Background: Among ambulatory patients with heart failure (HF), hospital admission is associated with higher subsequent mortality. HF is the leading cause of 30-day all-cause readmission, reduction of which is a goal of the Affordable Care Act. We examined the association of 30-day all-cause readmission with subsequent all-cause mortality in a propensity-matched cohort of hospitalized HF patients.. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 7578 were alive 30-day post-discharge, of which 1519 had 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without 30-day all-cause readmission, balanced on 34 baseline characteristics.. Results: During 2-12 months of post-discharge follow-up, all-cause mortality occurred in 41% and 27% of matched patients with and without 30-day all-cause readmission, respectively (HR, 1.68; 95% ...
Delivery of quality healthcare in resource-limited settings is an important, understudied public health priority. Thirty-day (early) hospital readmission is often avoidable and an important indicator of healthcare quality. We investigated the prevalence of all-cause early readmission and its associated factors using age and sex adjusted risk ratios (RR) and 95% confidence intervals (CI). A retrospective review of the medical ward database at Kamuzu Central Hospital in Lilongwe, Malawi was conducted between February and December 2013. There were 3547 patients with an index admission of which 2776 (74.4%) survived and were eligible for readmission. Among these patients: 49.7% were male, mean age was 39.7 years, 36.1% were HIV-positive, 34.6% were HIV-negative, and 29.3% were HIV-unknown. The prevalence of early hospital readmission was 5.5%. Diagnoses associated with 30-day readmission were HIV-positive status (RR = 2.41; 95% CI: 1.64-3.53) and malaria (RR = 0.45; 95% CI: 0.22-0.91). Other factors
The Particulars: Medicare reduces compensation rates for hospitals with high readmission rates. However, many hospitals can only track same-hospital readmissions. It has not been established if same-hospital readmission rates correlate with all-hospital readmission rates.. Data Breakdown: Study investigators evaluated 30-day same-hospital and all-hospital readmission rates for patients who underwent one of three common surgeries. When institutions in the worst performing quintile of same-hospital readmissions were evaluated based on all-hospital readmission, 95% were reclassified. When hospitals ranked in the top quintile of same-hospital readmissions were evaluated based on all-hospital readmission, 62% were reclassified, with 11% moving to a ranking in the worst quintile.. Take Home Pearls: Same-hospital readmission rates appear to be an unreliable predictor of all-hospital readmission rates. Novel approaches to accurately track postoperative readmissions in real-time are necessary to prevent ...
|p|Unplanned readmissions to hospital have been identified as common, costly and potentially avoidable. Understanding the factors that contribute to unplanned readmissions can inform strategies to reduce unplanned readmission rates. |/p| |p| |em|All-Cause Readmission to Acute Care and Return to the Emergency Department|/em| provides an overview of unplanned readmissions to acute care hospitals in Canada within thirty days of discharge. It is also the first study in Canada to report rates of return to the emergency department (ED) within seven days of discharge for three jurisdictions (Alberta, Ontario and Yukon). The study focuses on factors associated with readmissions and ED returns at the patient level (e.g. age, clinical condition), hospital (e.g. length of stay, size) and community level (e.g. urban/rural, income quintile). It also describes the costs associated with readmissions and the provincial variation in readmission rates.|/p| |p||strong|Companion Product |/strong||/p| |UL| |LI||A
The use of electronic discharge orders aimed at providing evidence-based decision support and clear instructions to heart failure patients helped increase compliance with quality care measures and lowered hospital readmission rates, according to research presented at the American College of Cardiologys 62nd Annual Scientific Session.. Despite more widespread use of standardized discharge orders and evidence suggesting their effectiveness, little is known about how they impact adherence to quality measures or hospital readmission rates among heart failure patients. This study showed use of a computerized discharge system was associated with a 23 percent lower all-cause hospital readmission rate and a 10-fold increase in compliance with quality care measures.. Researchers conducted a retrospective study of heart failure patients discharged from 11 hospitals across Utah between January 2011 and September 2012 to determine whether the use of an electronic discharge orders tool was associated with ...
