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Ingvarsson E, Schildmeijer K, Hagerman H, Lindberg C. "Being the main character but not always involved in one's own care transition" - a qualitative descriptive study of older adults' experiences of being discharged from in-patient care to home. BMC Health Serv Res 2024; 24:571. [PMID: 38698451 PMCID: PMC11067295 DOI: 10.1186/s12913-024-11039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The growing number of older adults with chronic diseases challenges already strained healthcare systems. Fragmented systems make transitions between healthcare settings demanding, posing risks during transitions from in-patient care to home. Despite efforts to make healthcare person-centered during care transitions, previous research indicates that these ambitions are not yet achieved. Therefore, there is a need to examine whether recent initiatives have positively influenced older adults' experiences of transitions from in-patient care to home. This study aimed to describe older adults' experiences of being discharged from in-patient care to home. METHODS This study had a qualitative descriptive design. Individual interviews were conducted in January-June 2022 with 17 older Swedish adults with chronic diseases and needing coordinated care transitions from in-patient care to home. Data were analyzed using inductive qualitative content analysis. RESULTS The findings indicate that despite being the supposed main character, the older adult is not always involved in the planning and decision-making of their own care transition, often having poor insight and involvement in, and impact on, these aspects. This leads to an experience of mismatch between actual needs and the expectations of planned support after discharge. CONCLUSIONS The study reveals a notable disparity between the assumed central role of older adults in care transitions and their insight and involvement in planning and decision-making.
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Affiliation(s)
- Emelie Ingvarsson
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
| | - Heidi Hagerman
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
| | - Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
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Upadhyay S, Bhandari N. Patient Engagement Functionalities' Influence on Quality Outcomes: The Road via EHR Presence. J Healthc Manag 2024; 69:118-131. [PMID: 38467025 DOI: 10.1097/jhm-d-23-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
GOAL Patients engaged in self-care through information technology can potentially improve the quality of healthcare they receive. This study aimed to examine how electronic health record (EHR) system functionalities help hospitals mediate the impact of patient engagement on quality outcomes-notably, readmission rates. METHODS A pooled cross-sectional study design employed data containing 3,547 observations from general acute care hospitals (2014-2018). The breadth of patient engagement functionalities adopted by a hospital was used as the independent variable and the degree of EHR presence was used as the mediating variable. Mean time to readmission for acute myocardial infarction (AMI), pneumonia, and heart failure were the dependent variables. The Baron and Kenny method was used to test mediation. PRINCIPAL FINDINGS Patient engagement was associated with reduced AMI readmission rates both directly and via EHR system presence. Mediation effects were present, in that a 1-unit increase in patient engagement through EHR system presence was associated with a 0.33% decrease in AMI readmission rates (p < .05). For other disease categories (heart failure and pneumonia), a significant effect was not found. PRACTICAL APPLICATIONS For hospitals with a comprehensive EHR system, patient engagement through information technology can potentially reduce readmission rates for some diseases. More research is needed to determine which specific clinical conditions are amenable to quality improvement through patient engagement. Synergies between patient engagement functionalities and an EHR system positively affect quality outcomes. Therefore, practitioners and hospital managers should leverage hospital investments made in their EHR system infrastructure and use it to engage patients in self-care.
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Affiliation(s)
| | - Neeraj Bhandari
- School of Public Health, University of Nevada, Las Vegas, Nevada
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3
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Ohta R, Maejima S, Sano C. Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective. Cureus 2024; 16:e57015. [PMID: 38681408 PMCID: PMC11046255 DOI: 10.7759/cureus.57015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Rural hospitals, particularly those in geographically isolated regions like Shimane Prefecture, Japan, face significant healthcare delivery challenges. These include limited resources, an aging population, and a scarcity of healthcare professionals. Advanced practice nurses (APNs) have emerged as pivotal in addressing these gaps, offering specialized patient assessment, diagnosis, and management skills. This study aimed to evaluate the demand for APNs in rural community hospitals, focusing on the specific educational needs and clinical competencies required to improve healthcare outcomes in these settings. Method Employing a mixed-methods approach, this research combined qualitative insights from stakeholder interviews with quantitative data analysis of electronic health records (EHRs) at Unnan City Hospital. This sequential exploratory design aimed to capture comprehensive educational needs and outcomes, integrating the depth of qualitative data with the breadth of quantitative evidence to tailor a curriculum for APNs in rural healthcare contexts. Results The study revealed a critical demand for APNs skilled in managing common medical issues in rural settings, such as infections, circulatory failures, and respiratory problems. Stakeholder interviews highlighted the necessity for a curriculum that enhances clinical competencies and emphasizes soft skills like communication and leadership. An analysis of EHRs identified 21 specific diseases across six categories, underlining the importance of targeted education on these prevalent conditions. Conclusion The findings underscore the urgent need for specialized education programs for APNs in rural hospitals to address these communities' unique healthcare challenges. Developing a curriculum that focuses on clinical and soft skills essential for rural healthcare delivery can significantly enhance the quality of care. This study advocates for implementing such tailored educational programs to empower APNs, thereby contributing to healthcare equity and improving patient outcomes in rural settings.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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4
