Journal articles on the topic 'Post-discharge healthcare'
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Chun Fat, Shelby, Juan P. Herrera-Escobar, Anupamaa J. Seshadri, Syeda S. Al Rafai, Zain G. Hashmi, Elzerie de Jager, Constantine Velmahos, et al. "Racial disparities in post-discharge healthcare utilization after trauma." American Journal of Surgery 218, no. 5 (November 2019): 842–46. http://dx.doi.org/10.1016/j.amjsurg.2019.03.024.
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Nelson, Richard E., Makoto Jones, Chuan-Fen Liu, Matthew H. Samore, Martin E. Evans, Nicholas Graves, Bruce Lee, and Michael A. Rubin. "The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus Aureus Infections on Post-Discharge Healthcare Costs and Utilization." Infection Control & Hospital Epidemiology 36, no. 5 (February 26, 2015): 534–42. http://dx.doi.org/10.1017/ice.2015.22.
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OBJECTIVEHealthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization.METHODSOur study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge.RESULTSOur full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008).CONCLUSIONSThe results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.Infect Control Hosp Epidemiol 2015;00(0): 1–9
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Bernard, Jennifer R., Eileen L. Creel, and Rhonda K. Pecoraro. "Care transition from rehabilitation to home: A QI project using the RED Toolkit to decrease readmission rates." Journal of Hospital Administration 10, no. 1 (March 17, 2021): 46. http://dx.doi.org/10.5430/jha.v10n1p46.
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Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.
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Elman, Miriam R., Craig D. Williams, David T. Bearden, John M. Townes, John D. Heintzman, Jodi A. Lapidus, Ravina Kullar, et al. "Healthcare-associated urinary tract infections with onset post hospital discharge." Infection Control & Hospital Epidemiology 40, no. 8 (June 20, 2019): 863–71. http://dx.doi.org/10.1017/ice.2019.148.
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AbstractObjective:Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design:Retrospective cohort study.Setting:Academic, quaternary care, referral center.Patients:Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods:Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results:We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).Conclusions:HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.
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Livorsi, Daniel J., Jade Feller, Brian Lund, Bruce Alexander, Rajeshwari Nair, Brice Beck, Michihiko Goto, Brett Heintz, and Eli N. Perencevich. "2892. The Relationship Between Inpatient and Post-discharge Antimicrobial Use at the Hospital-level Across an Integrated Healthcare Network." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S79—S80. http://dx.doi.org/10.1093/ofid/ofz359.170.
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Abstract Background Hospital-based antimicrobial stewardship interventions and metrics have typically focused only on inpatient antimicrobial exposure. However, single-center studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. We sought to describe antimicrobial-prescribing upon hospital discharge across the Veterans Health Administration (VHA) and to compare inpatient and post-discharge antimicrobial use at the hospital-level. Methods This retrospective study used national VHA administrative data to identify all acute-care admissions from January 1, 2014 to December 31, 2016. Post-discharge antimicrobials were defined as oral outpatient antimicrobials prescribed at the time of hospital discharge. We measured inpatient-days of therapy (DOT) and post-discharge DOTs. At the hospital-level, inpatient DOTs per 100 admissions were compared with post-discharge DOTs per 100 admissions using Spearman’s rank-order correlation. Results Among 1.7 million acute-care admissions across 122 VHA hospitals, 46.1% were administered inpatient antimicrobials and 19.9% were prescribed an oral antimicrobial at discharge. Fluoroquinolones were the most common antimicrobial prescribed at discharge among 335,396 antimicrobial prescriptions (38.3%). At the hospital-level, median inpatient antimicrobial use was 331.3 DOTs per 100 admissions (interquartile range (IQR) 284.9–367.9) and median post-discharge use was 209.5 DOTs per 100 admissions (IQR 181.5–239.6). Thirty-nine percent of the total duration of antimicrobial exposure occurred after hospital discharge. The metrics of inpatient DOTs per 100 admissions and post-discharge DOTs per 100 admissions were weakly correlated at the hospital-level (rho = 0.44, P < 0.0001). Conclusion Antimicrobial-prescribing at hospital discharge was common and contributed substantially to the total antimicrobial exposure associated with an acute-care hospital stay. A hospital’s inpatient antimicrobial use was only weakly correlated with its post-discharge antimicrobial use. Antimicrobial stewardship interventions should specifically target antimicrobial-prescribing at discharge. Disclosures All Authors: No reported Disclosures.
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Shrestha, Shikhar, Melissa H. Roberts, Jessie R. Maxwell, Lawrence M. Leeman, and Ludmila N. Bakhireva. "Post-discharge healthcare utilization in infants with neonatal opioid withdrawal syndrome." Neurotoxicology and Teratology 86 (July 2021): 106975. http://dx.doi.org/10.1016/j.ntt.2021.106975.
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Patel, Rupalee, Matthew Nudelman, Adebola Olarewaju, Sunshine Weiss Pooley, Priya Jegatheesan, Dongli Song, and Balaji Govindaswami. "Homecare and Healthcare Utilization Errors Post–Neonatal Intensive Care Unit Discharge." Advances in Neonatal Care 17, no. 4 (August 2017): 258–64. http://dx.doi.org/10.1097/anc.0000000000000390.
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Paul, Shadae, Kirkby D. Tickell, Ednah Ojee, Chris Oduol, Sarah Martin, Benson Singa, Scott Ickes, and Donna M. Denno. "Knowledge, attitudes, and perceptions of Kenyan healthcare workers regarding pediatric discharge from hospital." PLOS ONE 16, no. 4 (April 23, 2021): e0249569. http://dx.doi.org/10.1371/journal.pone.0249569.
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Objective To assess attitudes, perceptions, and practices of healthcare workers regarding hospital discharge and follow-up care for children under age five in Migori and Homa Bay, Kenya. Methods This mixed-methods study included surveys and semi-structured telephone interviews with healthcare workers delivering inpatient pediatric care at eight hospitals between November 2017 and December 2018. Results The survey was completed by 111 (85%) eligible HCWs. Ninety-seven of the surveyed HCWs were invited for interviews and 39 (40%) participated. Discharge tasks were reported to be “very important” to patient outcomes by over 80% of respondents, but only 37 (33%) perceived their hospital to deliver this care “very well” and 23 (21%) believed their facility provides sufficient resources for its provision. The vast majority (97%) of participants underestimated the risk of pediatric post-discharge mortality. Inadequate training, understaffing, stock-outs of take-home therapeutics, and user fees were commonly reported health systems barriers to adequate discharge care while poverty was seen as limiting caregiver adherence to discharge and follow-up care. Respondents endorsed the importance of follow-up care, but reported supportive mechanisms to be lacking. They requested enhanced guidelines on discharge and follow-up care. Conclusion Kenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality. Pre- and in-service training should incorporate instruction on discharge and follow-up care. Improved post-discharge deaths tracking–e.g., through vital registry systems, child mortality surveillance studies, and community health worker feedback loops–is needed, alongside dissemination which could leverage platforms such as routine hospital-based mortality reports. Finally, further interventional trials are needed to assess the efficacy and cost-effectiveness of novel packages to improve discharge and follow-up care.
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Manoukian, S., S. Stewart, N. Graves, H. Mason, C. Robertson, S. Kennedy, J. Pan, et al. "Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland." Journal of Hospital Infection 114 (August 2021): 51–58. http://dx.doi.org/10.1016/j.jhin.2020.12.026.
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Bebell, L., J. Ngonzi, A. Boatin, and L. Riley. "Post-discharge infections and healthcare contact in ugandan women hospitalized for delivery." American Journal of Obstetrics and Gynecology 217, no. 6 (December 2017): 735. http://dx.doi.org/10.1016/j.ajog.2017.08.026.
