scholarly journals Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions

2019 ◽  
Vol 37 (3) ◽  
pp. 390-394
Author(s):  
Jennifer J Johnston ◽  
Jo M Longman ◽  
Dan P Ewald ◽  
Margaret I Rolfe ◽  
Sergio Diez Alvarez ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Expert Panel ◽  
Community Dwelling ◽  
Chronic Obstructive ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions

Abstract Background Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions. Objective The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel. Methods Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process. Results There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor. Conclusions The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.

scholarly journals Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038415
Author(s):  
Jennifer Johnston ◽  
Jo Longman ◽  
Dan Ewald ◽  
Jonathan King ◽  
Sumon Das ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Medication Management ◽  
Community Dwelling ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Study Sites

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.

Abstract TP383: Creating Educational Modules for Family Caregivers to Reduce Potentially Preventable Hospitalizations in Stroke Survivors

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Linda L Pierce ◽  
Victoria Steiner
Keyword(s):  
Family Caregivers ◽  
Nurse Practitioners ◽  
Reading Level ◽  
Community Dwelling ◽  
Chronic Obstructive ◽  
Stroke Survivors ◽  
Comorbid Conditions ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations ◽  
Educational Modules

Background and Issues: Preventable hospitalization utilization among stroke survivors is common. Although about 1/3 of potentially preventable hospitalizations are attributed to recurrent ischemic stroke, other comorbidities that lead to hospitalization are prevalent and need to be monitored. Timely and appropriate care for community-dwelling stroke survivors is critical. Since family caregivers provide the majority of care in the home, support and education of caregivers is essential to monitoring comorbid conditions. Purpose: This project’s aim was to develop brief educational modules on common comorbid conditions (e.g. chronic obstructive pulmonary disease, congestive heart failure, gastroenteritis); have family caregivers and nurse practitioners (NPs) review the content for validity; and then construct 8-10 minute voice-over PowerPoint presentations for each module. Methods: Based on evidence from randomized controlled trials, these modules were developed to provide caregivers with needed information to competently care for stroke survivors. Each module was concisely written at an 8th grade reading level and consists of: 1) a short introduction to the topic and key points; 2) what caregivers can do to alleviate the condition, should watch for, and should report to healthcare providers; 3) linked websites for more information and references; and 4) a four-question assessment about what they learned. Results: Once developed, these modules were evaluated by family caregiver (n=10) and NP (n=5) reviewers. The caregivers thought that the modules were appropriate in length to facilitate easy reading and understanding. The NPs noted that some content needed to be added, such as additional websites and drug information, but overall believed the modules contained supportive resources for caregivers. To provide an alternate learning modality, audio-presentations that highlight pertinent information for each module were then constructed. Conclusions: Registered nurses are well-suited to assess, teach, and support family caregivers. These modules are appropriate for inclusion in web-based or in-person education/support for these caregivers.

scholarly journals Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Hussain Ibrahim ◽  
Adnan Khan ◽  
Shawn P. Nishi ◽  
Ken Fujise ◽  
Syed Gilani
Keyword(s):  
Right Atrium ◽  
Chronic Conditions ◽  
Patent Foramen Ovale ◽  
Hospital Admissions ◽  
Clinical Suspicion ◽  
Chronic Obstructive ◽  
Foramen Ovale ◽  
Obstructive Pulmonary Disease ◽  
Benign Condition ◽  
High Clinical Suspicion

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

scholarly journals Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010–2012

2016 ◽  
Vol 4 ◽  
pp. 614-621 ◽  
Author(s):  
Prabhu P. Gounder ◽  
Sara M. Seeman ◽  
Robert C. Holman ◽  
Alice Rarig ◽  
Mary K. McEwen ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations

scholarly journals Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic conditions in New South Wales, Australia: a historical cohort study

2020 ◽  
Author(s):  
Amanda Anne Jayakody ◽  
Christopher Oldmeadow ◽  
Mariko Carey ◽  
Jamie Bryant ◽  
Tiffany Evans ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Aboriginal People ◽  
New South ◽  
Cohort Analysis ◽  
New South Wales ◽  
Chronic Obstructive ◽  
Historical Cohort ◽  
South Wales ◽  
Avoidable Admissions

Abstract Background: Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic conditions, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. Methods: A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years.Results: Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR=1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR=1.90; 95% CI=1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p=0.859; 0.860 respectively). Conclusion: Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.

scholarly journals Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic disease in New South Wales, Australia: a historical cohort study

2020 ◽  
Author(s):  
Amanda Anne Jayakody ◽  
Christopher Oldmeadow ◽  
Mariko Carey ◽  
Jamie Bryant ◽  
Tiffany Evans ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Aboriginal People ◽  
New South ◽  
Cohort Analysis ◽  
New South Wales ◽  
Chronic Obstructive ◽  
Historical Cohort ◽  
South Wales ◽  
Avoidable Admissions