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Ohta R, Yakabe T, Sano C. Decision-Making in the Admission of Older Patients: A Thematic Analysis From Multiple-Stakeholder Perspectives. Cureus 2024; 16:e51966. [PMID: 38333500 PMCID: PMC10851036 DOI: 10.7759/cureus.51966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction As rural healthcare systems grapple with an aging population, understanding the factors influencing hospital admission decisions for elderly patients is crucial. This study explores the complex interplay of medical, social, and psychological factors that shape these decisions, as perceived by multiple stakeholders, including physicians, patients, and their families. Method This study was conducted in Unnan City Hospital, a rural community hospital in Unnan, Japan, using a qualitative thematic analysis approach. Participants included general physicians, patients admitted more than once, and their families. One-on-one semi-structured interviews were conducted in Japanese, recorded, transcribed, and analyzed. The analysis focused on identifying themes that influence decision-making processes regarding the admission of elderly patients. The research team, comprising family medicine, public health, and community health care experts, ensured a multi-perspective approach through collaborative coding and discussion. Results Three primary themes emerged from the analysis: "dilemma between medical indications and social admissions," "risks and benefits of hospitalization in response to unpredictable changes in the elderly," and "social factors intertwined with the multilayered nature of hospital admission decisions." Physicians reported a conflict between their medical training and the social needs of patients, often leading to stress and negative emotions. The unpredictable health trajectories of elderly patients necessitated a nuanced risk-benefit analysis for hospitalization. In addition, social factors, such as bed availability, patient's living environment, and psychosocial contexts, significantly influenced admission decisions. Conclusion The study highlights the need for a more holistic approach to medical education and practice, especially in rural healthcare settings. Recognizing the complexity of factors influencing hospitalization decisions, including medical, social, and individual patient circumstances, is vital. The findings underscore the importance of integrating biopsychosocial aspects into the decision-making process for the hospitalization of elderly patients, advocating for patient-centered care that respects the unique challenges in rural healthcare environments.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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McCourt AD, White SA, Green VR, McGinty EE. Medicare Changes in Response to COVID-19: Unintended Effects for Beneficiaries With Mental Illness or Substance Use Disorders. Psychiatr Serv 2023; 74:1285-1288. [PMID: 37287226 DOI: 10.1176/appi.ps.20220502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The authors explored potential unintended consequences of Medicare policy changes in response to the COVID-19 pandemic for beneficiaries with behavioral health care needs. METHODS The authors collected policies relevant to mental health and substance use care. Informed by a literature review conducted in spring 2022, the authors convened a modified Delphi panel with 13 experts in June 2022. The authors assessed expert consensus through panelist surveys conducted before and after the panel convened. RESULTS Two policies that had a risk for unintended consequences for those with behavioral health care needs were identified. Panelists identified a discharge planning waiver as likely to decrease care access, care quality, and desirable outcomes and HIPAA enforcement discretion as likely to increase access to care and desirable outcomes (with some mixed effects on other outcomes) for Medicare beneficiaries with mental illness or substance use disorders. CONCLUSIONS Policies implemented quickly during the pandemic did not always account for unintended consequences for beneficiaries with behavioral health care needs.
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Affiliation(s)
- Alexander D McCourt
- Departments of Health Policy and Management (McCourt, White) and Mental Health (Green), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (McGinty)
| | - Sarah A White
- Departments of Health Policy and Management (McCourt, White) and Mental Health (Green), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (McGinty)
| | - Victoria R Green
- Departments of Health Policy and Management (McCourt, White) and Mental Health (Green), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (McGinty)
| | - Emma E McGinty
- Departments of Health Policy and Management (McCourt, White) and Mental Health (Green), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (McGinty)
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Li B, Verma R, Beaton D, Tamim H, Hussain MA, Hoballah JJ, Lee DS, Wijeysundera DN, de Mestral C, Mamdani M, Al‐Omran M. Predicting Major Adverse Cardiovascular Events Following Carotid Endarterectomy Using Machine Learning. J Am Heart Assoc 2023; 12:e030508. [PMID: 37804197 PMCID: PMC10757546 DOI: 10.1161/jaha.123.030508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
Background Carotid endarterectomy (CEA) is a major vascular operation for stroke prevention that carries significant perioperative risks; however, outcome prediction tools remain limited. The authors developed machine learning algorithms to predict outcomes following CEA. Methods and Results The National Surgical Quality Improvement Program targeted vascular database was used to identify patients who underwent CEA between 2011 and 2021. Input features included 36 preoperative demographic/clinical variables. The primary outcome was 30-day major adverse cardiovascular events (composite of stroke, myocardial infarction, or death). The data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, 6 machine learning models were trained using preoperative features. The primary metric for evaluating model performance was area under the receiver operating characteristic curve. Model robustness was evaluated with calibration plot and Brier score. Overall, 38 853 patients underwent CEA during the study period. Thirty-day major adverse cardiovascular events occurred in 1683 (4.3%) patients. The best performing prediction model was XGBoost, achieving an area under the receiver operating characteristic curve of 0.91 (95% CI, 0.90-0.92). In comparison, logistic regression had an area under the receiver operating characteristic curve of 0.62 (95% CI, 0.60-0.64), and existing tools in the literature demonstrate area under the receiver operating characteristic curve values ranging from 0.58 to 0.74. The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.02. The strongest predictive feature in our algorithm was carotid symptom status. Conclusions The machine learning models accurately predicted 30-day outcomes following CEA using preoperative data and performed better than existing tools. They have potential for important utility in guiding risk-mitigation strategies to improve outcomes for patients being considered for CEA.