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Ang, Ian Yi Han, Chuen Seng Tan, Milawaty Nurjono, Xin Quan Tan, Gerald Choon-Huat Koh, Hubertus Johannes Maria Vrijhoef, Shermin Tan, Shu Ee Ng, and Sue-Anne Toh. "Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore." BMJ Open 9, no. 5 (May 2019): e027220. http://dx.doi.org/10.1136/bmjopen-2018-027220.
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ObjectiveTo evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.DesignA retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.SettingThe National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.ParticipantsLinked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.InterventionsFor both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients’ post-discharge.Primary outcome measuresOne-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.ResultsPatients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.ConclusionsBoth NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.
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Nelson, Richard E., Makoto Jones, Chuan-Fen Liu, Matthew Samore, Martin Evans, Nicholas Graves, Bruce Lee, and Michael Rubin. "296The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization." Open Forum Infectious Diseases 1, suppl_1 (2014): S123—S124. http://dx.doi.org/10.1093/ofid/ofu052.162.
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Changsuphan, Supattra, Puangpaka Kongvattananon, and Chomchuen Somprasert. "Patient readiness for discharge after total hip replacement: an integrative review." Journal of Health Research 32, no. 2 (March 12, 2018): 164–71. http://dx.doi.org/10.1108/jhr-01-2018-016.
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Purpose The purpose of this paper is to reduce or eliminate pain while enabling full advantage and function of daily living activities after hospital discharge. Readiness for discharge depends largely on prior healthcare team preparations for both patients and their families. Design/methodology/approach This integrative review was conducted using the Whittemore and Knafl method, and synthesized published research concerning patients’ readiness for discharge, particularly those who had undergone total hip replacement (THR) surgery. Findings Results were categorized into five main themes as physiological experiences, psychological experiences, coping ability, needs from the healthcare team, and family support influential to the readiness of THR patients for discharge. Originality/value The preparation for discharge of THR patients should be fully engaged and addressed. Moreover, healthcare professionals should provide care for patients at both the pre- and post-operation phases as well as during the transitional phase from hospital to home.
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Fisher, Morgan, Amber Cardoza, Autumn Gordon, Molly Howard, Lynsey Neighbors, and Addison Ragan. "Enhancing Clinical Pharmacy Specialist Involvement in Transitions of Care Focusing on Ambulatory Care Sensitive Conditions within a Veterans Affairs Healthcare System." Pharmacy 8, no. 1 (March 22, 2020): 47. http://dx.doi.org/10.3390/pharmacy8010047.
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The purpose of this quality improvement project was to evaluate the impact of clinical pharmacy specialist (CPS) involvement in the post-discharge period on 30-day readmission rates within a Veterans Affairs Healthcare System. Patients eligible for inclusion were discharged from a Veterans Affairs (VA) acute care facility with a principle or secondary diagnosis of heart failure (HF), chronic obstructive pulmonary disease (COPD), or both HF and COPD from 15 October 2018 through 14 January 2019. CPSs functioning as a mid-level provider with a scope of practice conducted telephone and in-clinic medication management appointments within 7 and 21 days post-discharge for qualifying patients discharged with a principle or secondary diagnosis of HF or COPD. CPS appointments focused on medication reconciliation, ensuring continuity of care, disease state counseling, and medication management. By enhancing the role of the CPS in the post-discharge period, there was an observed decrease in 30-day COPD index (p = 0.35), HF index (p = 0.23), and all-cause (p = 0.62) readmission rates from pre- to post-intervention. The results of this intervention show that CPS intervention in the post-discharge period may reduce index and all-cause readmission rates for patients discharged with a principle or secondary discharge diagnosis of COPD or HF.
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Kim, Kibum, Joseph E. Biskupiak, Jennifer L. Babin, and Sabrina Ilham. "Positive Association between Peri-Surgical Opioid Exposure and Post-Discharge Opioid-Related Outcomes." Healthcare 11, no. 1 (December 30, 2022): 115. http://dx.doi.org/10.3390/healthcare11010115.
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Background: Multiple studies have investigated the epidemic of persistent opioid use as a common postsurgical complication. However, there exists a knowledge gap in the association between the level of opioid exposure in the peri-surgical setting and post-discharge adverse outcomes to patients and healthcare settings. We analyzed the association between peri-surgical opioid exposure use and post-discharge outcomes, including persistent postsurgical opioid prescription, opioid-related symptoms (ORS), and healthcare resource utilization (HCRU). Methods: A retrospective cohort study included patients undergoing cesarean delivery, hysterectomy, spine surgery, total hip arthroplasty, or total knee arthroplasty in an academic healthcare system between January 2015 and June 2018. Peri-surgical opioid exposure was converted into morphine milligram equivalents (MME), then grouped into two categories: high (>median MME of each surgery cohort) or low (≤median MME of each surgery cohort) MME groups. The rates of persistent opioid use 30 and 90 days after discharge were compared using logistic regression. Secondary outcomes, including ORS and HCRU during the 180-day follow-up, were descriptively compared between the high and low MME groups. Results: The odds ratios (95% CI) of high vs. low MME for persistent opioid use after 30 and 90 days of discharge were 1.38 (1.24–1.54) and 1.41 (1.24–1.61), respectively. The proportion of patients with one or more ORS diagnoses was greater among the high-MME group than the low-MME group (27.2% vs. 21.2%, p < 0.01). High vs. low MME was positively associated with the rate of inpatient admission, emergency department admissions, and outpatient visits. Conclusions: Greater peri-surgical opioid exposure correlates with a statistically and clinically significant increase in post-discharge adverse opioid-related outcomes. The study findings warrant intensive monitoring for patients receiving greater peri-surgical opioid exposure.
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Liberman, Justin Scott, Lauren R. Samuels, Kathryn M. Goggins, Sunil Kripalani, and Christianne Roumie. "2506 Post-discharge opioid prescriptions and their association with healthcare utilization in the Vanderbilt Inpatient Cohort Study." Journal of Clinical and Translational Science 2, S1 (June 2018): 86. http://dx.doi.org/10.1017/cts.2018.298.
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OBJECTIVES/SPECIFIC AIMS: Opioid prescribing is common and increasing in certain areas of the country with known risk of misuse and dependence. Our study examined the association of opioid prescription at discharge after hospitalization for acute coronary syndrome (ACS) or acute decompensated heart failure (ADHF) with emergency department (ED) care or all-cause readmission, intended healthcare utilization (follow-up with physician within 30 d of discharge and cardiac rehab participation), and all-cause mortality. METHODS/STUDY POPULATION: The Vanderbilt Inpatient Cohort Study is a prospective cohort of hospitalized patients age >18 enrolled with either ACS or ADHF between 2011 and 2015 (index hospitalization). We then excluded those who died during the index hospitalization, patients with hospitalization <24 hours, patients discharged to hospice care, or those who underwent coronary artery bypass surgery because of the high probability of receiving opioids. In addition, we limited the analyses to patients whom we had complete covariate data. The primary predictor variable was an opioid prescription at the time of hospital discharge. We collected healthcare utilization behavior for 90 days after discharge, and mortality data until March 8, 2017. Time-to-event analysis using Cox proportional hazard models was performed for both unintended healthcare utilization behavior and mortality outcomes. Logistic regression was performed for intended healthcare utilization (adherence to follow-up appointments and cardiac rehabilitation). All models were adjusted for demographic data, opioid use prior to index hospitalization, severity of illness, and healthcare utilization prior to the index hospitalization. RESULTS/ANTICIPATED RESULTS: There were 501 patients discharged with an opioid prescription and 1994 with no opioid prescription at discharge. Among patients with opioids at discharge 235 (47%) experienced unplanned healthcare events (71 ED visits and 164 readmissions) and among nonopioids patients 775 (39%) experienced unplanned healthcare events (254 ED visits and 521 readmissions) (aHR: 1.06, 95% CI: 0.87, 1.28). Patient mortality in the opioid group was 131 Versus 432 in the nonopioid group (aHR: 1.08, 95% CI 0.84, 1.39). Patients in the opioid at discharge group were less likely to attend follow up visits or participate in cardiac rehab (OR: 0.69, 95% CI 0.52, 0.91, p=0.009) compared with those not discharged on opioid medications. Sensitivity analysis of patients who were prescribed prehospital opioids (including prehospital opioids in the exposure group with postdischarge opioids) did not reveal a statistically significant increase in mortality (aHR: 1.09, 95% CI 0.91, 1.31) or unintended healthcare utilization (aHR: 1.12, 95% CI 0.89, 1.41) among opioid users. DISCUSSION/SIGNIFICANCE OF IMPACT: Morbidity and mortality related to opioid use is a public health concern. Our study demonstrates a statistically significant reduction in physician follow-up and participation in cardiac rehab among opioid users, both of which are known to decrease patient mortality. We did not find a statistically significant increase in unplanned healthcare utilization or mortality. Sensitivity analysis combining prehospital and posthospital opioid prescriptions did not reveal a statistically significant association between opioid use, hospital readmissions, or mortality. The hospital provides unique patient interactions where providers can make significant medical changes based on their patient’s clinical status. Continuing to understand the association between opioid use, healthcare utilization, morbidity, and mortality in recently hospitalized cardiac patients will provide data to support reduction in total opioid dose to improve clinical outcomes.
