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Ben-Assuli O, Heart T, Vest JR, Ramon-Gonen R, Shlomo N, Klempfner R. Profiling Readmissions Using Hidden Markov Model - the Case of Congestive Heart Failure. INFORMATION SYSTEMS MANAGEMENT 2020. [DOI: 10.1080/10580530.2020.1847362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Tsipi Heart
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Joshua R. Vest
- Fairbanks School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Roni Ramon-Gonen
- The Graduate School of Business Administration , Bar Ilan University, Ramat-Gan, Israel
| | - Nir Shlomo
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Robert Klempfner
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
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Falvey JR, Burke RE, Ridgeway KJ, Malone DJ, Forster JE, Stevens-Lapsley JE. Involvement of Acute Care Physical Therapists in Care Transitions for Older Adults Following Acute Hospitalization: A Cross-sectional National Survey. J Geriatr Phys Ther 2020. [PMID: 29533283 DOI: 10.1519/jpt.0000000000000187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Recent evidence has suggested physical therapist involvement in care transitions after hospitalization is associated with reduced rates of hospital readmissions. However, little is known about how physical therapists participate in care transitions for older adults, the content of care communications, and the facilitators and barriers of implementing evidence-based care transition strategies into practice. Thus, the purpose of this article is to evaluate participation in care transition activities known to influence readmission risk among older adults, and understand perceptions of and barriers to participation in these activities. METHODS We developed a survey questionnaire to quantify hospital-based physical therapist participation in care transitions and validated it using cognitive interviewing. It was introduced to a cross-sectional national sample of physical therapists who participate in the Academy of Acute Care Physical Therapy electronic discussion board using a SurveyMonkey tool. RESULTS AND DISCUSSION More than 90% of respondents agreed they routinely recommended a discharge location and provided recommendations for durable medical equipment for patients at the time of hospital discharge. Respondents did not routinely initiate communication with therapists in other care settings, or follow up with patients to determine whether recommendations were followed. A majority of respondents agreed their facilities would not consider many key care transition activities to count as productive time.This survey provides a novel insight into how hospital-based physical therapists participate in care transitions. Communications between rehabilitation providers across care settings are infrequent, even though those communications are recommended to help reduce readmissions. However, administrative barriers were elucidated in this study that may help explain lack of therapist involvement. CONCLUSIONS Physical therapists' communications across health care setting about older adults discharging from acute care hospitalization are infrequent, but may represent a meaningful intervention target for future studies. Future research is needed to evaluate best practices for hospital-based physical therapists during care transitions.
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Affiliation(s)
- Jason R Falvey
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - Robert E Burke
- Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Kyle J Ridgeway
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - Daniel J Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - Jeri E Forster
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora.,Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora.,Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, Colorado
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Ondeck NT, Bohl DD, Bovonratwet P, Geddes BJ, Cui JJ, McLynn RP, Samuel AM, Grauer JN. General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons' Perceptions and Reported Data for Rates and Risk Factors. Global Spine J 2018; 8:345-353. [PMID: 29977718 PMCID: PMC6022956 DOI: 10.1177/2192568217723017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Survey study and retrospective review of prospective data. OBJECTIVES To contrast surgeons' perceptions and reported national data regarding the rates of postoperative adverse events following anterior cervical discectomy and fusion (ACDF) and to assess the accuracy of surgeons in predicting the impact of patient factors on such outcomes. METHODS A survey investigating perceived rates of perioperative complications and the perceived effect of patient risk factors on the occurrence of complications following ACDF was distributed to spine surgeons at the Cervical Spine Research Society (CSRS) 2015 Annual Meeting. The equivalent reported rates of adverse events and impacts of patient risk factors on such complications were assessed in patients undergoing elective ACDF from the National Surgical Quality Improvement Program (NSQIP). RESULTS There were 110 completed surveys from attending physicians at CSRS (response rate = 44%). There were 18 019 patients who met inclusion criteria in NSQIP years 2011 to 2014. The rates of 11 out of 17 (65%) postoperative adverse events were mildly overestimated by surgeons responding to the CSRS questionnaire in comparison to reported NSQIP data (overestimates ranged from 0.24% to 1.50%). The rates of 2 out of 17 (12%) postoperative adverse events were mildly underestimated by surgeons (range = 0.08% to 1.2%). The impacts of 5 out of 10 (50%) patient factors were overestimated by surgeons (range relative risk = 0.56 to 1.48). CONCLUSIONS Surgeon estimates of risk factors for and rates of adverse events following ACDF procedures were reasonably nearer to national data. Despite an overall tendency toward overestimation, surgeons' assessments are roughly appropriate for surgical planning, expectation setting, and quality improvement initiatives.