BACKGROUND. Reducing hospital readmission rates is a top national priority. Unplanned hospital readmission is estimated to have accounted for more than $17 billion of the roughly $103 billion hospital payments made by Medicare in 2004.1 For patients in Medicare fee-for-service programs, the 30-day hospital readmission rates was recently found to be 19.6% nationally, and 20.7% in New York State (Jencks et al., 2009). Hospitals have urgent incentives to address readmission rates: readmission rates have been added to the National Quality Forum performance metrics (National Quality Forum, 2007); readmission rate comparisons are posted on www.hospitalcompare.hss.gov as public indicators of hospital quality; and provisions in health care reform legislation will soon mean that hospitals will not receive payment for many readmissions within 30 days of discharge.. Targeted transitional programs and better coordination of care between inpatient and outpatient settings have the potential to reduce hospital ...
There has been a relentless increase in emergency medical admissions in the UK over recent years. Many of these patients suffer with chronic conditions requiring continuing medical attention. We wished to determine whether conventional outpatient clinic follow up after discharge has any impact on the rate of readmission to hospital. Two consultant general physicians with the same patient case-mix but markedly different outpatient follow-up practice were chosen. Of 1203 patients discharged, one consultant saw twice as many patients in the follow-up clinic than the other (Dr A 9.8% v Dr B 19.6%). The readmission rate in the twelve months following discharge was compared in a retrospective analysis of hospital activity data. Due to the specialisation of the admitting system, patients mainly had cardiovascular or cerebrovascular disease or had taken an overdose. Few had respiratory or infectious diseases. Outpatient follow-up was focussed on patients with cardiac disease. Risk of readmission increased
Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the numbers of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings.
NQF will conduct an ad hoc review requested by the Centers for Medicare and Medicaid Services for the endorsed measures: 1551, hospital-level 30-day all-cause risk-standardized readmission rate following elective primary total hip arthroplasty and total knee arthroplasty; 0330, hospital 30-day all-cause risk-standardized readmission rate following heart failure hospitalization for patients 18 and older; and 0505, hospital 30-day all-cause risk-standardized readmission rate following acute myocardial infarction hospitalization. This review is being completed due to material changes to a currently endorsed measure (eg, expansion of a measure to a different population or setting). This is intended as a focused review of the planned readmission algorithms that have been incorporated into each of the condition/procedure specific readmission measures. ...
People discharged from hospital with heart failure have relatively poor outcomes. In this study, just over one in ten patients died before discharge, and of those discharged, 4% died within a month and one in five had an unplanned readmission. While unplanned readmission and post-discharge mortality rates did vary across hospitals, in our study this between-hospital variation did not account for a significant proportion of the total variation in outcomes once individual patient characteristics were accounted for. A range of patient characteristics were associated with a higher risk of unplanned readmission, including being male, prior hospitalisation for cardiovascular disease and for anemia, comorbidities at the time of admission, lower BMI and lower social interaction scores. Similarly, risk of 30-day mortality was associated with patient-level factors, in particular age and comorbidity.. Heart failure is one of the most common underlying medical conditions in patients readmitted to hospital ...
A hospitals quality of care with surgical procedures affects unplanned readmission rates. Those with high volume or low mortality rates have fewer readmissions.
BACKGROUND: Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adverse event. We aimed to establish the probability, time-distribution and predictability of unplanned rehospitalisation within 30 days of discharge in a population of French preterm babies. METHODS: This study used data from EPIPAGE 2, a population-based prospective study of French preterm babies. Only those babies discharged home alive and whose parents responded to the one-year survey were eligible for inclusion in our study. For Kaplan-Meier analysis, the outcome was unplanned rehospitalisation censored at 30 days. For predictive modelling, the outcome was binary, recording unplanned rehospitalisation within 30 days of discharge. Predictors included
Reducing hospital readmissions is a major patient safety priority. The Centers for Medicare and Medicaid Services policy of nonpayment for readmissions for certain conditions has decreased their incidence. However, the impact of this policy on 30-day postdischarge mortality remains unknown.
Harrisburg, PA - December 17, 2014 - In-hospital mortality rates decreased significantly statewide between 2008 and 2013 for eight of the 16 illnesses for which mortality was reported in the 2013 Hospital Performance Report (HPR), released today by the Pennsylvania Health Care Cost Containment Council (PHC4). The sharpest decrease was in Septicemia, where the mortality…
When a patient is treated at a hospital and released she should know exactly what medications and continued care shell need. If shes underinsured or uninsured, she should be connected to nearby free clinics and drug assistance programs. These are just a few ways to help prevent her…. Maine news, sports, politics, election results, and obituaries from the Bangor Daily News.