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Khayyat, Sarah, Philippa Walters, Cate Whittlesea, and Hamde Nazar. "Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study." BMJ Open 11, no. 3 (March 2021): e043344. http://dx.doi.org/10.1136/bmjopen-2020-043344.
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ObjectivesTo investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home.Design and settingA rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK.MethodsA mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts.ParticipantsAny consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not.ResultsTwenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients’ lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved.ConclusionThere was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services.
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Coffey, Leahy-Warren, Savage, Hegarty, Cornally, Day, Sahm, et al. "Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review." International Journal of Environmental Research and Public Health 16, no. 14 (July 10, 2019): 2457. http://dx.doi.org/10.3390/ijerph16142457.
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Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
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Barreto, Erin F., Diana J. Schreier, Heather P. May, Kristin C. Mara, Alanna M. Chamberlain, Kianoush B. Kashani, Shannon L. Piche, et al. "Incidence of Serum Creatinine Monitoring and Outpatient Visit Follow-Up among Acute Kidney Injury Survivors after Discharge: A Population-Based Cohort Study." American Journal of Nephrology 52, no. 10-11 (2021): 817–26. http://dx.doi.org/10.1159/000519375.
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<b><i>Introduction:</i></b> Acute kidney injury (AKI) affects 20% of hospitalized patients and worsens outcomes. To limit complications, post-discharge follow-up and kidney function testing are advised. The objective of this study was to evaluate the frequency of follow-up after discharge among AKI survivors. <b><i>Methods:</i></b> This was a population-based cohort study of adult Olmsted County residents hospitalized with an episode of stage II or III AKI between 2006 and 2014. Those dismissed from the hospital on dialysis, hospice, or who died within 30 days after discharge were excluded. The frequency and predictors of follow-up, defined as an outpatient serum creatinine (SCr) level or an in-person healthcare visit after discharge were described. <b><i>Results:</i></b> In the 627 included AKI survivors, the 30-day cumulative incidence of a follow-up outpatient SCr was 80% (95% confidence interval [CI]: 76% and 83%), a healthcare visit was 82% (95% CI: 79 and 85%), or both was 70% (95% CI: 66 and 73%). At 90 days and 1 year after discharge, the cumulative incidences of meeting both follow-up criteria rose to 82 and 91%, respectively. Independent predictors of receiving both an outpatient SCr assessment and healthcare visit within 30 days included lower estimated glomerular filtration rate at discharge, higher comorbidity burden, longer length of hospitalization, and greater maximum AKI severity. Age, sex, race/ethnicity, education level, and socioeconomic status did not predict follow-up. <b><i>Conclusions:</i></b> Among patients with moderate to severe AKI, 30% did not have follow-up with a SCr and healthcare visit in the 30-day post-discharge interval. Follow-up was associated with higher acuity of illness rather than demographic or socioeconomic factors.
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Prakash, Aditya M., Qiao-chu He, and Xiang Zhong. "Incentive-driven post-discharge compliance management for chronic disease patients in healthcare service operations." IISE Transactions on Healthcare Systems Engineering 9, no. 1 (January 2, 2019): 71–82. http://dx.doi.org/10.1080/24725579.2019.1567630.
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de Souza, Emília Carolina Oliveira, Sebastião Pires Ferreira Filho, Kasys Meira Gervatauskas, and Carlos Magno Castelo Branco Fortaleza. "Post-discharge impact of healthcare-associated infections in a developing country: A cohort study." Infection Control & Hospital Epidemiology 39, no. 10 (September 7, 2018): 1274–76. http://dx.doi.org/10.1017/ice.2018.201.
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Feller, J., B. C. Lund, E. N. Perencevich, B. Alexander, B. Heintz, B. Beck, R. Nair, M. Goto, and D. J. Livorsi. "Post-discharge oral antimicrobial use among hospitalized patients across an integrated national healthcare network." Clinical Microbiology and Infection 26, no. 3 (March 2020): 327–32. http://dx.doi.org/10.1016/j.cmi.2019.09.016.
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Dyer, April, Elizabeth Dodds Ashley, Deverick J. Anderson, Christina Sarubbi, Rebekah Wrenn, Lauri Hicks, Arjun Srinivasan, and Rebekah W. Moehring. "Inpatient plus Post-discharge Durations of Therapy to Identify Antimicrobial Stewardship Opportunities at Transitions of Care." Open Forum Infectious Diseases 4, suppl_1 (2017): S19—S20. http://dx.doi.org/10.1093/ofid/ofx162.049.
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Abstract Background In-hospital antimicrobial durations capture only a portion of total antimicrobial exposures attributable to that inpatient stay. Review of electronic discharge prescriptions could allow stewards to identify excessive prescribing durations. Methods We performed a retrospective review of inpatient and discharge antimicrobial prescribing at three hospitals from April to September 2016 using two data sources: electronic medication administrations and electronic prescription orders at discharge. Antimicrobial agents from the National Healthcare Safety Network Antimicrobial Use (NHSN AU) module were included. Durations were calculated for admissions in which patients received at least one dose of an antimicrobial agent on inpatient units. Intended post-discharge durations were captured in days duration fields or calculated from sig and quantity fields of discharge prescriptions. Post-discharge days and inpatient days were summed to calculate the total duration of therapy resulting from the admission. Descriptive statistics were used to describe inpatient, post-discharge, and total durations. Results Among 45,693 inpatient admissions, NHSN AU antimicrobials were given during 23,447 inpatient admissions (51%) and in electronic discharge prescriptions for 7,442 admissions (16%). Median total duration was 4 days (IQR 2–11) among all patients who received antimicrobials and 12 (IQR 9–17) among those who received discharge prescriptions. Common post-discharge durations were 5, 7, and 10 days (Figure 1). Post-discharge days accounted for 40% (78,195/196,792) of the total days of antimicrobial therapy. The most common discharge agents were ciprofloxacin (14%), amoxicillin/clavulanate (11%), and levofloxacin (8%). Most discharge prescriptions originated from medical (37.1%), surgical (15.6%), and hematology/oncology wards (14.5%). Conclusion Post-discharge days accounted for 40% of antimicrobial days related to inpatient admissions. Common post-discharge durations suggested clinicians were not counting inpatient days when completing discharge orders. Post-discharge days were feasibly captured through electronic prescribing records and could aid in targeting stewardship interventions at transitions of care. Disclosures All authors: No reported disclosures.
