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Boesing M, Gregoriano C, Minder AE, Abshagen C, Dahl S, Dieterle T, Eicher F, Leuppi-Taegtmeyer AB, Rageth L, Miedinger D, Wirz E, Leuppi JD. Predictors for Unplanned Readmissions within 18 Days after Hospital Discharge: a Retrospective Cohort Study. PRAXIS 2023; 112:57-63. [PMID: 36722113 DOI: 10.1024/1661-8157/a003985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Since the introduction of the reimbursement system based on diagnosis-related groups (DRG) in Swiss hospitals in 2012, most readmissions occurring within 18 days and appertaining to the same major diagnostic category (MDC) are merged and thus often reimbursed to a lesser extent. While readmissions reflect increased distress for patients and their relatives, the causes are mainly patient-related and difficult to influence. However, it may be possible to identify cases at higher risk for readmission. Therefore, the aim of this study was to find predictors for early readmissions in the same MDC, to identify high-risk index hospitalizations and possibly prevent unnecessary readmissions. The data of all patients admitted to the Clinic of Internal Medicine at the University Hospital of Basel, Switzerland, hospitalized for longer than 24 hours during the pre-DRG period between October 2009 and September 2010 were retrospectively collected. Data were examined for predictors of unplanned readmission within 18 days under the same MDC ('relevant readmission') by means of logistic regression. 7479 patients (median age 67.8 years, 56% male) were admitted to the Clinic of Internal Medicine, with 232 patients (3.1%) being readmitted at least once. Logistic regression revealed male sex (p =0.035) and a high number of prescribed drugs at discharge (p <0.005) as patient-related predictors. The MDCs respiratory system, cardiovascular system, and gastrointestinal/hepatobiliary system were identified as high-risk categories (each p <0.005). Age and length of index hospital stay added no significant explanatory value to the regression model. Unplanned readmissions under the same MDC within 18 days were infrequent and not related to patients' age or length of hospital stay. Overall, multimorbid patients, and hospitalizations regarding the cardiovascular, respiratory, or gastrointestinal system appear to be most at risk and should therefore be specifically targeted in the prevention of early readmissions.
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Affiliation(s)
- Maria Boesing
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Contributed equally
| | - Claudia Gregoriano
- Medical University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Contributed equally
| | - Anna E Minder
- Division of Endocrinology, Diabetology, Porphyria, Stadtspital Waid and Triemli, Zurich, Switzerland
- Contributed equally
| | - Christian Abshagen
- Medical and financial controlling, University Hospital of Basel, Basel, Switzerland
| | - Sylwia Dahl
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thomas Dieterle
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Cardiology, Klinik, Arlesheim, Switzerland
| | | | - Anne B Leuppi-Taegtmeyer
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | - Luana Rageth
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - David Miedinger
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Elina Wirz
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Rageth L, Leuppi JD, Leuppi-Taegtmeyer AB, Lüthi-Corridori G, Boesing M. [Predictors for Early Unplanned Readmissions]. PRAXIS 2023; 112:75-81. [PMID: 36722109 DOI: 10.1024/1661-8157/a003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Predictors for Early Unplanned Readmissions Abstract. Unplanned rehospitalizations represent a major burden for patients, their relatives and the healthcare system. Since the introduction of the SwissDRG in 2012, financial incentives for hospitals have been promoted to forestall readmissions. Not every patient is at risk for rehospitalization. Affected patients can be identified by predictors from various areas in order to implement adequate interventions and avoid readmissions. Predictors can be directly related to patients as in the case of polypharmacy, multiple comorbidities or related to gender, but also provider-related and system-related. Early follow-up visits or a pre-discharge medication review are cited as effective interventions.
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Affiliation(s)
- Luana Rageth
- Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Schweiz
- Medizinische Fakultät, Universität Basel, Basel, Schweiz
| | - Jörg D Leuppi
- Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Schweiz
- Medizinische Fakultät, Universität Basel, Basel, Schweiz
| | - Anne B Leuppi-Taegtmeyer
- Medizinische Fakultät, Universität Basel, Basel, Schweiz
- Klinische Pharmakologie und Toxikologie, Universitätsspital Basel, Basel, Schweiz
| | - Giorgia Lüthi-Corridori
- Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Schweiz
- Medizinische Fakultät, Universität Basel, Basel, Schweiz
| | - Maria Boesing
- Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Schweiz
- Medizinische Fakultät, Universität Basel, Basel, Schweiz
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Gong X, Zhang X, Liu D, Yang C, Zhang R, Xiao Z, Chen W, Chen J. Evaluation of physician experience in achieving non-perfused volume ratio of high-intensity focused ultrasound ablation for uterine fibroids: a multicentre study. J Int Med Res 2022; 50:3000605221102087. [PMID: 35634930 PMCID: PMC9158416 DOI: 10.1177/03000605221102087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training. Methods This prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician’s level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated. Results A total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve. Conclusions NPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.
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Affiliation(s)
- Xue Gong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinyue Zhang
- Department of Ultrasound Medicine, Mianyang Central Hospital, Mianyang, Sichuan Province, China
| | - Dang Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chao Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Rong Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhibo Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Centre, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ajmi SC, Aase K. Physicians' clinical experience and its association with healthcare quality: a systematised review. BMJ Open Qual 2021; 10:e001545. [PMID: 34740896 PMCID: PMC8573657 DOI: 10.1136/bmjoq-2021-001545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE There is conflicting evidence regarding whether physicians' clinical experience affects healthcare quality. Knowing whether an association exists and which dimensions of quality might be affected can help healthcare services close quality gaps by tailoring improvement initiatives according to physicians' clinical experience. Here, we present a systematised review that aims to assess the potential association between physicians' clinical experience and different dimensions of healthcare quality. METHODS We conducted a systematised literature review, including the databases MEDLINE, Embase, PsycINFO and PubMed. The search strategy involved combining predefined terms that describe physicians' clinical experience with terms that describe different dimensions of healthcare quality (ie, safety, clinical effectiveness, patient-centredness, timeliness, efficiency and equity). We included relevant, original research published from June 2004 to November 2020. RESULTS Fifty-two studies reporting 63 evaluations of the association between physicians' clinical experience and healthcare quality were included in the final analysis. Overall, 27 (43%) evaluations found a positive or partially positive association between physicians' clinical experience and healthcare quality; 22 (35%) found no association; and 14 (22%) evaluations reported a negative or partially negative association. We found a proportional association between physicians' clinical experience and quality regarding outcome measures that reflect safety, particularly in the surgical fields. For other dimensions of quality, no firm evidence was found. CONCLUSION We found no clear evidence of an association between measures of physicians' clinical experience and overall healthcare quality. For outcome measures related to safety, we found that physicians' clinical experience was proportional with safer care, particularly in surgical fields. Our findings support efforts to secure adequate training and supervision for early-career physicians regarding safety outcomes. Further research is needed to reveal the potential subgroups in which gaps in quality due to physicians' clinical experience might exist.
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Affiliation(s)
- Soffien Chadli Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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