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Affiliation(s)
- Ben Li
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
| | - Raj Verma
- School of Medicine, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Derek Beaton
- Data Science & Advanced Analytics, Unity Health TorontoUniversity of TorontoCanada
| | - Hani Tamim
- Faculty of Medicine, Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
- College of MedicineAlfaisal UniversityRiyadhKingdom of Saudi Arabia
| | - Mohamad A. Hussain
- Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Jamal J. Hoballah
- Division of Vascular and Endovascular Surgery, Department of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Douglas S. Lee
- Division of Cardiology, Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
| | - Duminda N. Wijeysundera
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Department of AnesthesiaSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
| | - Charles de Mestral
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
| | - Muhammad Mamdani
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
- Data Science & Advanced Analytics, Unity Health TorontoUniversity of TorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Leslie Dan Faculty of PharmacyUniversity of TorontoCanada
| | - Mohammed Al‐Omran
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
- College of MedicineAlfaisal UniversityRiyadhKingdom of Saudi Arabia
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
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7
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Po HW, Lin FJ, Cheng HJ, Huang ML, Chen CY, Hwang JJ, Chiu YW. Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study. J Nurs Res 2023; 31:e274. [PMID: 37167623 DOI: 10.1097/jnr.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND In many hospitals, a discharge planning team works with the medical team to provide case management to ensure high-quality patient care and improve continuity of care from the hospital to the community. However, a large-scale database analysis of the effectiveness of overall discharge planning efforts is lacking. PURPOSE This study was designed to investigate the clinical factors that impact the efficacy of discharge planning in terms of hospital length of stay, readmission rate, and survival status. METHODS A retrospective study was conducted based on patient medical records and the discharge plans applied to patients hospitalized in a regional medical center between 2017 and 2018. The medical information system database and the care service management information system maintained by the Ministry of Health and Welfare were used to collect data and explore patients' medical care and follow-up status. RESULTS Clinical factors such as activities of daily living ≤ 60, having indwelling catheters, having poor control of chronic diseases, and insufficient caregiver capacity were found to be associated with longer hospitalization stays. In addition, men and those with indwelling catheters were found to have a higher risk of readmission within 30 days of discharge. Moreover, significantly higher mortality was found after discharge in men, those ≥ 75 years old, those with activities of daily living ≤ 60, those with indwelling catheters, those with pressure ulcers or unclean wounds, those with financial problems, those with caregivers with insufficient capacity, and those readmitted 14-30 days after discharge. CONCLUSIONS The findings of this study indicate that implementing case management for discharge planning does not substantially reduce the length of hospital stay nor does it affect patients' readmission status or prognosis after discharge. However, age, underlying comorbidities, and specific disease factors decrease the efficacy of discharge planning. Therefore, active discharge planning interventions should be provided to ensure transitional care for high-risk patients.
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Affiliation(s)
- Hui-Wen Po
- MSN, RN, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Fang-Ju Lin
- MS, RN, Head Nurse, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Hsing-Jung Cheng
- MS, RN, Supervisor, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Mei-Ling Huang
- MS, RN, Director, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Chung-Yu Chen
- PhD, MD, Assistant Professor, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Juey-Jen Hwang
- PhD, MD, Professor, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Wen Chiu
- PhD, RN, Associate Professor, Department of Nursing, Chung Shan Medical University, and Chung Shan Medical University Hospital, Taiwan
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8
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Jones KC, Austad K, Silver S, Cordova-Ramos EG, Fantasia KL, Perez DC, Kremer K, Wilson S, Walkey A, Drainoni ML. Patient Perspectives of the Hospital Discharge Process: A Qualitative Study. J Patient Exp 2023; 10:23743735231171564. [PMID: 37151607 PMCID: PMC10159238 DOI: 10.1177/23743735231171564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.
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Affiliation(s)
- Kayla C Jones
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
| | - Kirsten Austad
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston
University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Santana Silver
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
| | - Erika G Cordova-Ramos
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Evans Center for Implementation & Improvement Sciences
(CIIS), Boston University Chobanian & Avedisian School of Medicine, Boston, MA,
USA
| | - Kathryn L Fantasia
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Endocrinology, Diabetes and
Nutrition, Department of Medicine, Boston University Chobanian & Avedisian
School of Medicine, Boston, MA, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Kristen Kremer
- Department of Ambulatory Operations, Boston Medical Center, Boston, MA, USA
| | - Sophie Wilson
- Department of Quality and Patient Safety,
Boston Medical Center, Boston, MA, USA
| | - Allan Walkey
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Pulmonary, Allergy, Critical
Care and Sleep, Department of Medicine, Boston University Chobanian & Avedisian
School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University Chobanian & Avedisian School of
Medicine, Boston, MA, USA
- Department of Health Law Policy &
Management, Boston University School of Public
Health, Boston, MA, USA
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Komenan K, Bouveret P, Delecluse C, Robinet P, Puisieux F, Visade F. A Qualitative Analysis of the Optimal Discharge Summary: Effective Communication of Medication Changes for Older Patients. J Appl Gerontol 2023; 42:871-878. [PMID: 36514276 DOI: 10.1177/07334648221145847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: The importance of the discharge summary (DS) is well recognized. The format to be used is also important, but this aspect has not yet been studied in the literature. The purpose of this work was to establish a DS format for older patients that ensures effective communication with general practitioners (GPs). Methods: This study was based on the grounded theory approach to qualitative analysis. Data was collected from GPs during semi-structured and directive interviews. Results: Semi-structured interviews were conducted with 12 GPs and directive interviews with 39 GPs. A consensus was reached on one DS version providing selected information items such as trends in laboratory results (rising/falling) and information about planned drug withdrawals or specialist consultations. Conclusion: This work led to a consensus on the most appropriate format for the DS for older patients returning home. Its use in routine practice is needed to confirm its reception by GPs.