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Müller, Katrin, Iris Poppele, Marcel Ottiger, Katharina Zwingmann, Ivo Berger, Andreas Thomas, Alois Wastlhuber, et al. "Impact of Rehabilitation on Physical and Neuropsychological Health of Patients Who Acquired COVID-19 in the Workplace." International Journal of Environmental Research and Public Health 20, no. 2 (January 13, 2023): 1468. http://dx.doi.org/10.3390/ijerph20021468.
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Workers, especially healthcare workers, are exposed to an increased risk for SARS-CoV-2 infection. However, less is known about the impact of rehabilitation on health outcomes associated with post-COVID. This longitudinal observational study examined the changes in physical and neuropsychological health and work ability after inpatient rehabilitation of 127 patients (97 females/30 males; age 21–69 years; Mean = 50.62) who acquired COVID-19 in the workplace. Post-COVID symptoms, functional status, physical performance, neuropsychological health, employment, and work ability were assessed before and after rehabilitation. Group differences relating to sex, professions, and acute COVID status were also analyzed. Except for fatigue, the prevalence of all post-COVID symptoms decreased after rehabilitation. Significant improvements in physical performance and neuropsychological health outcomes were determined. Moreover, healthcare workers showed a significantly greater reduction in depressive symptoms compared to non-healthcare workers. Nevertheless, participants reported poor work ability, and 72.5% of them were still unable to work after discharge from rehabilitation. As most participants were still suffering from the impact of COVID-19 at rehabilitation discharge, ongoing strategies in aftercare are necessary to improve their work ability. Further investigations of this study population at 6 and 12 months after rehabilitation should examine the further course of post-COVID regarding health and work ability status.
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Pereira, Filipa, Marion Bieri, Maria Manuela Martins, María del Río Carral, and Henk Verloo. "Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives." Nursing Reports 12, no. 2 (May 31, 2022): 403–23. http://dx.doi.org/10.3390/nursrep12020039.
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Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults’ medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals’ perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.
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Brandberg, Carina, Mirjam Ekstedt, and Maria Flink. "Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention." BMJ Open 11, no. 7 (July 2021): e046896. http://dx.doi.org/10.1136/bmjopen-2020-046896.
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ObjectivesThe aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.DesignThis is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions.SettingThe RCT was conducted at six wards in two hospitals—one university hospital and one general hospital in Stockholm, Sweden, during 2016–2018.ParticipantsSixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study.InterventionsEach participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed.ResultsSelf-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: ‘Managing a system-centred care’ and ‘Handling the burden of living with multiple illnesses at home post-discharge’.ConclusionsSelf-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs.Trial registration numberNCT02823795.
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Alsallakh, Mohammad, Laura Tan, Richard Pugh, Ashley Akbari, Rowena Bailey, Rowena Griffiths, Ronan A. Lyons, and Tamas Szakmany. "Patterns of Healthcare Resource Utilisation of Critical Care Survivors between 2006 and 2017 in Wales: A Population-Based Study." Journal of Clinical Medicine 12, no. 3 (January 21, 2023): 872. http://dx.doi.org/10.3390/jcm12030872.
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In this retrospective cohort study, we used the Secure Anonymised Information Linkage (SAIL) Databank to characterise and identify predictors of the one-year post-discharge healthcare resource utilisation (HRU) of adults who were admitted to critical care units in Wales between 1 April 2006 and 31 December 2017. We modelled one-year post-critical-care HRU using negative binomial models and used linear models for the difference from one-year pre-critical-care HRU. We estimated the association between critical illness and post-hospitalisation HRU using multilevel negative binomial models among people hospitalised in 2015. We studied 55,151 patients. Post-critical-care HRU was 11–87% greater than pre-critical-care levels, whereas emergency department (ED) attendances decreased by 30%. Age ≥50 years was generally associated with greater post-critical-care HRU; those over 80 had three times longer hospital readmissions than those younger than 50 (incidence rate ratio (IRR): 2.96, 95% CI: 2.84, 3.09). However, ED attendances were higher in those younger than 50. High comorbidity was associated with 22–62% greater post-critical-care HRU than no or low comorbidity. The most socioeconomically deprived quintile was associated with 24% more ED attendances (IRR: 1.24 [1.16, 1.32]) and 13% longer hospital stays (IRR: 1.13 [1.09, 1.17]) than the least deprived quintile. Critical care survivors had greater 1-year post-discharge HRU than non-critical inpatients, including 68% longer hospital stays (IRR: 1.68 [1.63, 1.74]). Critical care survivors, particularly those with older ages, high comorbidity, and socioeconomic deprivation, used significantly more primary and secondary care resources after discharge compared with their baseline and non-critical inpatients. Interventions are needed to ensure that key subgroups are identified and adequately supported.
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Burdette, Samantha, Nathan Handley, Katlin Birchmeier, Atrayee Basu Mallick, Joanne Filicko, and Adam Binder. "Implementation of a post discharge video visit telehealth initiative." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 274. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.274.
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274 Background: Telehealth is increasingly used as a means to influence four domains of healthcare: access, cost, experience, and effectiveness. The medical oncology service at Thomas Jefferson University implemented a post-discharge video visit program for all patients discharged from the Advanced Practice Provider (APP) service following scheduled inpatient chemotherapy. Data were collected to assess clinical interventions that occurred. Barriers to participation in the visits were also assessed. Methods: All patients on the APP service were screened for eligibility for a post discharge video visit. Patients who were eligible (requirements: reliable internet connection, access to a smart device, active patient portal account, English language speaker) had video visits scheduled prior to discharge. Data regarding the visits (including patient demographics, eligibility, patient interest, and interventions performed) were recorded. Results: One hundred forty nine admissions were included in the analysis. Sixty (40.27%) resulted in the scheduling of a post discharge video visit; 37 (61.67%) of these visits were completed. Medication reconciliation/education occurred in 22 encounters (59.46%); symptom management occurred in 17 encounters (45.95%).The most common reason for not completing a visit was the patient not answering the video visit call (17 encounters (73.91%)). Of the 89 encounters in which patients were ineligible or declined, technological barriers were the most common reason for not participating (29.21%), followed by disinterest (17.10%) and non-English speaking (16.85%). Conclusions: While significant barriers to implementation of post-discharge video visits exist, when visits did occur, frequent interventions occurred. Further research to understand and alleviate barriers to telehealth implementation are merited. Care must be taken to avoid creating disparities among patient populations.
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Elmore, Catherine, Alycia Bristol, Lisa Barry, Eli Iacob, Erin Johnson, and Andrea Wallace. "PERCEPTIONS OF DISCHARGE READINESS AND ENGAGEMENT IN DISCHARGE PLANNING FOR SPOUSAL VERSUS NONSPOUSAL CAREGIVERS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 228–29. http://dx.doi.org/10.1093/geroni/igac059.909.
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Abstract Informal caregivers are frequently excluded during hospital discharge planning, potentially impacting their ability to effectively care for older adults at home. Few studies have examined experiences of spousal versus non-spousal caregivers during hospital discharge planning. In a secondary analysis of a mixed-method study, we quantitatively examined how spousal relationships impact caregivers’ (n=266; 51.8% identified as a spouse or partner) scores of patient discharge readiness using the Readiness for Hospital Discharge Scale (RHDS-CG). We then conducted semi-structured interviews with a participant subset (n=23), and analyzed transcribed interviews using content analysis. First, comparing scores on the RHDS-CG, spouses/partners (88.4%) were more likely than non-spouses (75%) to report RHDS scores of 7+ corresponding with moderate to high readiness (X2 (1) = 8.070, p=.005). Among those interviewed, spouses/partners (65.2%) described their role as long-term, and shared strategies they had learned over time regarding how to seek involvement with healthcare professionals (HCPs). In contrast, non-spousal caregivers (34.8%) viewed their role as short term and struggled with how to communicate with HCPs, citing patient privacy rules and patient autonomy as perceived barriers. Overall, spousal caregivers had more experience with the healthcare system and felt better prepared to assume post-discharge care duties. Exploring the experiences of non-spousal caregivers, which make up more than one-third of our sample, is important since caregiving roles shift away from spouses to adult children and others as people age. Further consideration is necessary regarding how to support non-spousal caregivers in navigating the healthcare system.