Results:. After adjustment was made for demographic characteristics, severity of illness, and need for care, adherence scores correlated with early unplanned readmission (P , 0.05). For patients with diabetes and heart failure, decreased readiness-for-discharge adherence scores correlated with increased risk for readmission (P = 0.001 and P = 0.016, respectively). In patients with obstructive lung disease, decreased admission-workup scores correlated with increased risk for readmission (P = 0.013). One of 7 readmissions in patients with diabetes, 1 of 5 readmissions in patients with heart failure, and 1 of 12 readmissions in patients with obstructive lung disease were attributable to substandard care. ...
Background: Randomized clinical trials and observational studies have demonstrated the effect of multidisciplinary teams on heart failure readmissions. We report on the effect of heart failure trained nurses (Heart Failure Advocates) on readmission risk and costs during readmissions.. Methods and Results: Catholic Healthcare Partners (CHP) placed Heart Failure Advocates at 2 hospitals as part of an AHRQ funded initiative. Readmission rates and LOS at these 2 hospitals in Heart Failure Advocate supervised populations (n=311) versus usual care (control, n=716) were compared. Both populations were identified using ICD-9 codes designating patients admitted for heart failure. The Heart Failure Advocate supervised patients were tracked for readmission occurring after their enrollment date (first post-hospital contact). Control patients were tracked for readmission after the first admission during the time frame. All admissions for 2004 and 2005 at the 2 hospitals were used for analysis. The ...
Nearly one-quarter of patients hospitalized with heart failure and one-third of patients hospitalized with acute myocardial infarction (AMI) are readmitted within 30 days of discharge, despite evidence that a substantial portion of readmissions may be preventable. While these and other readmissions increase Medicare costs by an estimated $17 billion per year, little is known about the extent to which hospitals have employed recommended strategies to reduce readmission risk. As part of a Commonwealth Fund-supported study, researchers surveyed more than 500 U.S. hospitals to determine their use of 10 practices associated with lower readmission rates.. ...
... Ann Thorac Surg. 2019 Nov 07;: Authors: Barnett SD, Sarin E, Kiser AC, Ailawadi G, Hawkins RB, Mehaffey JH, Tyerman Z, Rich JB, Quader MA, Speir AM Abstract BACKGROUND: Readmissions cost an estimated $41 billion in the United States each year. To address this, a single institution recently...
Research has revealed that the use of electronic discharge orders helped increase compliance with quality care measures and lowered hospital readmission rates in heart failure patients.
Background Center failure may be the leading trigger for 30-time all-cause readmission, the reduced amount of which really is a objective from the Affordable Treatment Action. all-cause mortality (HR, 0.56; 95% CI, 0.33C0.98; p=0.041) and of the combined endpoint of 30-time all-cause readmission or 30-time all-cause mortality (HR, 0.73; 95% CI, 0.56C0.94; p=0.017). All organizations continued to be significant at 1-season post-discharge. Conclusions Among hospitalized sufferers with heart failing and decreased ejection fraction, the usage of ACEI-ARBs was connected with a considerably lower threat of 30-time all-cause readmission and 30-time all-cause mortality; both helpful organizations persisted during long-term follow-up. solid course="kwd-title" Keywords: ACEI or ARB, center failure, medical center readmission Center failure may be the leading reason behind hospital entrance and readmission for Medicare beneficiaries aged 65 years and old in america.1 The 2010 Individual Protection and ...
Are you effectively reducing hospital readmission rates for your heart failure patients? You need to - or pay a penalty. These 4 steps will help reduce rates…
The duration of birth hospitalization correlates with gestational age at birth.47,48 Among 235 LPTs at 1 birth center, the length of the birth hospitalization (mean ± SD) was 12.6 ± 10.6 days at 34 weeks gestation, 6.1 ± 5.8 days at 35 weeks gestation, and 3.8 ± 3.6 days at 36 weeks gestation. The usual hospital stay for a term infant is 2 days for a vaginal delivery and 3 days for a cesarean delivery. In addition, hospital readmission rates are increased for LPT (3.5%) versus term (2.0%) infants.49 Even among infants who were never in a NICU, the readmission rate was threefold higher in LPT than in term infants.50 Many LPT infants are discharged early but require readmission for jaundice, feeding problems, respiratory distress, and proven or suspected sepsis because of physiologic and metabolic immaturity.. Early discharge among LPT infants affected by discharge criteria established for term infants show an increase in morbidities. In statewide data from Massachusetts, all state-resident ...