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Self-reflection as a Tool to Increase Hospitalist Participation in Readmission Quality Improvement. Qual Manag Health Care 2016; 25:219-224. [PMID: 27749719 DOI: 10.1097/qmh.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reducing 30-day readmissions is a national priority. Although multipronged programs have been shown to reduce readmissions, the role of the individual hospitalist physician in reducing readmissions is not clear. OBJECTIVES We evaluated the effect of physicians' self-review of their own readmission cases on the 30-day readmission rate. METHODS Over a 1-year period, hospitalists were sent their individual readmission rates and cases on a weekly basis. They reviewed their cases and completed a data abstraction tool. In addition, a facilitator led small group discussion about common causes of readmission and ways to prevent such readmissions. RESULTS Our preintervention readmission rate was 16.16% and postintervention was 14.99% (P = .76). Among hospitalists on duty, nearly all participated in scheduled facilitated discussions. Self-review was completed in 67% of the cases. CONCLUSIONS A facilitated reflective practice intervention increased hospitalist participation and awareness in the mission to reduce readmissions and this intervention resulted in a nonsignificant trend in readmission reduction.
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Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form. Int J Clin Pharm 2016; 38:838-47. [DOI: 10.1007/s11096-016-0292-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 03/16/2016] [Indexed: 01/04/2023]
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Chenoweth L, Kable A, Pond D. Research in hospital discharge procedures addresses gaps in care continuity in the community, but leaves gaping holes for people with dementia: a review of the literature. Australas J Ageing 2015; 34:9-14. [PMID: 25735471 DOI: 10.1111/ajag.12205] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the literature on the impact of the discharge experience of patients with dementia and their continuity of care. METHODS Peer-reviewed and grey literature published in the English language between 1995 and 2014 were systematically searched using Medline, CINAHL, PubMed, PsycINFO and Cochrane library databases, using a combination of the search terms Dementia, Caregivers, Integrated Health Care Systems, Managed Care, Patient Discharge. Also reviewed were Department of Health and Ageing and Alzheimer's Australia research reports between 2000 and 2014. RESULTS The review found a wide range of studies that raise concerns in relation to the quality of care provided to people with dementia during hospital discharge and in transitional care. CONCLUSION Discharge planning and transitional care for patients with dementia are not adequate and are likely to lead to readmission and other poor health outcomes.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Press MJ, Gerber LM, Peng TR, Pesko MF, Feldman PH, Ouchida K, Sridharan S, Bao Y, Barron Y, Casalino LP. Postdischarge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes. J Am Geriatr Soc 2015; 63:1299-305. [DOI: 10.1111/jgs.13491] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Karin Ouchida
- Weill Cornell Medical College; New York City New York
| | | | - Yuhua Bao
- Weill Cornell Medical College; New York City New York
| | - Yolanda Barron
- Visiting Nurse Service of New York; New York City New York
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Horwitz LI, Lin Z, Herrin J, Bernheim S, Drye EE, Krumholz HM, Hines HJ, Ross JS. Association of hospital volume with readmission rates: a retrospective cross-sectional study. BMJ 2015; 350:h447. [PMID: 25665806 PMCID: PMC4353286 DOI: 10.1136/bmj.h447] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To examine the association of hospital volume (a marker of quality of care) with hospital readmission rates. DESIGN Retrospective cross-sectional study. SETTING 4651 US acute care hospitals. STUDY DATA 6,916,644 adult discharges, excluding patients receiving psychiatric or medical cancer treatment. MAIN OUTCOME MEASURES We used Medicare fee-for-service data from 1 July 2011 to 30 June 2012 to calculate observed-to-expected, unplanned, 30 day, standardized readmission rates for hospitals and for specialty cohorts medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology. We assessed the association of hospital volume by quintiles with 30 day, standardized readmission rates, with and without adjustment for hospital characteristics (safety net status, teaching status, geographic region, urban/rural status, nurse to bed ratio, ownership, and cardiac procedure capability. We also examined associations with the composite outcome of 30 day, standardized readmission or mortality rates. RESULTS Mean 30 day, standardized readmission rate among the fifth of hospitals with the lowest volume was 14.7 (standard deviation 5.3) compared with 15.9 (1.7) among the fifth of hospitals with the highest volume (P<0.001). We observed the same pattern of lower readmission rates in the lowest versus highest volume hospitals in the specialty cohorts for medicine (16.6 v 17.4, P<0.001), cardiorespiratory (18.5 v 20.5, P<0.001), and neurology (13.2 v 14.0, p=0.01) cohorts; the cardiovascular cohort, however, had an inverse association (14.6 v 13.7, P<0.001). These associations remained after adjustment for hospital characteristics except in the cardiovascular cohort, which became non-significant, and the surgery/gynecology cohort, in which the lowest volume fifth of hospitals had significantly higher standardized readmission rates than the highest volume fifth (difference 0.63 percentage points (95% confidence interval 0.10 to 1.17), P=0.02). Mean 30 day, standardized mortality or readmission rate was not significantly different between highest and lowest volume fifths (20.4 v 20.2, P=0.19) and was highest in the middle fifth of hospitals (range 20.6-20.8). CONCLUSIONS Standardized readmission rates are lowest in the lowest volume hospitals-opposite from the typical association of greater hospital volume with better outcomes. This association was independent of hospital characteristics and was only partially attenuated by examining mortality and readmission together. Our findings suggest that readmissions are associated with different aspects of care than mortality or complications.