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Keeves, Jemma, Sandra C. Braaf, Christina L. Ekegren, Ben Beck, and Belinda J. Gabbe. "Access to Healthcare Following Serious Injury: Perspectives of Allied Health Professionals in Urban and Regional Settings." International Journal of Environmental Research and Public Health 18, no. 3 (January 29, 2021): 1230. http://dx.doi.org/10.3390/ijerph18031230.
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Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients’ long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.
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Ray, Emily Miller, Richard F. Riedel, Christel N. Rushing, and Anthony N. Galanos. "Healthcare utilization among cancer patients prior to hospice." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 135. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.135.
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135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration. Methods: We conducted a retrospective cohort study of hospitalized patients on the solid tumor unit at DUMC who were discharged to hospice care between September 1, 2009-June 30, 2010 (pre-PC integration) and September 1, 2011-June 30, 2012 (post-PC integration). Cohorts were compared on the following outcome variables occurring within 30 days prior to discharge to hospice: number of hospitalizations, ICU days, ED visits, invasive procedures, subspecialty consultations, radiologic studies, medical oncology clinic visits, and use of chemotherapy or radiation. Wilcoxon rank-sum and Chi square tests were used for statistical analyses. Results: A total of 296 patients were included (133 pre-PC integration; 163 post-PC integration) in the analyses. Patient characteristics were well matched between cohorts. The overall mean age was 63 years (range 25-96), 62% were Caucasian, 51% were male, and 98% of patients had recurrent or metastatic disease. Of particular note, there were no significant differences noted between cohorts with regards to the resource utilization outcome variables assessed. Conclusions: Understanding healthcare utilization in this patient population is of great interest to clinical providers and policymakers alike. While we have previously demonstrated the benefit of integrating palliative care and medical oncology for reducing hospital readmissions and length of stay, this study shows no significant impact of an integrated approach on the utilization of healthcare resources measured within the 30 days prior to discharge to hospice. This may reflect the aggressive approach to management of symptoms for end-of-life patients, which often involves invasive procedures, use of imaging, and other resources to meet their needs.
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Dang, F., P. Habashi, Z. Gallinger, and G. C. Nguyen. "A241 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 118–19. http://dx.doi.org/10.1093/jcag/gwz047.240.
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Abstract Background Hospital readmission rates are high in the IBD population, with 20% of patients readmitted within the same calendar year. Hospital discharge processes are not routinely standardized and deficiencies in the transition of care after discharge puts patients at increased risk of illness, hospital utilization and healthcare cost. In addition to increased healthcare expenditure, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism and infection. Aims We hypothesize that implementing standardized follow-up by an IBD practice nurse and electronic health outcome monitoring through NoviSurvey can reduce the risk of hospital readmission compared to current approaches of hospital discharge alone. Methods This parallel randomized control trial is powered for N=400 and will include patients admitted for an IBD flare without requiring surgical intervention from the gastroenterology service or consulted from general internal medicine. Patients randomized to the control arm are discharged with usual standard of care. Patients in the intervention group will be eligible for usual post-discharge care in addition to organized telephone follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. In addition, these patients will receive bi-weekly correspondence from NoviSurvey to complete a short questionnaire on clinical disease severity and medication adherence. Based on telephone interaction and survey scores, the IBD nurse may arrange readmission or expedited ambulatory visit for high-risk patients. Results 15 patients are currently enrolled into our study, with 7 randomized to the intervention and 8 to the control group. In the control group, 25% of patients were readmitted to hospital within 30 days of discharge and 13% failed to follow their steroid taper. There were no patients in the intervention group who were readmitted to hospital within 30 days and none who failed their steroid taper. In both the control or intervention group, there were no occurrences of deep vein thrombosis within 30 days post-discharge. Conclusions The preliminary findings in our small sample study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates to hospital, better patient satisfaction and better medication adherence. Funding Agencies CCC
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Akhlaghi, Narjes, Dale M. Needham, Somnath Bose, Valerie M. Banner-Goodspeed, Sarah J. Beesley, Victor D. Dinglas, Danielle Groat, et al. "Evaluating the association between unmet healthcare needs and subsequent clinical outcomes: protocol for the Addressing Post-Intensive Care Syndrome-01 (APICS-01) multicentre cohort study." BMJ Open 10, no. 10 (October 2020): e040830. http://dx.doi.org/10.1136/bmjopen-2020-040830.
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IntroductionAs short-term mortality declines for critically ill patients, a growing number of survivors face long-term physical, cognitive and/or mental health impairments. After hospital discharge, many critical illness survivors require an in-depth plan to address their healthcare needs. Early after hospital discharge, numerous survivors experience inadequate care or a mismatch between their healthcare needs and what is provided. Many patients are readmitted to the hospital, have substantial healthcare resource use and experience long-lasting morbidity. The objective of this study is to investigate the gap in healthcare needs occurring immediately after hospital discharge and its association with hospital readmissions or death for survivors of acute respiratory failure (ARF).Methods and analysisIn this multicentre prospective cohort study, we will enrol 200 survivors of ARF in the intensive care unit (ICU) who are discharged directly home from their acute care hospital stay. Unmet healthcare needs, the primary exposure of interest, will be evaluated as soon as possible within 1 to 4 weeks after hospital discharge, via a standardised telephone assessment. The primary outcome, death or hospital readmission, will be measured at 3 months after discharge. Secondary outcomes (eg, quality of life, cognitive impairment, depression, anxiety and post-traumatic stress disorder) will be measured as part of 3-month and 6-month telephone-based follow-up assessments. Descriptive statistics will be reported for the exposure and outcome variables along with a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the relationship between the primary exposure and outcome.Ethics and disseminationThe study received ethics approval from Vanderbilt University Medical Center Institutional Review Board (IRB) and the University of Utah IRB (for the Veterans Affairs site). These results will inform both clinical practice and future interventional trials in the field. We plan to disseminate the results in peer-reviewed journals, and via national and international conferences.Trial registration detailsClinicalTrials.gov (NCT03738774). Registered before enrollment of the first patient.
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Mallia, Patrick, Jamilah Meghji, Brandon Wong, Kartik Kumar, Victoria Pilkington, Shaan Chhabra, Ben Russell, et al. "Symptomatic, biochemical and radiographic recovery in patients with COVID-19." BMJ Open Respiratory Research 8, no. 1 (April 2021): e000908. http://dx.doi.org/10.1136/bmjresp-2021-000908.
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BackgroundThe symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described.MethodsRetrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness.Results75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge.ConclusionsPatients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.
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Singh, Jasvinder A., and John D. Cleveland. "How Systemic Sclerosis Affects Healthcare Use and Complication Rates after Total Hip Arthroplasty." Journal of Rheumatology 47, no. 8 (October 15, 2019): 1218–23. http://dx.doi.org/10.3899/jrheum.190783.