Acute and post-acute providers are increasingly uniting around a shared goal - to lower hospital readmission rates for elderly and other vulnerable patients. Many caregivers and payers agree that readmission rates are unacceptably high.
Learn about Spine Center Quality and Safety data, including spine center patients who had unplanned readmissions to BIDMC within 30 days of discharge.
By Lynn Razzano, RN, MSN, ONCC A recently published study, December 2013, on preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries looked at the proportion of post stroke readmissions that are potentially preventable or avoidable. This continues to remain unknown. Preventable readmissions were identified based on 14 Prevention Quality Indicators developed for…
TY - JOUR. T1 - Hospital readmission among new dialysis patients associated with young age and poor functional status. AU - Hickson, Latonya J.. AU - Thorsteinsdottir, Bjorg. AU - Ramar, Priya. AU - Reinalda, Megan S.. AU - Crowson, Cynthia S.. AU - Williams, Amy W.. AU - Albright, Robert C.. AU - Onuigbo, Macaulay A.. AU - Rule, Andrew D.. AU - Shah, Nilay D.. PY - 2018/4/1. Y1 - 2018/4/1. N2 - Background/Aims: Over one-Third of hospital discharges among dialysis patients are followed by 30-day readmission. The first year after dialysis start is a high-risk time frame. We examined the rate, causes, timing, and predictors of 30-day readmissions among adult, incident dialysis patients. Methods: Hospital readmissions were assessed from the 91st day to the 15th month after the initiation of dialysis using a Mayo Clinic registry linkage to United States Renal Data System claims during the period January 2001-December 2010. Results: Among 1,727 patients with ≥1 hospitalization, 532 (31%) had ≥1, ...
The Particulars: Some studies suggest that the 30-day readmission rate for patients with heart failure (HF) is as high as 25%. Excess HF readmissions now come with financial penalties from CMS. A nurse-based home telemonitoring program may be a cost-effective approach to reducing readmission rates among HF patients.. Data Breakdown: For a study, HF patients were randomized to usual care or a telemonitoring program that consisted to two home visits by a nurse. The home visits focused on HF education and used home telemonitoring equipment. The equipment transmitted daily vital signs, weight, and pulse oximetry readings for 3 months. The All-cause readmission rate was 12.5% for the telemonitoring group, compared with a 27.5% rate observed in the usual care group. Respective HF 30-day readmission rates were 2.5% for those receiving telemonitoring and 10% for those receiving usual care. The telemonitoring program costs about $51,000, which is less expensive than the estimated $183,500 that comes with ...
Little is known about the etiology of hospitalizations among HF patients. Fang et al. (21) examined hospitalizations from the National Hospital Discharge Survey from 1979 through 2004. They found that the proportion of hospitalizations with HF as a first-listed diagnosis remained at approximately 30% over the study period. However, there was a decline in the proportion of admissions due to coronary or other cardiovascular diseases, and an increase in the proportion due to noncardiovascular diseases. Curtis et al. (8) examined hospital readmission rates among Medicare beneficiaries hospitalized with HF from 2001 through 2005 and found that approximately 27% of readmissions were due to HF. This analysis did not include patients without a prior HF hospitalization and only examined the first readmission, and thus cannot provide information on the total burden of hospitalizations. To date, the cause of hospitalization among community HF patients, and potential temporal changes, remain unclear.. The ...
Purpose: The aim of this study is to assess the effect of comorbidities on risk of readmission to an intensive care unit (ICU) and the excess hospital mortality associated with ICU readmissions.. Materials and Methods: A cohort study used clinical data from a 22-bed multidisciplinary ICU in a university hospital and comorbidity data from the Western Australian hospital morbidity database.. Results: From 16 926 consecutive ICU admissions between 1987 and 2002, and 654 (3.9%) of these patients were readmitted to ICU readmissions within the same hospitalization. Patients with readmission were older, more likely to be originally admitted from the operating theatre or hospital ward, had a higher Acute Physiology and Chronic Health Evaluation (APACHE)-predicted mortality, and had more comorbidities when compared with patients without readmission. The number of Charlson comorbidities was significantly associated with late readmission (,72 hours) but not early readmission (≤72 hours) in the ...
