower mortality, but not with lower LOS or severity score.
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Affiliation(s)
- Ahmed Fouad Mady
- Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Rayan Alshaya
- Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sahar Hussien
- Department of Internal Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Aletreby
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hend Mohammed Hamido
- Department of Obstetrics and Gynecology, King Saud Medical City, Riyadh, Saudi Arabia
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Pinto AFD, Teatini CM, Avelar NCPD, Leopoldino AAO, Moura ICG. Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort. Rev Bras Ortop 2023; 58:222-230. [PMID: 37252296 PMCID: PMC10212622 DOI: 10.1055/s-0043-1768624] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/18/2022] [Indexed: 05/31/2023] Open
Abstract
Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.
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Affiliation(s)
| | | | | | | | - Isabel Cristina Gomes Moura
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
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Shiroff AM, Wolf S, Wu A, Vanderkarr M, Anandan M, Ruppenkamp JW, Galvain T, Holy CE. Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: A US hospital matched cohort database analysis. J Trauma Acute Care Surg 2023; 94:538-545. [PMID: 36730674 PMCID: PMC10045967 DOI: 10.1097/ta.0000000000003828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design. METHODS Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links. RESULTS A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245). CONCLUSION Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Arbaje AI, Woodman S, Keita Fakeye MB, Leff B, Yu Q. Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act. J Appl Gerontol 2023. [PMID: 36864584 DOI: 10.1177/07334648231161925] [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] [Indexed: 03/04/2023] Open
Abstract
Background: The Senior Care Services Scale (SCSS) describes hospital provision of older adult services before the passage of the Affordable Care Act. Objectives: Since act passage, (1) update SCSS service groups; and (2) investigate hospital SCSS scores' relationship to readmission or mortality among Medicare beneficiaries. Methods: Retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes: Hospital readmission, or death, within 30 and 90 days of discharge. Results: The updated SCSS had three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days (RR .94, 95% CI .91-.98), and 90 days (RR .94, 95% CI .91-.97). There was no significant association between Home-Care-and-Hospice and Post-Acute-Community-Care scores and study outcomes. Conclusion: Greater provision of hospital-level senior services may be associated with mortality reduction among Medicare beneficiaries.
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Affiliation(s)
- Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, 1466Johns Hopkins UniversitySchool of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA
| | - Susannah Woodman
- Center for Medicare and Medicaid Innovation, 1498Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | - Maningbe B Keita Fakeye
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, 1466Johns Hopkins UniversityBloomberg School of Public Health, Baltimore, MD, USA.,Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Qilu Yu
- Office of Clinical and Regulatory Affairs, 25943National Center for Complementary and Alternative Medicine, Bethesda, MD, USA
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Petruzzi L, Ewald B, Covington E, Rosenberg W, Golden R, Jones B. Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review. Soc Work Public Health 2023; 38:147-160. [PMID: 35895505 DOI: 10.1080/19371918.2022.2104415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.
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Affiliation(s)
- Liana Petruzzi
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
| | - Bonnie Ewald
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Walter Rosenberg
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn Golden
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Barbara Jones
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
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Pappadis MR, Chou LN, Howrey B, Al Snih S. Life-space mobility and post-hospitalization outcomes among older Mexican American Medicare beneficiaries. J Am Geriatr Soc 2023; 71:1617-1626. [PMID: 36779619 PMCID: PMC10175172 DOI: 10.1111/jgs.18281] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Older adults with limited mobility are at an increased risk of adverse health outcomes, an outcome inadequately investigated in older Mexican Americans. We explored whether pre-admission life-space mobility predicts post-hospitalization outcomes among hospitalized Mexican American Medicare beneficiaries. METHODS Life-space mobility, using the Life-Space Assessment (LSA), was analyzed using quartiles and 5-point intervals. Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Waves 7 and 8 data linked to Medicare claims data, 426 older Mexican Americans with at least 2 months of Medicare coverage who were hospitalized within 2 years of completing the LSA were included. Logistic and Cox Proportional regression analyses estimated the association of pre-admission LSA with post-hospitalization outcomes. RESULTS Prior to hospitalization, 85.4% reported limited life-space mobility. Most patients (n = 322, 75.6%) were hospitalized for medical reasons. About 65% were discharged to the community. Pre-admission LSA scores were not associated with community discharge (Odds Ratio [OR] = 1.02, 0.95-1.10). Higher pre-admission LSA scores were associated with 30-day readmission (OR = 1.11, 1.01-1.22). Patients in the highest pre-admission LSA quartile (i.e., greatest life-space mobility) were less likely to die within 2 years after hospital discharge (OR = 0.61, 0.39-0.97) compared to those with lower pre-admission LSA scores. CONCLUSIONS Among older Mexican American Medicare beneficiaries, greater pre-admission LSA scores were associated with an increased risk of 30-day readmission and a decreased risk of mortality within 2 years following hospitalization. Future work should further investigate the relationship between LSA and post-hospitalization outcomes in a larger sample of Mexican American older adults.
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Affiliation(s)
- Monique R Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, Texas, USA
- Sealy Center on Aging, UTMB, Galveston, Texas, USA
| | - Lin-Na Chou
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, Texas, USA
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, Texas, USA
| | - Bret Howrey
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, Texas, USA
- Department of Family Medicine, School of Medicine, UTMB, Galveston, Texas, USA
| | - Soham Al Snih
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, Texas, USA
- Sealy Center on Aging, UTMB, Galveston, Texas, USA
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