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Objective.To assess whether outcomes after primary total hip arthroplasty (THA) differ in systemic sclerosis (SSc).Methods.We used the 1998–2014 US National Inpatient Sample. THA and SSc were identified using procedure and diagnostic codes, respectively. Multivariable-adjusted logistic regression analyses assessed the association of SSc with in-hospital complications (implant infection, revision, transfusion, mortality) post-THA and associated healthcare use (hospital charges, hospital stay, discharge to non-home setting), adjusting for age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis for THA, household income, and insurance payer.Results.Of the 4,116,485 primary THA performed in the United States in 1998–2014, SSc patients made up 0.06% (n = 2672). In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher adjusted OR (95% CI) of the following post-primary THA: (1) non-home discharge, 1.25 (95% CI 1.03–1.50); (2) hospital stay > 3 days, 1.61 (95% CI 1.35–1.92); (3) transfusion, 1.54 (95% CI 1.28–1.84); and (4) in-hospital revision, 9.53 (95% CI 6.75–13.46). Differences in in-hospital mortality had a nonsignificant trend [2.19 (95% CI 0.99–4.86)]. There were no differences in total hospital charges or implant infection rates.Conclusion.SSc was associated with a higher rate of in-hospital complications and healthcare use after primary THA. Future studies should examine whether pre- or postoperative interventions can reduce the risk of post-THA complications in people with SSc.
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Hill, Brent, Seneca Perri-Moore, Jinqiu Kuang, Bruce E. Bray, Long Ngo, Alexa Doig, and Qing Zeng-Treitler. "Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction." Journal of the American Medical Informatics Association 23, no. 6 (May 27, 2016): 1136–42. http://dx.doi.org/10.1093/jamia/ocw019.
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Abstract Objectives First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients’ immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions. Materials and Methods Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73). Results Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions. Discussion Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions. Conclusion It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients’ short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients’ understanding of and interaction with their discharge instructions is improved by the addition of illustrations.
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de Wit, André, John de Heide, Paul Cummins, Ada van Bruchem-van de Scheur, Rohit Bhagwandien, and Mattie Lenzen. "A quality improvement initiative for patient knowledge comprehension during the discharge procedure using a novel computer-generated patient-tailored discharge document in cardiology." DIGITAL HEALTH 8 (January 2022): 205520762211290. http://dx.doi.org/10.1177/20552076221129079.
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Objective The duration of hospital admissions has shortened significantly. This challenges healthcare professionals to provide the necessary information and instructions in a limited time. Patient-tailored discharge information may improve the patient's understanding of the discharge information but may also be time-consuming. The objective of this descriptive quality improvement study was to evaluate patient comprehension of discharge information using a novel computer-generated patient-tailored discharge document. Methods A prospective pre-post study comparing patient-tailored discharge information with conventional discharge information, for patients undergoing an electrophysiological procedure during two periods of six weeks between January and March 2016. Group I received conventional discharge information ( n = 55). Group II received a computer-generated, patient-tailored discharge document ( n = 57). Their comprehension of the discharge information was evaluated using a peer-reviewed questionnaire distributed among patients, comparing groups I and II using Likert scales. Nurses and nurse practitioners evaluated the use of personalized discharge information by means of a short survey. Results In terms of discharge information, comprehensibility was equivalent; however, an increase in comprehension was observed in patients seeking a telephone consultation with the cardiology department within one-week post-discharge. A reduction in discharge preparation time and an increased uniformity of discharge information were reported by nurses. Nurse practitioners found the web tool easy to use and time-saving. Conclusions In this study, computer-generated patient-tailored discharge information was equivalent to conventional discharge information. A more positive trend was seen for patients who initiated teleconsultation with the hospital within one-week post-discharge. This suggests that for this subgroup the patient-tailored discharge web tool might lead to an improvement in care. However, more research with a larger number of participants is needed to confirm this trend.
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Ngari, Moses M., Christina Obiero, Martha K. Mwangome, Amek Nyaguara, Neema Mturi, Sheila Murunga, Mark Otiende, et al. "Mortality during and following hospital admission among school-aged children: a cohort study." Wellcome Open Research 5 (October 8, 2020): 234. http://dx.doi.org/10.12688/wellcomeopenres.16323.1.
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Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than under-fives in low- and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya. Methods: A retrospective cohort study of children 5−12 years old admitted at KCH, 2007 to 2016, and resident of the Kilifi Health Demographic Surveillance System (KHDSS). Children discharged alive were followed up for one year by quarterly census. Main outcomes were inpatient and one-year post-discharge mortality. Results: We included 3,907 admissions among 3,196 children with a median age of 7 years 8 months (IQR 74−116 months). Severe anaemia (792, 20%), malaria (749, 19%), sickle cell disease (408, 10%), trauma (408, 10%), and severe pneumonia (340, 8.7%) were the commonest reasons for admission. Comorbidities included 623 (16%) with severe wasting, 386 (10%) with severe stunting, 90 (2.3%) with oedematous malnutrition and 194 (5.0%) with HIV infection. 132 (3.4%) children died during hospitalisation. Inpatient death was associated with signs of disease severity, age, bacteraemia, HIV infection and severe stunting. After discharge, 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3−38.4] per 1,000 child-years). 63/89 (71%) of post-discharge deaths occurred within three months and 45% of deaths occurred outside hospital. Post-discharge mortality was positively associated with weak pulse, tachypnoea, severe anaemia, HIV infection and severe wasting and negatively associated with malaria. Conclusions: Reasons for admissions are markedly different from those reported in under-fives. There was significant post-discharge mortality, suggesting hospitalisation is a marker of risk in this population. Our findings inform guideline development to include risk stratification, targeted post-discharge care and facilitate access to healthcare to improve survival in the early months post-discharge in school-aged children.
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Ngari, Moses M., Christina Obiero, Martha K. Mwangome, Amek Nyaguara, Neema Mturi, Sheila Murunga, Mark Otiende, et al. "Mortality during and following hospital admission among school-aged children: a cohort study." Wellcome Open Research 5 (January 4, 2021): 234. http://dx.doi.org/10.12688/wellcomeopenres.16323.2.
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Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than among under-fives in low- and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya. Methods: A retrospective cohort study of children 5−12 years old admitted at KCH, 2007 to 2016, and resident within the Kilifi Health Demographic Surveillance System (KHDSS). Children discharged alive were followed up for one year by quarterly census. Outcomes were inpatient and one-year post-discharge mortality. Results: We included 3,907 admissions among 3,196 children with a median age of 7 years 8 months (IQR 74−116 months). Severe anaemia (792, 20%), malaria (749, 19%), sickle cell disease (408, 10%), trauma (408, 10%), and severe pneumonia (340, 8.7%) were the commonest reasons for admission. Comorbidities included 623 (16%) with severe wasting, 386 (10%) with severe stunting, 90 (2.3%) with oedematous malnutrition and 194 (5.0%) with HIV infection. 132 (3.4%) children died during hospitalisation. Inpatient death was associated with signs of disease severity, age, bacteraemia, HIV infection and severe stunting. After discharge, 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3−38.4] per 1,000 child-years). 63/89 (71%) of post-discharge deaths occurred within three months and 45% of deaths occurred outside hospital. Post-discharge mortality was positively associated with weak pulse, tachypnoea, severe anaemia, HIV infection and severe wasting and negatively associated with malaria. Conclusions: Reasons for admissions are markedly different from those reported in under-fives. There was significant post-discharge mortality, suggesting hospitalisation is a marker of risk in this population. Our findings inform guideline development to include risk stratification, targeted post-discharge care and facilitate access to healthcare to improve survival in the early months post-discharge in school-aged children.
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Sun, Weizhe, Leila Gholizadeh, Lin Perry, and Kyoungrim Kang. "Predicting Return to Work Following Myocardial Infarction: A Prospective Longitudinal Cohort Study." International Journal of Environmental Research and Public Health 19, no. 13 (June 30, 2022): 8032. http://dx.doi.org/10.3390/ijerph19138032.