Objective to build up and validate the Drug Derived Difficulty Index (DDCI), a predictive model derived from drug prescriptions able to stratify the general population according to the risk of death, unplanned hospital admission, and readmission, and to compare the new predictive index with the Charlson Comorbidity Index (CCI). was compared to the CCI in terms of calibration, discrimination and reclassification. Setting 6 local health government bodies with 2.0 million citizens aged 40 years or above. Results One year and overall mortality rates, unplanned hospitalization rates and hospital readmission rates gradually improved with increasing ABT-737 DDCI score. In the overall human population, the model including age, gender and DDCI showed a high overall performance. DDCI expected 1-yr mortality, general mortality and unplanned hospitalization with an precision of 0.851, 0.835, and 0.584, respectively. If in comparison to CCI, DDCI demonstrated reclassification and discrimination properties ...
Using the Model for Improvement, our study demonstrated a reduction in ,48-hour readmissions to the CICU after the development and testing of a new care process practice bundle. Our study demonstrated that the bundle was sustainable in a busy tertiary paediatric cardiology setting, and that it led to a significant decrease in the frequency of these clinically important events without interfering with other quality outcome metrics, such as LOS or rapid clinical decompensation.. It is recognised that in-hospital readmission to the ICU has been associated with increased LOS, increased cost and increased mortality. Previous studies have focused primarily on identifying factors or conditions associated with increased risk of readmission to the ICU, the effect on mortality or to identify all-cause hospital readmissions.1 4 6 12 13 Despite the negative effects of in-hospital ICU readmission, reports of system modifications to prevent these events are limited. Our efforts were instead focused on ...
Our results suggest that attendings, residents, and nurses perform as well as the LACE index, an industry-standard and widely utilized prediction tool, in predicting 30-day hospital readmissions. The AUC for the LACE index in our population of 0.620 (95% CI 0.521, 0.718) was qualitatively consistent with the originally reported LACE index c-statistic of 0.684 (95% CI 0.679-0.691) [13]. Clinicians performed just as well, with AUCs that were higher but not statistically different from the LACE index. These results conflict with a previous report, in which neither providers nor the risk model that was assessed (the Pra) were able to outperform chance in predicting 30-day readmissions [7]. We cannot know with certainty what accounts for the difference in our results, but possibilities include the difference in our patient population, including our inclusion of clinicians predictions for patients over age 18 instead of only for patients over age 65; as well as the approximately 7 years that elapsed ...
A bigger proportion of stroke patients were readmitted to hospital as an emergency case in 2010/11 compared to 2001/02, new figures show. Twelve in every 100 stroke patients (12 percent, or 6,770 out of 56,440) were readmitted as an emergency … Read more → - Emergency hospital readmission rates among stroke patients now higher than in 2001/02. ...
BG medicine is hopeful that data from two studies published earlier this year will help shore up the scientific foundation for the companys new strategy of marketing its galectin-3 test to hospitals as a tool for reducing unplanned readmissions.
The treatment of advanced wounds is expensive and often complicated, says Patricia Burns, vice president of clinical affairs for Smith & Nephew. Fortunately, advances in technology, as well as a focus on treating patients in the home, can help save the health care system money, and make treatment easier on the patient, she told HME News recently.. HME News: What are some of the economic costs associated with wound care?. Patricia Burns: Significant dollars are spent on wound care and those costs increase when there are complications. Someone might have a routine surgical procedure and if they develop a post-op infection, that can add significantly to the cost of managing the wound, whether it be through re-admission or delayed healing. HME: Health care reform is pushing for a reduction in hospital readmission rates. Is wound care an area in which this works?. Burns: Certainly. Efforts to reduce pressure are a quality indicator now, and are reported publicly. Going forward, payers are not going ...
Provide your members with support from a registered nurse to help reduce hospital readmission rates and increase healthy outcomes.