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Affiliation(s)
- Ked Komenan
- General Medicine Department, 27023University of Lille, Lille, France
| | - Perrine Bouveret
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Céline Delecluse
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Pierre Robinet
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | | | - Fabien Visade
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
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10
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A Targeted Discharge Planning for High-Risk Readmissions: Focus on Patients and Caregivers. Prof Case Manag 2023; 28:60-73. [PMID: 36662660 DOI: 10.1097/ncm.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF STUDY Racial and ethnic minorities with socioeconomic disadvantages are vulnerable to 30-day hospital readmissions. A 16-week quality improvement (QI) project aimed to decrease readmissions of the vulnerable patient populations through tailored discharge planning. The project evaluated the effectiveness of using a 25-item checklist to increase patients' and caregivers' health knowledge, skills, and willingness for self-care and decrease readmissions. PRIMARY PRACTICE SETTING The project took place in an inner-city teaching hospital in the Mid-Atlantic region. METHODOLOGY AND PARTICIPANTS A casual comparative design compared readmissions of the before-intervention group (May 1-July 31, 2021) and the after-intervention group (August 1-October 31, 2021). A pre- and postintervention design evaluated the effectiveness of a 25-item checklist by analyzing the differences of Patient Activation Measure (PAM) pre- and postintervention survey scores and levels in the after-intervention group. Participants were General Medicine Unit patients 18 years or older who had Medicare Fee-for-Service, resided in 10 zip codes near the hospital, and were discharged home. RESULTS Of 30 patients who received the intervention, one patient was readmitted compared with 11 readmissions from 58 patients who did not receive the intervention. The readmission rate was decreased from 19% to 4% during the 16-week project: 11 (19%) versus 1 (4%), p = .038. After receiving the intervention, patients' PAM scores were increased by 8.55, t(22) = 2.67, p < .014. Three patients had a lower postintervention survey level, whereas 12 patients obtained a higher postintervention survey level (p = .01). The increase in scores and levels supported that the intervention effectively improved patients' self-management knowledge, skill, and willingness for self-care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The QI project showed that the hospital could partner with patients at high risk for readmission and their caregivers. Accurate evaluation of patients' health knowledge, skills, and willingness for self-care was essential for sufficient discharge planning. Tailored use of the checklist improved patients' self-activation and functionally facilitated patients' and caregivers' care needs and capabilities. The checklist was statistically and clinically effective in decreasing 30-day hospital readmissions of vulnerable patient populations.
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11
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Zilberberg MD, Nathanson BH, Puzniak LA, Zilberberg NWD, Shorr AF. Descriptive epidemiology of hospitalized patients with bacterial nosocomial pneumonia who experience 30-day readmission in the US, 2014-2019. PLoS One 2022; 17:e0276192. [PMID: 36490261 PMCID: PMC9733878 DOI: 10.1371/journal.pone.0276192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on measures such as re-admission at 30 days remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions. METHODS We conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO) with respect to the type of NP (ventilator-associated bacterial pneumonia [VABP], ventilated hospital-acquired bacterial pneumonia [vHABP], and non-ventilated HABP [nvHABP]), and characteristics and outcomes of the index hospitalization. RESULTS Among 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age [SD] 67.4 (13.9] vs. 63.0 [15.2] years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%). CONCLUSIONS One in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP.
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Affiliation(s)
| | | | | | - Noah W. D. Zilberberg
- EviMed Research Group, LLC, Goshen, MA, United States of America
- Universty of Massachusetts, Amherst, MA, United States of America
| | - Andrew F. Shorr
- Washington Hospital Center, Washington, DC, United States of America
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12
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Early postpartum readmissions: identifying risk factors at birth hospitalization. AJOG GLOBAL REPORTS 2022; 2:100094. [DOI: 10.1016/j.xagr.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Rodriguez VA, Boggs EF, Verre MC, Siebenaler MK, Wicks JS, Castiglioni C, Palac H, Garfield CF. Hospital Discharge Instructions: Characteristics, Accessibility, and National Guideline Adherence. Hosp Pediatr 2022; 12:959-970. [PMID: 36195675 DOI: 10.1542/hpeds.2021-006493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The content of pediatric hospital discharge instructions is highly variable. This study aimed to describe the characteristics, accessibility per patient literacy level and language, and national guideline adherence of pediatric hospital discharge instructions. METHODS This retrospective study assessed discharge instructions at a tertiary children's hospital. Patient and instruction characteristics, including patient health literacy level, grade level of instructions, patient language preference, and language of instructions were collected via chart review and electronic medical record query. Standard admission processes assessed health literacy via Brief Health Literacy Screening. The association between demographic and clinical characteristics and adherence to Solutions for Patient Safety guidelines was analyzed by using unadjusted and adjusted analysis methods. RESULTS Of 240 discharge instructions, 25% were missing at least 1 recommended content area: signs of worsening, where to seek help, or medication reconciliation. A patient health literacy deficit was identified in 15%; the mean grade level of instructions was 10.1. Limited English proficiency was reported among 17% one quarter of whom received language concordant instructions. Use of discharge instruction templates and discharge services were associated with improved guideline adherence (P <.001). Almost one-half of the study population had a complex medical history, which was associated with decreased guideline adherence (P = .04). CONCLUSIONS One-quarter of discharge instructions for this predominantly medically complex population failed to meet national standards. Accessibility was often limited by the reading grade level or discordant language of instructions. Templates may be a valuable tool for improving discharge instruction content, accessibility, and adherence to national guidelines.
