The Impact of Limited English Proficiency on Hospital Readmission Rate in Culturally and Linguistically Diverse Patients Hospitalised with Acute Heart Failure

Abstract Aims Health services worldwide face the challenge of providing care for increasingly culturally and linguistically diverse (CALD) populations. The aims of this study were to determine whether CALD patients hospitalized with acute heart failure (HF) are at increased risk of rehospitalization and emergency department (ED) visitation after discharge, compared to non-CALD patients, and within CALD patients to ascertain the impact of limited English proficiency (LEP) on outcomes. Methods and results A cohort of 1613 patients discharged from hospital following an episode of acute HF was derived from hospital administrative datasets. CALD status was based on both country of birth and primary spoken language. Comorbidities, HF subtype, age, sex and socioeconomic status, and hospital readmission and ED visitation incidences, were compared between groups. A Cox proportional hazard model was employed to adjust for potential confounders. The majority of patients were classified as CALD [1030 (64%)]. Of these, 488 (30%) were designated as English proficient (CALD-EP) and 542 (34%) were designated CALD-LEP. Compared to non-CALD, CALD-LEP patients exhibited a greater cumulative incidence of HF-related readmission and ED visitation, as expressed by an adjusted hazard ratio (HR) [1.27 (1.02–1.57) and 1.40 (1.18–1.67), respectively]; this difference was not significant for all-cause readmission [adjusted HR 1.03 (0.88–1.20)]. CALD-EP showed a non-significant trend towards increased rehospitalization and ED visitation. Conclusion This study suggests that CALD patients with HF, in particular those designated as CALD-LEP, have an increased risk of HF rehospitalization and ED visitation. Further research to elucidate the underlying reasons for this disparity are warranted.

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Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System

Hospital Pharmacy ◽

10.1177/0018578717749925 ◽

2017 ◽

Vol 53 (4) ◽

pp. 266-271 ◽

Cited By ~ 1

Author(s):

Pooja H. Patel ◽

Kimberly W. Dickerson

Keyword(s):

Heart Failure ◽

Primary Care ◽

Primary Care Physician ◽

Hospital Readmission ◽

Readmission Rate ◽

Cost Savings ◽

Care Physician ◽

Day Hospital ◽

All Cause Mortality ◽

The Impact

Background: Hospitalizations due to chronic diseases such as heart failure (HF) continue to increase worldwide. Fragmentation of care while transitioning from one care setting to another is an important factor contributing to hospitalizations. Fragmented discharge tools have been implemented; however, the impact of a comprehensive interdisciplinary discharge tool has not been previously studied. Objective: The goal of this study is to assess the impact of the implementation of Project Re-Engineered Discharge (RED) on the incidence of hospital readmissions, all-cause mortality, primary care physician follow-up rate, and cost savings for patients with HF. Methods: This was a single-center, retrospective, cohort study of patients admitted with HF exacerbation at the Central Arkansas Veterans Healthcare System (CAVHS). A random sample of 100 patients admitted prior to implementation of Project RED and 50 patients after Project RED intervention were included in the study. The primary end point was 30-day hospital readmission for HF exacerbation. The co-secondary end points were all-cause mortality, cost savings, and rate of primary care physician appointments scheduled as well as attended per postdischarge recommendations. Results: The 30-day hospital readmission rate was 28% in the pre–Project RED group, and it was 18% in the post–Project RED group ( P = .18). The all-cause mortality was significantly lower in the post–Project RED group as compared with the pre–Project RED group (18% vs 41%, P = .04). More patients in the post–Project RED group attended an outpatient primary care appointment as recommended per postdischarge instructions (40% vs 19%, P = .006). In addition, with the decrease in hospital 30-day readmission rate in the post–Project RED group, there was a cost savings of $1453 per patient visit for HF exacerbation. Conclusions: Coordination of care using a discharge tool like Project RED should be utilized in institutions to improve patient outcomes as well as patient safety while decrease the overall health care cost.

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A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: A Retrospective Analysis (Preprint)

10.2196/preprints.29101 ◽

2021 ◽

Author(s):

Daniel Max Friedman ◽

Jana Marie Goldberg ◽

Rebecca Lynn Molinsky ◽

Mark Andrew Hanson ◽

Adam Castaño ◽

...