Background: Readmissions for ACS are common, costly, and potentially preventable. According to Medicare 13.4% of AMI admissions were followed by a rehospitalization within 15 days. A 2007 MedPAC report declared 76% of 30-day readmissions preventable. These rates are used as quality indicators despite lack of consensus on the definition of avoidable and unavoidable readmissions. We sought to define these terms and to analyze the effect of these definitions on 30-day outcomes.. Methods: BRIDGE (Bridging the Discharge Gap Effectively) is an NP-led transitional care program for cardiac patients within 14 days of discharge. Retrospective data were abstracted on ACS patients readmitted before their appointments between 2008-2010. All readmissions were characterized as avoidable or unavoidable. Definitions were developed from the literature and in concert with senior cardiologists. Avoidable readmission was defined as being the result of a patient or provider issue that if managed may have prevented ...
Epidemiological studies have established that approximately one-half of all patients with congestive heart failure have a preserved ejection fraction (HFpEF). This syndrome predominantly afflicts older hypertensive individuals. The prevalence of HFpEF is increasing (1), paralleling the demographic shift in the population toward older age. Although HFpEF was previously thought to have a more favorable course than heart failure with reduced ejection fraction (HFrEF), recent studies have shown that the mortality rate (1), the hospital readmission rate (2), and the economic cost (3) of HFpEF rival those of HFrEF.. The rate of morbidity and mortality of patients with HFrEF has gradually improved during the past 2 decades, reflecting the impact of several evidence-based interventions that have been incorporated into the care of patients with chronic HFrEF. In contrast, the prognosis of patients with HFpEF has remained steadfastly unchanged during the same time period (1), reflecting the dearth of ...
A "30-day readmission" happens when a patient who had a recent hospital stay needs to go back to the hospital within 30 days of hospital discharge for the same problem. This chart tells you how well Guthrie Robert Packer Hospital did at preventing 30-day readmissions for heart attack, heart failure, and pneumonia patients when compared to other hospitals across the U.S.. This chart take into account how sick a patient was when they were admitted to the hospital. ...
Healthcare and social services encompass hospital medical care, outpatient care provided by physicians, urgent care, elderly and hospice care, dental work, and social assistance. About 75 percent of U.S. hospitals in this industry sector are not-for-profit institutions. New regulatory requirements require hospitals to decrease their hospital readmission rates to cut Medicare costs or face financial penalties. Implementation of electronic health records (EHRs) are expected to help control costs through efficiency. Cost containment is a priority for healthcare organizations.. The general rule of business is to control costs, increase revenues, and maximize profit. As revenues increase, the tendency of businesses it to add workers, purchase technology, and increase inventories. However, many companies grow themselves out of business by diverting cash into fixed assets and inventory investments in anticipation of expanding sales.. One way to avoid this situation is to reduce and control ...
The study by Stewart et al provides important support for home focused interventions by nurses and clinical pharmacists. The authors used a mix of medical and surgical patients so the results potentially apply to most elderly adults in hospital. A combined end point of unplanned hospital readmissions plus out of hospital deaths was used as the main outcome, but the study also measured the duration of unplanned readmissions, emergency visits, provider visits, and costs. This was a relatively simple, inexpensive intervention. From a clinical perspective, this programme is easy to do. Indeed, the comprehensive assessment of the patient, patient teaching, and nurse-primary provider contact are already part of home health nursing. The difference was the medication management assessment and teaching by a pharmacist and the close coordination between inpatient teaching and the home visit. The costs for this programme were not prohibitive. How costs are calculated may be the deciding factor in ...
From hospital readmission rates and simulation training to family planning for rural women and pediatric triage assessment, the scope of work undertaken by students at the Betty Irene Moore School of Nursing at UC Davis ranges from clinical to community, from birth to end of life. Gaduate students pursuing doctoral and master’s degrees present their scholarly work at the 2015 Academic Symposium, June 5 on the UC Davis Sacramento campus.