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Affiliation(s)
- Victoria A Rodriguez
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth F Boggs
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Michael C Verre
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Katherine Siebenaler
- HSHS St. John's Children's Hospital, Springfield, Illinois.,Southern Illinois University School of Medicine, Springfield, Illinois; and
| | - Jennifer S Wicks
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia Castiglioni
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah Palac
- Independent Statistical Consultant, Wauwatosa, Wisconsin
| | - Craig F Garfield
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Physical Therapists. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Rodriguez HP, Ciemins EL, Rubio K, Shortell SM. Physician Practices With Robust Capabilities Spend Less On Medicare Beneficiaries Than More Limited Practices. Health Aff (Millwood) 2022; 41:414-423. [PMID: 35254927 DOI: 10.1377/hlthaff.2021.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
No research has considered a range of physician practice capabilities for managing patient care when examining practice-level influences on quality of care, utilization, and spending. Using data from the 2017 National Survey of Healthcare Organizations and Systems linked to 2017 Medicare fee-for-service claims data from attributed beneficiaries, we examined the association of practice-level capabilities with process measures of quality, utilization, and spending. In propensity score-weighted mixed-effects regression analyses, physician practice locations with "robust" capabilities had lower total spending compared to locations with "mixed" or "limited" capabilities. Quality and utilization, however, did not differ by practice-level capabilities. Physician practice locations with robust capabilities spend less on Medicare fee-for-service beneficiaries but deliver quality of care that is comparable to the quality delivered in locations with low or mixed capabilities. Reforms beyond those targeting practice capabilities, including multipayer alignment and payment reform, may be needed to support larger performance advantages for practices with robust capabilities.
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Affiliation(s)
- Hector P Rodriguez
- Hector P. Rodriguez , University of California Berkeley, Berkeley, California
| | | | - Karl Rubio
- Karl Rubio, University of California Berkeley
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16
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Aßfalg V, Hassiotis S, Radonjic M, Göcmez S, Friess H, Frank E, Königstorfer J. [Implementation of discharge management in the surgical department of a university hospital: exploratory analysis of costs, length of stay, and patient satisfaction]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:348-356. [PMID: 35138420 PMCID: PMC8888510 DOI: 10.1007/s00103-022-03497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discharge management has been mandatory by law in Germany since October 2017, and hospitals are required to finance and implement this. Currently there are no data available on the costs and effects of discharge management on the length of hospital stay. AIMS Determination of the costs of discharge management in the Department of Surgery at the University Hospital rechts der Isar of the Technical University of Munich, Germany, assessment of the length of stay in comparison with and without discharge management, and evaluation of patients' satisfaction to create first precedents for future negotiations about adequate financing. METHODS Cost analysis of discharge management in the Department of Surgery at the School of Medicine at the Technical University of Munich, retrospective analysis of the mean length of hospital stays before and after implementation of discharge management, and patient surveys on the quality of the structured transition process and their satisfaction. RESULTS The cost analysis revealed lump costs of € 43 per patient and € 391 for patients with a need for complex management. No statistically significant shorter length of hospital stay after the implementation of discharge management was found by analyzing three patient subgroups. The overall rate of patients returning to the hospital due to complications associated with the surgical procedure was 3.4%. DISCUSSION Discharge management in the Department of Surgery at the hospital is an effective and potentially quality-enhancing but at the same time cost-driving measure, which, in the medium term, will enter G‑DRG rates and may thus increase costs. A possible solution to meet various stakeholders' needs could be a case-specific financial remuneration of discharge management that is adapted to the transition qualities of the various medical departments.
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Affiliation(s)
- Volker Aßfalg
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Sophia Hassiotis
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.,Lehrstuhl für Sport- und Gesundheitsmanagement, TU München, München, Deutschland
| | - Marion Radonjic
- Finanzcontrolling, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Sarah Göcmez
- Kaufmännische Direktion, Zentrale Steuerung Entlassmanagement, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Elke Frank
- Kaufmännische Direktion, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Jörg Königstorfer
- Lehrstuhl für Sport- und Gesundheitsmanagement, TU München, München, Deutschland
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Ding P, Guo H, Sun C, Yang P, Tian Y, Liu Y, Zhang Z, Wang D, Zhao X, Tan B, Liu Y, Li Y, Zhao Q. Relationship Between Nutritional Status and Clinical Outcome in Patients With Gastrointestinal Stromal Tumor After Surgical Resection. Front Nutr 2022; 9:818246. [PMID: 35187038 PMCID: PMC8847716 DOI: 10.3389/fnut.2022.818246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
BackgroundCurrently, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors in the gastrointestinal tract, and surgical resection is the main treatment. Malnutrition after gastrointestinal surgery is not uncommon, which may have adverse effects on postoperative recovery and prognosis. However, the nutritional status of GIST patients after surgical resection and its impact on clinical outcomes have received less attention. Therefore, the aim of this study was to dynamically evaluate the nutritional status of GIST patients undergoing surgical resection, and to analyze the correlation between nutritional status and clinical outcomes.MethodsWe retrospectively analyzed the clinical data of GIST patients who underwent surgical resection in the Fourth Hospital of Hebei Medical University from January 2016 to January 2020. Nutritional risk screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess the nutritional status of all patients at admission and discharge, and the correlation between nutritional risk and clinical outcomes was analyzed.ResultsA total of 413 GIST patients were included in this study, among which 114 patients had malnutrition risk at admission (NRS2002 score ≥ 3), and 65 patients had malnutrition (PG-SGA score ≥ 4). The malnutrition risk rate (27.60 vs. 46.73%, p < 0.001) and malnutrition incidence (15.73 vs. 37.29%, p < 0.001) at admission were lower than those at discharge. Compared with the laboratory results at admission, the albumin, prealbumin, and total protein of the patients at discharge were significantly lower (all p < 0.05). And there was a negative correlation between PG-SGA and clinical outcome (all p < 0.05).ConclusionThe nutritional status of GIST patients after surgical resection at discharge was worse than that at admission, and malnutrition is an important risk factor leading to poor clinical outcomes.