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Affiliation(s)
- Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, New York University Langone Medical Center, New York, NY, USA Center for Healthcare Innovation and Delivery Science, New York University School of Medicine, New York
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven Health Research and Educational Trust, Chicago IL, USA
| | - Susannah Bernheim
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven
| | - Elizabeth E Drye
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA Department of Pediatrics, Yale School of Medicine, New Haven
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven Section of Health Policy and Administration, Yale School of Epidemiology and Public Health, New Haven
| | | | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven Section of Health Policy and Administration, Yale School of Epidemiology and Public Health, New Haven
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Gonzalez AA, Shih T, Dimick JB, Ghaferi AA. Using same-hospital readmission rates to estimate all-hospital readmission rates. J Am Coll Surg 2014; 219:656-63. [PMID: 25159017 DOI: 10.1016/j.jamcollsurg.2014.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/02/2014] [Accepted: 05/05/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since October of 2012, Medicare's Hospital Readmissions Reduction Program has fined 2,200 hospitals a total of $500 million. Although the program penalizes readmission to any hospital, many institutions can only track readmissions to their own hospitals. We sought to determine the extent to which same-hospital readmission rates can be used to estimate all-hospital readmission rates after major surgery. STUDY DESIGN We evaluated 3,940 hospitals treating 741,656 Medicare fee-for-service beneficiaries undergoing CABG, hip fracture repair, or colectomy between 2006 and 2008. We used hierarchical logistic regression to calculate risk- and reliability-adjusted rates of 30-day readmission to the same hospital and to any hospital. We next evaluated the correlation between same-hospital and all-hospital rates. To analyze the impact on hospital profiling, we compared rankings based on same-hospital rates with those based on all-hospital rates. RESULTS The mean risk- and reliability-adjusted all-hospital readmission rate was 13.2% (SD 1.5%) and mean same-hospital readmission rate was 8.4% (SD 1.1%). Depending on the operation, between 57% (colectomy) and 63% (CABG) of hospitals were reclassified when profiling was based on same-hospital readmission rates instead of on all-hospital readmission rates. This was particularly pronounced in the middle 3 quintiles, where 66% to 73% of hospitals were reclassified. CONCLUSIONS In evaluating hospital profiling under Medicare's Hospital Readmissions Reduction Program, same-hospital rates provide unstable estimates of all-hospital readmission rates. To better anticipate penalties, hospitals require novel approaches for accurately tracking the totality of their postoperative readmissions.
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Affiliation(s)
- Andrew A Gonzalez
- Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, MI; Department of Surgery, University of Illinois Hospital & Health Sciences System, Chicago, IL.