Background: Readmission after hospital discharge is common in patients with acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Although frailty predicts hospital readmission in patients with chronic nonpulmonary diseases, no multidimensional frailty measures have been validated to stratify the risk for patients with COPD. Aim: The aim of this study was to explore multidimensional frailty as a potential risk factor for readmission due to a new exacerbation episode during the 90 days after hospitalization for AE-COPD and to test whether frailty could improve the identification of patients at high risk of readmission. We hypothesized that patients with moderate-to-severe frailty would be at greater risk for readmission within that period of follow up. A secondary aim was to test whether frailty could improve the accuracy with which to discriminate patients with a high risk of readmission. Our investigation was part of a wider study protocol with
We present an in-patient 30-day risk-adjusted all-cause readmission model for pneumonia patients that can be used in performance measurement and quality improvement at a similar tertiary care hospital. We included 956 subjects hospitalized for pneumonia, who showed a 30-day readmission rate of 15.5%. Our model identified 7 variables as significant risk factors for pneumonia 30-day all-cause readmissions. Some of these factors confirm previous findings, and other are newly reported. In addition, 3 significant risk factors associated were revealed in the pneumonia-related 30-day readmission model, and 4 risk factors were associated with pneumonia-unrelated readmissions. The measure of hospital utilization was significant, regardless of the model outcome.. We chose to select baseline variables for univariate analysis from the CMS Medical Record risk-adjusted model for pneumonia readmissions6 because we were using a similar patient population with identical inclusion/exclusion criteria, were ...
A widely cited statistic in the national readmissions debate holds that one in five acute hospital discharges will lead to a readmission within 30 days.1 Associated costs are estimated at $17.5 billion, although that figure encapsulates significant variation across diagnoses, regions, and hospital models.1 Analyses by CMS and others suggest that average 30-day readmission rates have been falling, albeit slowly, to 17.8% during the fourth quarter of 2012 after averaging 19% over the previous five years, according to Congressional testimony by Medicare Director Jonathan Blum in February 2013.2. CMS calculates "excessive readmissions rates" for subsequent hospital admissions to the same or a different hospital for specific diagnoses within 30 days of discharge, risk-adjusted for planned and unrelated readmissions using methodology endorsed by the National Quality Forum. Based on the hospitals rate of actual to expected readmissions, HRRP penalties are applied to all Medicare-based ...
Ashish Jha had a double header in the NEJM last week - he also had an editorial suggesting that the emphasis on preventing hospital readmissions might be misdirected. Hospital readmissions are staggering in the US Medicare population (almost one in five in 30 days). However, readmissions are much lower in those under 65. Further, Jha points to a literature review from the Canadian Medical Association Journal (The JAMA of the North) that showed that with clinical record review less than 12% of readmissions were judged to be preventable. Overall only 2.2% of discharges led to a preventable readmission in this literature review. Jha points out that penalties for high readmission rates could inadvertently penalize hospitals with lower mortality rates (who discharge patients who are by definition sicker). Emphasizing the "wrong" measure draws our attention from other areas that may lead to better outcomes or more cost savings ...
I think we were all really happy to see this paper because its really well done and it confirms what our gut feeling was as hospitalists-that the readmissions rate falling wasnt linked to the increase in the use of observation stays," says Ann Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health and member of SHMs Public Policy Committee. "The paper definitively shows that hospitals are not gaming the system to avoid readmission penalties." Potentially avoidable hospital readmissions within 30 days of discharge were estimated in 2009 to cost Medicare more than $17 billion annually and are considered a mark of poor-quality care.2 The ACA established HRRP to penalize hospitals with higher-than-expected 30-day readmission rates for several targeted conditions: heart failure, pneumonia, COPD, acute myocardial infarction, total hip and knee replacement, and coronary artery bypass graft surgery. "Readmission rates had been rock stable for years and ...
Hospitals account for nearly $1 trillion (~30%) of US health care spending. Preventing avoidable hospital readmissions is considered a key opportunity for reduc...
Issue: The Affordable Care Act, ACA Section III, encourages development of new transitional care models linking hospital reimbursements to improved quality, efficiency, and transparency in care delivery. Unplanned readmissions, a quality indicator, are costly under ACA and on the forefront of the Joints Commission effort to advance data utilization and improve care to stroke patients through the Comprehensive Stroke Center (CSC) certification requirements. Follow- up phone calls to patients discharged home from the hospital within seven days are embedded in the above requirements and can be a valuable tool in reducing unplanned readmissions and in improving support to stroke patients with complex psychosocial and medical needs.. Purpose: Phone calls initiated by a Nurse Practitioner (NP) to stroke patients after discharge to home in our CSC aimed at increased medication compliance, avoidable readmission rate monitoring, and comparison of outcomes to those reported in the literature. In ...