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Affiliation(s)
- Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhidong Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong Wang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuefeng Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bibo Tan
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Li
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Qun Zhao
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Ning N, Haynes A, Romley J. Trends in the quality and cost of inpatient surgical procedures in the United States, 2002-2015. PLoS One 2021; 16:e0259011. [PMID: 34731186 PMCID: PMC8565758 DOI: 10.1371/journal.pone.0259011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study documents trends in risk-adjusted quality and cost for a variety of inpatient surgical procedures among Medicare beneficiaries from 2002 through 2015, which can provide valuable insight on future strategies to improve public health and health care. METHODS We focused on 11 classes of inpatient surgery, defined by the Agency for Health Research and Quality's (AHRQ's) Clinical Classification System. The surgical classes studied included a wide range of surgeries, including tracheostomy, heart valve procedures, colorectal resection, and wound debridement, among others. For each surgical class, we assessed trends in treatment costs and quality outcomes, as defined by 30-day survival without unplanned readmissions, among Medicare beneficiaries receiving these procedures during hospital stays. Quality and costs were adjusted for patient severity based on demographics, comorbidities, and community context. We also explored surgical innovations of these 11 classes of inpatient surgery from 2002-2015. RESULTS We found significant improvements in quality for 7 surgical classes, ranging from 0.08% (percutaneous transluminal coronary angioplasty) to 0.74% (heart valve procedures) per year. Changes in cost varied by surgery, the significant decrease in cost ranged from -2.59% (tracheostomy) to -0.34% (colorectal resection) per year. Treatment innovation occurred with respect to surgical procedures utilized for heart valve procedures and colorectal resection, which may be associated with the decrease in surgical cost. CONCLUSIONS Our results suggest that there was significant quality improvement for 7 surgery categories over the 14-year study period. Costs decreased significantly for 6 surgery categories, and increased significantly for 3 other categories.
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Affiliation(s)
- Ning Ning
- Department of Pharmaceutical and Health Economics, USC School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America
| | - Alex Haynes
- Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - John Romley
- Department of Pharmaceutical and Health Economics, USC School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America
- Public Policy, USC Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States of America
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Tevald MA, Clancy MJ, Butler K, Drollinger M, Adler J, Malone D. Activity Measure for Post-Acute Care "6-Clicks" for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2021; 102:2300-2308.e3. [PMID: 34496269 PMCID: PMC8418699 DOI: 10.1016/j.apmr.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design Retrospective cohort study. Setting An academic health system in the United States consisting of 5 inpatient hospitals. Participants Adult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment. Interventions Not applicable. Main Outcome Measures Discharge destination, hospital length of stay, in-hospital mortality, and readmission. Results A total of 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (odds ratio, 0.867 and 0.833, respectively) and activity scores (odds ratio, 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (area under the curve [AUC]=0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, whereas specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (odds ratio, 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged length of stay (odds ratio, 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC=0.659-0.679). AM-PAC scores did not predict rehospitalization. Conclusions Functional status as measured by the AM-PAC “6-Clicks” mobility and activity scores are independent predictors of key clinical outcomes individual hospitalized with COVID-19.
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Affiliation(s)
- Michael A Tevald
- Department of Physical Therapy, Arcadia University, Glenside, PA.
| | - Malachy J Clancy
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kelly Butler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Megan Drollinger
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joe Adler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
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Dong X, Pan C, Wang D, Shi M, Li Y, Tan X, Guo T. Bladder Backfilling versus Standard Catheter Removal for Trial of Void after Outpatient Laparoscopic Gynecologic Surgery: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021; 29:196-203.e1. [PMID: 34481986 DOI: 10.1016/j.jmig.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the rate of postoperative urinary retention and time to discharge between bladder backfilling and standard catheter removal for trial of void (TOV) after outpatient laparoscopic gynecologic surgery. Our secondary objectives were to compare the time to void, postoperative complications, and patient satisfaction. DATA SOURCES We searched the PubMed, Ovid MEDLINE, Embase, Cochrane Library databases, and relevant reference lists of eligible articles up to March of 2021. METHODS OF STUDY SELECTION This review included randomized controlled trials (RCTs) of TOV after outpatient laparoscopic gynecologic surgery. Odds ratios (ORs) with 95% confidence interval (CI) and weighted mean differences (WMDs) were reported. The quality of the studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data were analyzed with Review Manager 5.4 software (RevMan 5.4.1; Cochrane Collaboration, London, United Kingdom). TABULATION, INTEGRATION, AND RESULTS Five RCTs (N = 488) were included. The bladder backfilling group had a significantly shorter time to void than the standard TOV group (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). Successful TOV was not significantly different between the 2 (OR, 0.92; 95% CI, 0.51 to -1.65; p = .77), without significant heterogeneity (I2 = 24%). There was also no significant difference in the time to discharge between the 2 TOV techniques (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). There was no significant difference in complication rates or patient satisfaction between the 2 groups. CONCLUSION The bladder backfilling technique of TOV after outpatient laparoscopic gynecologic surgery may reduce the time to first spontaneous void without affecting patient satisfaction or postoperative complications, but it does not significantly affect the time to discharge or urinary retention.
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Affiliation(s)
- Xue Dong
- Ambulatory Surgery Department (Dr. Tan and Ms. Dong), West China Second Hospital, Sichuan University, Chengdu
| | - Changqing Pan
- Gynecology and Obstetrics Department, Mianyang Central Hospital (Mr. Pan and Mr. Wang), Mianyang, China
| | - Dan Wang
- Gynecology and Obstetrics Department, Mianyang Central Hospital (Mr. Pan and Mr. Wang), Mianyang, China
| | - Mengdan Shi
- Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu
| | - Yonghong Li
- Gynecology and Obstetrics Department, People's Hospital of Wenjiang District (Mr. Li), Chengdu, China
| | - Xin Tan
- Ambulatory Surgery Department (Dr. Tan and Ms. Dong), West China Second Hospital, Sichuan University, Chengdu; Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu
| | - Tao Guo
- Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu.