Keyword(s):

Heart Failure ◽

Hospital Readmission ◽

Readmission Rate ◽

Hospital Readmissions ◽

Care Program ◽

Day Hospital ◽

Skilled Nursing ◽

Care Plans ◽

The Impact ◽

Cardiovascular Care

BACKGROUND Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, post-consultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc. (HBH), a cardiovascular digital health company, to 11 SNFs (3,510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. OBJECTIVE The aim of the study is to assess whether a virtual cardiovascular care program could improve access to specialty care, thereby reducing the 30-day hospital readmission rate for HF patients discharged to SNF relative to the expected rate for this population. METHODS We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted ≥1 telemedicine visit via smartphone, tablet, or laptop device for cardiac patients identified by a SNF care team. Post-consult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. RESULTS We observed lower hospital readmission among patients who received ≥1 virtual consultation compared to the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3,510 SNF beds. 185 patients (7%) received virtual cardiovascular care via the HBH program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as $860 per patient. CONCLUSIONS The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally-enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

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Awakening a critical consciousness among multidisciplinary professionals supporting culturally and linguistically diverse families: a pilot study on the impact of professional development

Child Care in Practice ◽

10.1080/13575279.2018.1516626 ◽

2018 ◽

Vol 26 (1) ◽

pp. 4-21 ◽

Cited By ~ 1

Author(s):

Sarah Verdon

Keyword(s):

Professional Development ◽

Pilot Study ◽

Critical Consciousness ◽

Linguistically Diverse ◽

Culturally And Linguistically Diverse ◽

Diverse Families ◽

The Impact

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Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre

BMJ evidence-based medicine ◽

10.1136/bmjebm-2018-111026 ◽

2018 ◽

Vol 24 (1) ◽

pp. 10-14 ◽

Cited By ~ 3

Author(s):

Mukul Bhattarai ◽

Tamer Hudali ◽

Robert Robinson ◽

Mohammad Al-Akchar ◽

Carrie Vogler ◽

...

Keyword(s):

Logistic Regression ◽

Risk Factor ◽

Length Of Stay ◽

Hospital Readmission ◽

Readmission Rate ◽

Warfarin Therapy ◽

Oral Anticoagulants ◽

Emergency Department Visits ◽

Day Hospital ◽

The Impact

Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis. Warfarin was the most common anticoagulant prescribed at discharge (273 patients) with a readmission rate of 20% (p<0.01). DOACs were used by 94 patients at discharge with a readmission rate of 4% (p=0.219). Multivariate logistic regression showed an increased risk of readmission with warfarin therapy (OR 1.36, p=0.045). Logistic regression did not show DOACs to be a risk factor for hospital readmission. Our data suggests that warfarin therapy is a risk factor for all-cause 30-day hospital readmission. DOAC therapy is not found to be associated with a higher risk of hospital readmission. Warfarin anticoagulation may be an important target for interventions to reduce hospital readmissions.

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Depression Effects the 30-day Readmission Rate in Patients Admitted for an Acute Heart Failure Syndrome

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.07.239 ◽

2017 ◽

Vol 23 (8) ◽

pp. S83

Author(s):

Hassan Alkhawam ◽

Fadi Ghrair ◽

Anwar Zaitoun ◽

Priya Bansal ◽

Timothy J. Vittorio

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Readmission Rate ◽

Acute Heart Failure Syndrome

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Age Based Trends for Unplanned Pediatric Rehospitalizations in the United States

10.1101/2021.11.13.21266306 ◽

2021 ◽

Author(s):

Nupur Amritphale ◽

Amod Amritphale ◽

Deepa Vasireddy ◽

Mansi Batra ◽

Mukul Sehgal ◽

...

Keyword(s):

Hospital Readmission ◽

Readmission Rate ◽

Age Groups ◽

The United States ◽

Unplanned Readmission ◽

Post Discharge ◽

Readmission Rates ◽

Discharge Care ◽

Hospital Readmission Rate ◽

Bowel Diseases

BACKGROUND AND OBJECTIVES: Hospital readmission rate helps to highlight the effectiveness of post- discharge care. There remains a paucity of plausible age based categorization especially for ages below one year for hospital readmission rates. METHODS: Data from 2017 Healthcare cost and utilization project National readmissions database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. RESULTS: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant comorbidities leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages 1-4 yrs, dehydration, asthma and bronchitis were negative predictors of unplanned readmission. CONCLUSIONS: Thirty-day unplanned readmissions remain a problem leading to billions of tax-payer-dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

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178: PERIPHERAL VENOUS WAVEFORM ASSESSMENT (PIVA) PREDICTING HOSPITAL READMISSION FOR ACUTE HEART FAILURE

Critical Care Medicine ◽

10.1097/01.ccm.0000528198.34349.ce ◽

2018 ◽

Vol 46 (1) ◽

pp. 72-72

Author(s):

Bret Alvis ◽

Merrick Miles ◽

Jenna Helmer ◽

Colleen Brophy ◽

Franz Baudenbacher ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Hospital Readmission

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Risk factors for acute psychiatric readmission

Psychiatric Bulletin ◽

10.1192/pb.21.10.600 ◽

1997 ◽

Vol 21 (10) ◽

pp. 600-603 ◽

Cited By ~ 9

Author(s):

Mandy Dixon ◽

Emma Robertson ◽

Mohan George ◽

Femi Oyebode

Keyword(s):

Risk Factors ◽

Hospital Readmission ◽

Readmission Rate ◽

Service Planning ◽

Living Alone ◽

Retrospective Case ◽

Psychiatric Readmission ◽

Factors Associated ◽

Hospital Readmission Rate ◽

Discharge Against Medical Advice

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.

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