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Klein S, Eaton KP, Bodnar BE, Keller SC, Helgerson P, Parsons AS. Transforming Health Care from Volume to Value: Leveraging Care Coordination Across the Continuum. Am J Med 2023; 136:985-990. [PMID: 37481020 DOI: 10.1016/j.amjmed.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Sharon Klein
- Department of Medicine, New York University Langone Health, New York
| | - Kevin P Eaton
- Department of Medicine, New York University Langone Health, Brooklyn
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sara C Keller
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paul Helgerson
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Andrew S Parsons
- Department of Medicine, University of Virginia School of Medicine, Charlottesville.
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Bann M, Meo N, Lopez JP, Ou A, Rosenthal M, Khawaja H, Goodman LA, Barone M, Coleman B, High HJ, Overbeek L, Shelbourn P, VerMaas L, Baughman A, Sekaran A, Cyrus R, O'Dorisio N, Beatty L, Loica-Mersa S, Kubey A, Jaffe R, Vokoun C, Koom-Dadzie K, Graves K, Tuck M, Helgerson P. Medically ready for discharge: A multisite "point-in-time" assessment of hospitalized patients. J Hosp Med 2023; 18:795-802. [PMID: 37553979 DOI: 10.1002/jhm.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Time spent awaiting discharge after the acute need for hospitalization has resolved is an important potential contributor to hospital length of stay (LOS). OBJECTIVE To measure the prevalence, impact, and context of patients who remain hospitalized for prolonged periods after completion of acute care needs. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional "point-in-time" survey at each of 15 academic US hospitals using a structured data collection tool with on-service acute care medicine attending physicians in fall 2022. MAIN OUTCOMES AND MEASURES Primary outcomes were number and percentage of patients considered "medically ready for discharge" with emphasis on those who had experienced a "major barrier to discharge" (medically ready for discharge for ≥1 week). Estimated LOS attributable to major discharge barriers, contributory discharge needs, and associated hospital characteristics were measured. RESULTS Of 1928 patients sampled, 35.0% (n = 674) were medically ready for discharge including 9.8% (n = 189) with major discharge barriers. Many patients with major discharge barriers (44.4%; 84/189) had spent a month or longer medically ready for discharge and commonly (84.1%; 159/189) required some form of skilled therapy or daily living support services for discharge. Higher proportions of patients experiencing major discharge barriers were found in public versus private, nonprofit hospitals (12.0% vs. 7.2%; p = .001) and county versus noncounty hospitals (14.5% vs. 8.8%; p = .002). CONCLUSIONS Patients experience major discharge barriers in many US hospitals and spend prolonged time awaiting discharge, often for support needs that may be outside of clinician control.
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Affiliation(s)
- Maralyssa Bann
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
| | - Nicholas Meo
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
| | - J P Lopez
- University of Washington, Seattle, Washington, USA
| | - Amy Ou
- University of California San Francisco, San Francisco, California, USA
| | - Molly Rosenthal
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
- University of Washington Medical Center, Seattle, Washington, USA
| | - Hussain Khawaja
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Leigh A Goodman
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Banner-University Medical Center-Phoenix, Phoenix, Arizona, USA
| | - Melanie Barone
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Heidi J High
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | - Amy Baughman
- Massachussetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adith Sekaran
- Massachussetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Cyrus
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nathan O'Dorisio
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lane Beatty
- Springfield Hospital, Springfield, Vermont, USA
| | | | - Alan Kubey
- Mayo Clinic, Rochester, Minnesota, USA
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Rebecca Jaffe
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Chad Vokoun
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Kencee Graves
- University of Utah Health, Salt Lake City, Utah, USA
| | - Matthew Tuck
- Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Paul Helgerson
- University of Virginia Health System, Charlottesville, Virginia, USA
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