| | - Terry Shih
- Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, MI
| | - Amir A Ghaferi
- Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, MI
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Islam T, O'Connell B, Hawkins M. Factors associated with transfers from healthcare facilities among readmitted older adults with chronic illness. AUST HEALTH REV 2014; 38:354-62. [PMID: 24670934 DOI: 10.1071/ah13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/09/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Because chronic illness accounts for a considerable proportion of Australian healthcare expenditure, there is a need to identify factors that may reduce hospital readmissions for patients with chronic illness. The aim of the present study was to examine a range of factors potentially associated with transfer from healthcare facilities among older adults readmitted to hospital within a large public health service in Melbourne, Australia. METHODS Data on readmitted patients between June 2006 and June 2011 were extracted from hospital databases and medical records. Adopting a retrospective case-control study design, a sample of 51 patients transferred from private residences was matched by age and gender with 55 patients transferred from healthcare facilities (including nursing homes and acute care facilities). Univariate and multivariate logistic regression analyses were used to compare the two groups, and to determine associations between 46 variables and transfer from a healthcare facility. RESULTS Univariate analysis indicated that patients readmitted from healthcare facilities were significantly more likely to experience relative socioeconomic advantage, disorientation on admission, dementia diagnosis, incontinence and poor skin integrity than those readmitted from a private residence. Three of these variables remained significantly associated with admission from healthcare facilities after multivariate analysis: relative socioeconomic advantage (odds ratio (OR) 11.30; 95% confidence interval (CI) 2.62-48.77), incontinence (OR 7.18; 95% CI 1.19-43.30) and poor skin integrity (OR 18.05; 95% CI 1.85-176.16). CONCLUSIONS Older adults with chronic illness readmitted to hospital from healthcare facilities are significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. The findings direct efforts towards addressing the apparent disparity in management of patients admitted from a facility as opposed to a private residence.
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Affiliation(s)
- Tasneem Islam
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Beverly O'Connell
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Mary Hawkins
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Locked Bag 29, Clayton South, Vic. 3169, Australia.
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Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The changes involved in patient-centered medical home transformation. Prim Care 2012; 39:241-59. [PMID: 22608865 DOI: 10.1016/j.pop.2012.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In 2007, the major primary care professional societies collaboratively introduced a new model of primary care: the patient-centered medical home (PCMH). The published document outlines the basic attributes and expectations of a PCMH but not with the specificity needed to help interested clinicians and administrators make the necessary changes to their practice. To identify the specific changes required to become a medical home, the authors reviewed literature and sought the opinions of two multi-stakeholder groups. This article describes the eight consensus change concepts and 32 key changes that emerged from this process, and the evidence supporting their inclusion.
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Affiliation(s)
- Edward H Wagner
- MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
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Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Clay T, Rennie DJ, Dudley RA. Predictors of early postdischarge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care 2010; 26:65-75. [PMID: 20716477 DOI: 10.1016/j.jcrc.2010.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 06/10/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown. METHODS We performed a retrospective study of 8484 ICU patients. Our primary outcome was early postdischarge mortality: death after hospital discharge and 30 days or less from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome. RESULTS In multivariate analyses, the hazard for early postdischarge mortality increased with rising severity of illness and decreased with full-code status (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.49). Compared with discharges home, early postdischarge mortality was highest for acute care transfers (HR, 3.18; 95% CI, 2.45-4.12). Finally, patients with very short ICU length of stay (<1 day) had greater early postdischarge mortality (HR, 1.86; 95% CI; 1.32-2.61) than those with longest stays (≥7 days). CONCLUSIONS Early postdischarge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely on in-hospital mortality measures to do so.
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Affiliation(s)
- Eduard E Vasilevskis
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA.
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Singer SJ, Burgers J, Friedberg M, Rosenthal MB, Leape L, Schneider E. Defining and Measuring Integrated Patient Care: Promoting the Next Frontier in Health Care Delivery. Med Care Res Rev 2010; 68:112-27. [DOI: 10.1177/1077558710371485] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of “integrated patient care” would benefit from further clarification regarding (a) the object of integration and (b) its essential components, particularly when constructing measures.To address these issues, the authors propose a definition of integrated patient care that distinguishes it from integrated delivery organizations, acknowledging that integrated organizational structures and processes may fail to produce integrated patient care. The definition emphasizes patients’ central role as active participants in managing their own health by including patient centeredness as a key element of integrated patient care. Measures based on the proposed definition will enable empirical assessment of the potential relationships between the integration of organizations, the integration of patient care, and patient outcomes, providing valuable guidance to health systems reformers.
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Affiliation(s)
- Sara J. Singer
- Harvard School of Public Health, Boston, MA, Institute for Health Policy, Massachusetts General Hospital, Boston, MA,
| | - Jako Burgers
- Harvard School of Public Health, Boston, MA, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Mark Friedberg
- Harvard School of Public Health, Boston, MA, RAND, Santa Monica, CA
| | | | | | - Eric Schneider
- Harvard School of Public Health, Boston, MA, RAND, Boston, MA
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