Abstract Background: Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic diseases, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. Methods: A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years.Results: Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR=1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR=1.90; 95% CI=1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p=0.859; 0.860 respectively). Conclusion: Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.

scholarly journals Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic conditions in New South Wales, Australia: a historical cohort study

2020 ◽  
Author(s):  
Amanda Anne Jayakody ◽  
Christopher Oldmeadow ◽  
Mariko Carey ◽  
Jamie Bryant ◽  
Tiffany Evans ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Aboriginal People ◽  
New South ◽  
Cohort Analysis ◽  
New South Wales ◽  
Chronic Obstructive ◽  
Historical Cohort ◽  
South Wales ◽  
Avoidable Admissions

Abstract Background: Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic conditions, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. Methods: A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years.Results: Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR=1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR=1.90; 95% CI=1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p=0.859; 0.860 respectively). Conclusion: Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.

scholarly journals Assessing the scalability of an integrated falls prevention service for community-dwelling older people: a mixed methods study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Susan Calnan ◽  
Karen Lee ◽  
Sheena McHugh
Keyword(s):  
Older People ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Scale Up ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Online Questionnaire ◽  
Qualitative Feedback ◽  
Prevention Service ◽  
Community Dwelling Older People

Abstract Background There is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up. Methods Multiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores. Results Three of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services. Conclusions Plans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete.

scholarly journals Preventable Hospital Admissions and 30-Day All-Cause Readmissions: Does Hospital Participation in Accountable Care Organizations Improve Quality of Care?

2018 ◽  
Vol 34 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Askar Chukmaitov ◽  
David W. Harless ◽  
Gloria J. Bazzoli ◽  
David B. Muhlestein
Keyword(s):  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Care Organization ◽  
Accountable Care ◽  
Quality Performance ◽  
Obstructive Pulmonary Disease ◽  
Preventable Hospitalizations ◽  
Complications Of Diabetes ◽  
Using Data

This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. Overall, 198 ACO participating and 1210 propensity score matched, nonparticipating hospitals were examined in a difference-in-difference analysis, using data from 17 states in the years 2010-2013. The authors studied preventable hospitalizations for conditions sensitive to high-quality ambulatory care—chronic obstructive pulmonary disease (COPD) and asthma, chronic heart failure (CHF), complications of diabetes—and 30-day all-cause readmissions potentially influenced by hospital care. A decrease was found in preventable hospitalizations for COPD and asthma and for diabetes complications for ACO participating hospitals, but no significant differences for preventable CHF hospitalizations and 30-day readmissions. Mixed results may be attributable to insufficient incentives for ACO participating hospitals to decrease 30-day readmissions, whereas disease-focused initiatives may have a beneficial effect on preventable hospitalizations for COPD and asthma and complications of diabetes.

scholarly journals The burden of preventable hospitalizations before and after implementation of the health transformation plan in a hospital in west of Iran

2019 ◽  
Vol 20 ◽  
Author(s):  
Bakhtiar Piroozi ◽  
Mohammad Amerzadeh ◽  
Hossein Safari ◽  
Amjad Mohamadi-Bolbanabad ◽  
Abdorrahim Afkhamzadeh ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Preventable Hospitalizations ◽  
Primary Health ◽  
Significant Difference ◽  
Before And After ◽  
Bed Days

Abstract Background: Increased number of preventable hospitalizations (PHs) for ambulatory care sensitive conditions (ACSCs) represents less efficiency and low access to outpatient and primary health care, leading to waste of health system resources. Aim: The purpose of this study is to assess the quality of outpatient and primary health care using the rate of PHs for ACSCs and to estimate the economic burden of ASCS before and after the implementation of the health transformation plan (HTP) in Iran. Methods: This research was a before–after quasi-experimental study. The study population included all patients hospitalized in the largest general hospital of Kurdistan province with five diseases such as asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease in 2014 (before the implementation of the HTP) and 2015 (after the implementation of the HTP). Data were analyzed by SPSS v.20 using Chi-square test. Findings: Total number of hospitalizations before and after the implementation of the HTP was 1501 and 1405, respectively. Moreover, the proportion of PHs in all types of the hospital admissions before and after the implementation of the HTP was 47% and 49%, respectively. There was no statistically significant difference between the number of PHs before and after the HTP. In total, PHs imposed 885 798 US$ and 9920 bed-days on health system before and after the implementation of the HTP. Conclusion: Despite the previous expectations of policy makers for improving quality, efficiency, and access to primary health care through implementation of the HTP, proportion of PHs is considerable and it imposes a lot of costs and bed-days on the health system both before and after the HTP.

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