Impact of different models of improvement of continuity of care on lipid control and the delay of visits to cardiology

Association of Continuity of Care With Health Care Utilization and Expenditures Among Patients Discharged Home After Stroke or Transient Ischemic Attack

OBJECTIVES

To examine the association of prestroke continuity of care (COC) with postdischarge health care utilization and expenditures.

STUDY POPULATION

The study population included 2233 patients with a diagnosis of stroke or a transient ischemic attack hospitalized in one of 41 hospitals in North Carolina between March 2016 and July 2019 and discharged directly home from acute care.

METHODS

COC was assessed from linked Centers for Medicare and Medicaid Services Medicare claims using the Modified, Modified Continuity Index. Logistic regressions and 2-part models were used to examine the association of prestroke primary care COC with postdischarge health care utilization and expenditures.

RESULTS

Relative to patients in the first (lowest) COC quartile, patients in the second and third COC quartiles were more likely [21% (95% CI: 8.5%, 33.5%) and 33% (95% CI: 20.5%, 46.1%), respectively] to have an ambulatory care visit within 14 days. Patients in the highest COC quartile were more likely to visit a primary care provider but less likely to see a stroke specialist. Highest as compared with lowest primary care COC quartile was associated with $45 lower (95% CI: $14, $76) average expenditure for ambulatory care visits within 30 days postdischarge. Patients in the highest, as compared with the lowest, primary care COC quartile were 36% less likely (95% CI: 8%, 64%) to be readmitted within 30 days postdischarge and spent $340 less (95% CI: $2, $678) on unplanned readmissions.

CONCLUSIONS

These findings underscore the importance of primary care COC received before stroke hospitalization to postdischarge care and expenditures.

Effect of Continuous Care Combined with Constraint-Induced Movement Therapy Based on a Continuing Care Health Platform on MBI and FMA Scores of Acute Stroke Patients

Methods

68 acute stroke patients admitted to our hospital from July 2018 to July 2019 were selected as the study participants and divided into group A and group B based on the odd and even numbers of their admission numbers, with 34 cases in each group. Patients in group B accepted the routine rehabilitation exercise, while patients in group A accepted the continuous care combined with constraint-induced movement therapy (CIMT) under a health platform, so as to compare their upper limb function recovery by the Fugl–Meyer assessment (FMA) and improved median Barthel index (MBI).

Results

The general information of the two groups were not obviously different (P > 0.05) but comparable; after intervention, the FMA scores (38.42 ± 7.62 vs 31.22 ± 7.25) and MBI scores (78.63 ± 6.52 vs 70.24 ± 6.48) of patients in group A were significantly higher than those of group B (P < 0.001); the activities of daily living (ADL) and trunk control test (TCT) scores at T1, T2, and T3 of group A were significantly higher than those of group B (P < 0.05); at 6 months after discharge, the self-concept, self-care skills, self-care, self-responsibility, health knowledge level, and total ability scores of patients in group A were significantly higher than those in group B (P < 0.05); the Generic Quality of Life Inventory-74 (GQOL-74) scores after intervention of the two groups were significantly higher than those before intervention (P < 0.05) and those of group A were significantly higher than those of group B (72.13 ± 4.69 vs 63.19 ± 4.72; P < 0.05); when comparing with group B, group A presented significantly higher walking speed and gait period and lower support phase (P < 0.05).

Conclusion

The combination of continuous care and CIMT under a health platform can effectively promote the rehabilitation of upper limb functions and improve the activities of daily living and trunk control for acute stroke patients, with an effect better than conventional rehabilitation exercises, which is worthy of promotion.

Telecardiology interventions for patients with cardiovascular Disease: A systematic review on characteristics and effects

INTRODUCTION

The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects.

METHODS

A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included.

RESULTS

Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction.

CONCLUSION

Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction.

[Management of patients with dyslipidaemia in Spain. The Cardio Right Care Control of cardiovascular risk project]

OBJECTIVE

To ascertain the opinion of physicians about diagnostic criteria, control targets, control rates, and therapeutic approach of patients with dyslipidaemia in Spain.

METHODS

A specific questionnaire was created about diagnostic criteria, control targets, control rates, lipid lowering therapies, and therapeutic inertia in patients with dyslipidaemia. Physicians completed the questionnaire online during a 4-month period.

RESULTS

A total of 959 questionnaires were collected from all over Spain. The most frequent scale to stratify cardiovascular risk is SCORE (54.9%), and guidelines from the European Society of Cardiology are the most common guidelines used (50.5%). The majority of patients are on primary prevention (57.7%), and 31.4% have a high-very high cardiovascular risk. More than 70% of investigators considered that the target among patients at very high risk and those in secondary prevention is an LDL cholesterol < 70 mg/dL. It is considered by 60.0% and 66.4% of investigators that their patients on primary and secondary prevention, respectively, achieve control targets. Statins are the most common lipid lowering drugs used, followed by ezetimibe. In the majority of cases, when a patient is not adequately controlled with statins, there is an increase in the dose or a change to another statin. Poor adherence to treatment and therapeutic inertia are the main reasons for poor LDL cholesterol control.

CONCLUSIONS

The Cardio Right Care CVR Control project allows those aspects to be identified, as well as areas of improvement in patients with dyslipidaemia in Spain.