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Chen H, Hara Y, Horita N, Saigusa Y, Kaneko T. An Early Screening Tool for Discharge Planning Shortened Length of Hospital Stay for Elderly Patients with Community-Acquired Pneumonia. Clin Interv Aging 2021; 16:443-450. [PMID: 33731989 PMCID: PMC7956591 DOI: 10.2147/cia.s296390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Community-acquired pneumonia is one of the most common diseases in elderly persons and usually results in a prolonged hospital stay. Discharge planning plays an important role in reducing the length of hospitalization. This study was designed to determine whether early screening for risk factors for delayed discharge could improve the quality of discharge planning. Methods This retrospective, observational study was conducted in two medical facilities from January 2016 to December 2018. Hospital A used a screening tool on admission (screening group): screening for risk factors for delayed discharge and initiating discharge planning immediately for those for whom it was applicable, and discharge planning in the stable phase for those for whom it was not applicable; and Hospital B initiated discharge planning without screening (usual group). Propensity score-matched pneumonia patients in the two groups were then compared. The primary outcome was length of hospital stay. Results A total of 648 patients were enrolled in this study. After adjusting for age, sex, aspiration, comorbidity, pneumonia severity index, and key person, 118 pairs underwent analysis. Length of stay was significantly different (20 days vs 13 days, p<0.001) between the groups. There were no differences in duration of antibiotic treatment, in-hospital mortality, and 30-day readmission (9 days vs 9 days, p=0.744; 10 (8.5%) vs 10 (8.5%), p=1.000; 10 (8.5%) vs 9 (7.6%), p=0.811, respectively). Conclusion Early screening for delayed discharge improved the quality of discharge planning by reducing the length of stay in pneumonia patients.
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Affiliation(s)
- Hao Chen
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Prolonged Length of Stay and Risk of Unplanned 30-Day Readmission After Elective Spine Surgery: Propensity Score-Matched Analysis of 33,840 Patients. Spine (Phila Pa 1976) 2020; 45:1260-1268. [PMID: 32341301 DOI: 10.1097/brs.0000000000003520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database study. OBJECTIVE To assess the association between prolonged length of hospital stay (pLOS) (≥4 d) and unplanned readmission in patients undergoing elective spine surgery by controlling the clinical and statistical confounders. SUMMARY OF BACKGROUND DATA pLOS has previously been cited as a risk factor for unplanned hospital readmission. This potentially modifiable risk factor has not been distinguished as an independent risk factor in a large-scale, multi-institutional, risk-adjusted study. METHODS Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database. A retrospective propensity score-matched analysis was used to reduce baseline differences between the cohorts. Univariate and multivariate analyses were performed to assess the degree of association between pLOS and unplanned readmission. RESULTS From the 99,575 patients that fit the inclusion criteria, propensity score matching yielded 16,920 well-matched pairs (mean standard propensity score difference = 0.017). The overall 30-day unplanned readmission rate of these 33,840 patients was 5.5%. The mean length of stay was 2.0 ± 0.9 days and 6.0 ± 4.5 days (P ≤ 0.001) for the control and pLOS groups, respectively. In our univariate analysis, pLOS was associated with postoperative complications, especially medical complications (22.7% vs. 8.3%, P < 0.001). Multivariate analysis of the propensity score-matched population, which adjusted identified confounders (P < 0.02 and ≥10 occurrences), showed pLOS was associated with an increased risk of 30-day unplanned readmission (odds ratio [OR] 1.423, 95% confidence interval [CI] 1.290-1.570, P < 0.001). CONCLUSION Patients who undergo elective spine procedures who have any-cause pLOS (≥4 d) are at greater risk of having unplanned 30-day readmission compared with patients with shorter hospital stays. LEVEL OF EVIDENCE 4.
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A Machine Learning Approach to Predicting Readmission or Mortality in Patients Hospitalized for Stroke or Transient Ischemic Attack. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186337] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Readmissions after stroke are not only associated with greater levels of disability and a higher risk of mortality but also increase overall medical costs. Predicting readmission risk and understanding its causes are thus essential for healthcare resource allocation and quality improvement planning. By using machine learning techniques on initial admission data, this study aimed to develop prediction models for readmission or mortality after stroke. During model development, resampling methods were implemented to balance the class distribution. Two-layer nested cross-validation was used to build and evaluate the prediction models. A total of 3422 patients were included for analysis. The 90-day rate of readmission or mortality was 17.6%. This study identified several important predictive factors, including age, prior emergency department visits, pre-stroke functional status, stroke severity, body mass index, consciousness level, and use of a nasogastric tube. The Naïve Bayes model with class weighting to compensate for class imbalance achieved the highest discriminatory capacity in terms of the area under the receiver operating characteristic curve (0.661). Despite having room for improvement, the prediction models could be used for early risk assessment of patients with stroke. Identification of patients at high risk for readmission or mortality immediately after admission has the potential of enabling early discharge planning and transitional care interventions.