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This study aimed to determine the proportion of patients who returned to work within three months post-myocardial infarction and the factors that predicted return to work. A total of 136 participants with myocardial infarction completed the study questionnaires at baseline and three months post-discharge between August 2015 and February 2016. At the three-month follow-up, 87.5% (n = 49) of the participants who were working pre-infarction had resumed work. Age, gender, education, smoking, readmission after discharge, number of comorbidities, diabetes, social support, anxiety, and depression were significantly associated with returning to work at three months post-discharge. Age, gender, smoking, anxiety, and depression significantly predicted those patients with myocardial infarction that returned to work, using binary logistic regression. The majority of patients in work who experience myocardial infarction have the capacity to achieve a work resumption by three months post-discharge. Interventions that facilitate returning to work should focus on modifiable risk factors, such as improving these patients’ mental health, comorbid conditions, risk of readmission, smoking, and social support. Healthcare providers should work in partnership with patients’ family members, friends, and employers in developing and implementing interventions to address these modifiable factors to facilitate patients’ return to work.
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SHARMA, A., C. ROGERS, D. RIMLAND, C. STAFFORD, S. SATOLA, E. CRISPELL, and R. GAYNES. "Post-discharge mortality in patients hospitalized with MRSA infection and/or colonization." Epidemiology and Infection 141, no. 6 (September 13, 2012): 1187–98. http://dx.doi.org/10.1017/s0950268812001963.
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SUMMARYMethicillin-resistantStaphylococcus aureus(MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years,P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31–2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22–3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.
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Randhawa, Varinder K., Kimberly D. Bischel, Alexander Milinovich, Christina Felix, Nicole Zimmerman, Jay L. Alberts, Randall C. Starling, Corinne Bott-Silverman, WH Wilson Tang, and Antonio L. Perez. "Implications of Post-Discharge Care Coordination on Survival and Healthcare Utilization for Hospitalized Heart Failure Patients." Journal of Cardiac Failure 26, no. 10 (October 2020): S89—S90. http://dx.doi.org/10.1016/j.cardfail.2020.09.262.
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Macefield, Rhiannon C., Barnaby C. Reeves, Thomas K. Milne, Alexandra Nicholson, Natalie S. Blencowe, Melanie Calvert, Kerry NL Avery, et al. "Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion." Journal of Infection Prevention 18, no. 4 (February 1, 2017): 170–79. http://dx.doi.org/10.1177/1757177416689724.
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Background: Surgical site infections (SSIs) are the third most common hospital-associated infection and can lead to significant patient morbidity and healthcare costs. Identification of SSIs is key to surveillance and research but reliable assessment is challenging, particularly after hospital discharge when most SSIs present. Existing SSI measurement tools have limitations and their suitability for post-discharge surveillance is uncertain. Aims: This study aimed to develop a single measure to identify SSI after hospital discharge, suitable for patient or observer completion. Methods: A three-phase mixed methods study was undertaken: Phase 1, an analysis of existing tools and semi-structured interviews with patients and professionals to establish the content of the measure; Phase 2, development of questionnaire items suitable for patients and professionals; Phase 3, pre-testing the single measure to assess acceptability and understanding to both stakeholder groups. Interviews and pre-testing took place over 12 months in 2014–2015 with patients and professionals from five specialties recruited from two UK hospital Trusts. Findings: Analyses of existing tools and interviews identified 19 important domains for assessing SSIs. Domains were developed into provisional questionnaire items. Pre-testing and iterative revision resulted in a final version with 16 items that were understood and easily completed by patients and observers (healthcare professionals). Conclusion: A single patient and observer measure for post-discharge SSI assessment has been developed. Further testing of the validity, reliability and accuracy of the measure is underway.
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Mourra, Natalie Rose, Jason S. Fish, and Michael Adam Pfeffer. "Analysis of an intervention on discharge summary quality and timeliness." European Journal for Person Centered Healthcare 3, no. 3 (September 3, 2015): 362. http://dx.doi.org/10.5750/ejpch.v3i3.1005.
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Objective: Deficits in communication between inpatient and outpatient physicians in the post-hospital discharge period are common and potentially detrimental to person-centered doctor-patient relationships and to patient health. This study assesses the impact of a hospital discharge improvement project implemented at an urban academic hospital, aimed at improving the timeliness and quality of discharge summaries using a standardized discharge template, education and a small monetary incentive. Methods: A random sample of 624 charts from an academic, urban hospitalist medicine service was analyzed from the pre- and post-project implementation time periods: 2009-2010 and 2010-2011. The sampling was evenly distributed throughout the months of the year. Ordinary linear regression modeling was used to evaluate the impact of the intervention on time to completion; logistic regression modeling was used to assess the impact on the quality of the discharge summaries. Both models control for patient characteristics, hospitalization acuity and in-hospital continuity of care.Results: Unadjusted time to discharge summary completion rates decreased by 2.4 days (p<0.001) between the pre- and post-implementation times. Controlling for patient demographics, acuity of hospitalization and hand-offs between physicians, time to completion of discharge summaries was decreased by 2.17 days (p< 0.001). The odds of including at least 50% of the recommended information into a discharge summary post-intervention was 6.44 (p<0.001) compared to the odds before the intervention, controlling for patient demographics, acuity of hospitalization and hand-offs between physicians. Conclusion: The use of education, a simple formatted recommended discharge template and a small monetary incentive improved both the timeliness and quality of the information exchanged between inpatient and outpatient providers and contributes significantly to a person-centered healthcare.
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Clark, Robyn, Jonathon Foote, Vincent Versace, Alex Brown, Mark Daniel, Neil Coffee, Tania Marin, et al. "The Keeping on Track Study: Exploring the Activity Levels and Utilization of Healthcare Services of Acute Coronary Syndrome (ACS) Patients in the First 30-Days after Discharge from Hospital." Medical Sciences 7, no. 4 (April 19, 2019): 61. http://dx.doi.org/10.3390/medsci7040061.
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The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30–90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an example of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.
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Allison, Geneve M., Bernard Weigel, and Christina Holcroft. "Does electronic medication reconciliation at hospital discharge decrease prescription medication errors?" International Journal of Health Care Quality Assurance 28, no. 6 (July 13, 2015): 564–73. http://dx.doi.org/10.1108/ijhcqa-12-2014-0113.
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Purpose – Medication errors are an important patient safety issue. Electronic medication reconciliation is a system designed to correct medication discrepancies at transitions in healthcare. The purpose of this paper is to measure types and prevalence of intravenous antibiotic errors at hospital discharge before and after the addition of an electronic discharge medication reconciliation tool (EDMRT). Design/methodology/approach – A retrospective study was conducted at a tertiary hospital where house officers order discharge medications. In total, 100 pre-EDMRT and 100 post-EDMRT subjects were randomly recruited from the study center’s clinical Outpatient Parenteral Antimicrobial Therapy (OPAT) program. Using infectious disease consultant recommendations as gold standard, each antibiotic listed in these consultant notes was compared to the hospital discharge orders to ascertain the primary outcome: presence of an intravenous antibiotic error in the discharge orders. The primary covariate of interest was pre- vs post-EDMRT group. After generating the crude prevalence of antibiotic errors, logistic regression accounted for potential confounding: discharge day (weekend vs weekday), average years of practice by prescribing physician, inpatient service (medicine vs surgery) and number of discharge mediations per patient. Findings – Prevalence of medication errors decreased from 30 percent (30/100) among pre-EDMRT subjects to 15 percent (15/100) errors among post-EDMRT subjects. Dosage errors were the most common type of medication error. The adjusted odds ratio of discharge with intravenous antibiotic error in the post-EDMRT era was 0.39 (0.18, 0.87) compared to the pre-EDMRT era. In the adjusted model, the total number of discharge medications was associated with increased OR of discharge error. Originality/value – To the authors’ knowledge, no other study has examined the impact of reconciliation on types and prevalence of medication errors at hospital discharge. The focus on intravenous antibiotics as a class of high-stakes medications with serious risks to patient safety during error events highlights the clinical importance of the findings. Electronic medication reconciliation may be an important tool in efforts to improve patient safety.