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Pfoh ER, Hamilton A, Hu B, Stilphen M, Rothberg MB. The Six-Clicks Mobility Measure: A Useful Tool for Predicting Discharge Disposition. Arch Phys Med Rehabil 2020; 101:1199-1203. [DOI: 10.1016/j.apmr.2020.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/02/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
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Abstract
BackgroundAmidst the unprecedented outbreak of COVID-19, it is both critical and increasingly difficult for healthcare professionals to engage in the teamwork that will underlie an effective response to the pandemic. The simultaneous need for and challenge to teamwork, though, is not unique to healthcare.ResultsDrawing on management and organisational research conducted in healthcare as well as other industries, this article offers an overview of key, and robust, findings that highlight both what teamwork looks like and how to achieve it. I focus on two aspects of teamwork (the coordination of expertise and communication), and I review how leaders can jumpstart them by leveraging mechanisms including framing the work, using communication structures and engaging in leader inclusiveness.
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Sganga G, Pea F, Aloj D, Corcione S, Pierangeli M, Stefani S, Rossolini GM, Menichetti F. Acute wound infections management: the 'Don'ts' from a multidisciplinary expert panel. Expert Rev Anti Infect Ther 2020; 18:231-240. [PMID: 32022606 DOI: 10.1080/14787210.2020.1726740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The management of acute wounds may be affected by malpractices leading to poor outcome, prolonged hospital stay and inappropriate use of antibiotic therapy.Areas covered: Acute wound infections are represented by surgical site and post-traumatic infections. The aim of this expert opinion is to identify a list of inadvisable actions and to provide a guide for an optimal management of acute wound infections. A literature search using Pubmed/MEDLINE database was performed. Articles pertaining to areas covered published until December 2019 were selected. We identified the most common malpractices in this setting and, using the Choosing Wisely methodology, we proposed a list of "Don'ts" for an easy use in clinical practice.Expert opinion: Malpractices may occur from the surgical prophylaxis to the discharge of patient. A prolonged surgical prophylaxis, the underestimation of signs and symptoms, the omission of source control, the inappropriate collection of wound swab, the improper use of clinical microbiology and pharmacology, the lack of hygiene measures and the delay of discharge are all factors that may lead to unfavorable outcome. A multidisciplinary approach is needed to optimally manage these patients. The "Don'ts" refer to all professional figures involved in the management of patients with acute wound infections.
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Affiliation(s)
- Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Federico Pea
- Department of Medicine, University of Udine, Udine, Italy.,Institute of Clinical Pharmacology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria, Universitaria Integrata Di Udine, Udine, Italy
| | - Domenico Aloj
- Department of Traumatology, Hospital of Vercelli, Vercelli, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Marina Pierangeli
- S.O.D. Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Riuniti of Ancona, Ancona, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology, Florence Careggi University Hospital, Florence, Italy
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Upadhyay S, Stephenson AL, Smith DG. Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019860386. [PMID: 31282282 PMCID: PMC6614936 DOI: 10.1177/0046958019860386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This longitudinal study examines whether readmission rates, made transparent
through Hospital Compare, affect hospital financial performance by examining 98
hospitals in the State of Washington from 2012 to 2014. Readmission rates for
acute myocardial infarction (AMI), pneumonia (PN), and heart failure (HF) were
examined against operating revenues per patient, operating expenses per patient,
and operating margin. Using hospital-level fixed effects regression on 276
hospital year observations, the analysis indicated that a reduction in AMI
readmission rates is related with increased operating revenues as expenses
associated with costly treatments related with unnecessary readmissions are
avoided. Additionally, reducing readmission rates is related with an increase in
operating expenses. As a net effect, increased PN readmission rates may show
marginal increase in operating margin because of the higher operating revenues
due to readmissions. However, as readmissions continue to happen, a gradual
increase in expenses due to greater use of resources may lead to decreased
profitability.
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Affiliation(s)
| | | | - Dean G Smith
- 3 Louisiana State University Health Sciences Center, New Orleans, USA
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Budinich M, Sastre J. PLANIFICACIÓN DEL ALTA. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effect of active versus passive void trials on time to patient discharge, urinary tract infection, and urinary retention: a randomized clinical trial. World J Urol 2019; 38:2247-2252. [DOI: 10.1007/s00345-019-03005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022] Open
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Spillover Effects of the Hospital Readmissions Reduction Program on Radical Cystectomy Readmissions. UROLOGY PRACTICE 2019; 6:350-356. [PMID: 31709276 DOI: 10.1097/upj.0000000000000042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction and Objective Readmission rates after radical cystectomy are among the highest of any surgery. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with excess readmissions for certain targeted conditions, including total hip and knee arthroplasty. We examined whether changes made by hospitals in response to the HRRP had spillover effects on radical cystectomy readmissions. Methods We used a 20% sample of Medicare data to identify patients undergoing cystectomy from 2010 to 2014 and measured 30-day adjusted cystectomy readmission rates. To determine the effect of the HRRP, we calculated adjusted readmission rates following total hip or knee arthroplasty and stratified hospitals into quartiles (most improved, middle quartiles, least improved) based on their improvement in reducing those targeted readmissions. Multivariable logistic regression was used to identify factors associated with spillover effects from the targeted joint surgery to cystectomy. Results We identified 2,394 patients undergoing radical cystectomy. Of these, 606 were treated at hospitals in the "most improved" quartile and 522 in the "least improved." Patients undergoing cystectomy were similar in age, comorbidity, and SEC independent of hospital performance quartile. The readmission rate following cystectomy was 26% in the most improved quartile and 24% in the least improved. No spillover effect was identified between readmission reduction after major joint surgery and radical cystectomy (adjusted OR 0.90, p=0.42). Conclusions Hospitals that succeeded in reducing readmissions following major joint surgery targeted by the HRRP did not have similar reductions in readmissions following radical cystectomy. This lack of spillover effect suggests that each surgical condition may require tailored interventions to prevent readmissions.
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