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Abousayed, Mostafa, Christopher Johnson, and Andrew Rosenbaum. "Trends in Urgent Care Utilization Following Ankle Fracture Fixation." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0013. http://dx.doi.org/10.1177/2473011418s00136.
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Category: Ankle Introduction/Purpose: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve post-discharge care and reduce unnecessary readmissions. Readmissions within 30-days are frequent and represent an economic burden on patients and the healthcare system alike. A recent study reported a 3.17% readmission rate after open reduction and internal fixation (ORIF) of ankle fractures. While readmission implies inpatient-discharge to inpatient-readmission, patients may present to urgent care facilities and receive medical treatment without being admitted. This too has socioeconomic implications. The incidence and reasons for urgent care visits following ankle fracture surgery has not been studied. The aim of this study is to evaluate the frequency and causes for urgent care visits within 30-days of discharge after ankle ORIF and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between 7/1/2016 and 6/30/2017 were included. Patients were identified using CPT codes for ankle ORIF ((27814, 27822, 27823, 27792, 27766, and 27829). Patients less than 18 years of age, with open fractures or with other appendicular or axial skeleton injuries were excluded. Patients’ demographics including age, sex, race, BMI, occupation, insurance payer and comorbidities were documented. The primary outcome of our study was to determine the frequency of urgent care visits within 30-days of discharge after ankle ORIF. Our secondary goals were to evaluate the association between urgent care visits and demographics, and identify the reason for post-operative urgent care utilization. Results: A total of 333 patients met the inclusion criteria. Fifty four percent of our cohort were males. Thirty five patients (10.51%) had urgent care visits with 30-days of discharge. Patients presented at a mean of 11.83 days from the day of surgery. Sixteen patients (45.71%) had cast/splint related issues, seven (20%) presented with pain and seven (20%) with increased surgical site drainage (Fig 1). Univariable analysis demonstrated a statistically significant association between post-operative urgent care utilization and patients with diabetes (p=0.03) and underlying psychiatric disorders (p=0.03). Conclusion: In this population study of patients undergoing ankle fracture surgery who underwent ankle ORIF, we found that the rate of urgent care visits within 30-days of discharge exceeds the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders are significantly more likely to present to an urgent care facility post-operatively. This is an important finding, as there are large costs to the healthcare system associated with this. Future studies must identify additional risk factors and means of reducing such added costs to our already stressed healthcare system.
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Panday, RS Nannan, Christian P. Subbe, LS van Galen, John Kellett, Mikkel Brabrand, CH Nickel, and Prabath WB Nanayakkara. "Changes in vital signs post discharge as a potential target for intervention to avoid readmission." Acute Medicine Journal 17, no. 2 (April 1, 2018): 77–82. http://dx.doi.org/10.52964/amja.0703.
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Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems. We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Data sets were graded according to the National Early Warning Score (NEWS). Of 487 patients in whom NEWS could be calculated on discharge and again on re-admission, 39.6% had worse vital signs with a NEWS score difference ≥ 2 points while only 7.6% had improved by ≥ 2 points. Changes in individual vital signs of 20% or more were most common in respiratory rate and heart rate. Monitoring of respiratory rate and pulse rate post-discharge might predict some deteriorations.
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Ray, Emily Miller, Sharon Peacock Hinton, and Katherine Elizabeth Reeder-Hayes. "Patterns of healthcare utilization in patients with newly diagnosed advanced lung cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18386-e18386. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18386.
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e18386 Background: Advanced lung cancer (ALC) is a symptomatic disease that is often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve cancer care delivery. We aimed to define the frequency of ALC diagnosis associated with hospitalization and the relationship to subsequent cancer care and readmissions. Methods: We identified patients in the SEER-Medicare database with: ALC (stage IIIB-IV non-small cell or small cell), diagnosed 2007 to 2013; with continuous enrollment in Medicare from 6 months prior to lung cancer diagnosis through death or 12/2014; and an index hospitalization within 7 days of their ALC diagnosis. Our primary outcomes of interest were 30-day re-hospitalization and emergency department (ED) use. We examined: utilization of services during index hospitalization, including intensive care and oncology or palliative care consultation; discharge destination; receipt of systemic therapy; and hospice enrollment. Results: Fifty-four percent (n = 28,976) of ALC patients had an index hospitalization, with 90% of those having their cancer diagnosed while hospitalized. During their index hospitalization, 16% had oncology consultation, and 6% had palliative care (PC) consultation. Thirty-three percent were in the intensive care unit. At discharge, 59% returned home, 8% died, and 11% went to hospice. Of those who survived to discharge, 69% later returned to the ED or were re-hospitalized, with 49% of re-hospitalizations and 35% of ED visits occurring within 30 days of the index hospitalization. Thirty-five percent of these patients eventually received systemic treatment for their cancer. By 180 days post-discharge, 77% had enrolled in hospice with a median of 10 days on hospice care. Conclusions: Newly diagnosed ALC patients are high risk for acute care utilization, and many patients experience a return to the hospital early in their cancer trajectory. These patients may benefit from additional health system support prior to hospital discharge to help prevent high-cost, low-value healthcare utilization.
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Bamforth, Ryan J., Ruchi Chhibba, Thomas W. Ferguson, Jenna Sabourin, Domenic Pieroni, Nicole Askin, Navdeep Tangri, Paul Komenda, and Claudio Rigatto. "Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis." PLOS ONE 16, no. 4 (April 22, 2021): e0249542. http://dx.doi.org/10.1371/journal.pone.0249542.
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Background Readmission following hospital discharge is common and is a major financial burden on healthcare systems. Objectives Our objectives were to 1) identify studies describing post-discharge interventions and their efficacy with respect to reducing risk of mortality and rate of hospital readmission; and 2) identify intervention characteristics associated with efficacy. Methods A systematic review of the literature was performed. We searched MEDLINE, PubMed, Cochrane, EMBASE and CINAHL. Our selection criteria included randomized controlled trials comparing post-discharge interventions with usual care on rates of hospital readmission and mortality in high-risk chronic disease patient populations. We used random effects meta-analyses to estimate pooled risk ratios for all-cause and cause-specific mortality as well as all-cause and cause-specific hospitalization. Results We included 31 randomized controlled trials encompassing 9654 patients (24 studies in CHF, 4 in COPD, 1 in both CHF and COPD, 1 in CKD and 1 in an undifferentiated population). Meta-analysis showed post-discharge interventions reduced cause-specific (RR = 0.71, 95% CI = 0.63–0.80) and all cause (RR = 0.90, 95% CI = 0.81–0.99) hospitalization, all-cause (RR = 0.73, 95% CI = 0.65–0.83) and cause-specific mortality (RR = 0.68, 95% CI = 0.54–0.84) in CHF studies, and all-cause hospitalization (RR = 0.52, 95% CI = 0.32–0.83) in COPD studies. The inclusion of a cardiac nurse in the multidisciplinary team was associated with greater efficacy in reducing all-cause mortality among patients discharged after heart failure admission (HR = 0.64, 95% CI = 0.54–0.75 vs. HR = 0.87, 95% CI = 0.73–1.03). Conclusions Post-discharge interventions reduced all-cause mortality, cause-specific mortality, and cause-specific hospitalization in CHF patients and all-cause hospitalization in COPD patients. The presence of a cardiac nurse was associated with greater efficacy in included studies. Additional research is needed on the impact of post-discharge intervention strategies in COPD and CKD patients.