1082: POST-DISCHARGE OUTCOMES IN CRITICAL ILLNESS SURVIVORS WITH MEDICAID INSURANCE STATUS

Background: Prior studies have shown that patients with diabetes mellitus (DM) have increased risk for developing cardiovascular disease. BRIdging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner-delivered cardiac transitional care program for patients who have been recently discharged following a cardiac event. Previous research has shown BRIDGE to be effective in improving patient outcomes. This study sought to describe differences in outcomes 1) of heart failure (HF), acute coronary syndrome (ACS), and atrial fibrillation (AF) patients with and without concomitant DM, and 2) between diabetic patients who did and did not attend BRIDGE. Methods: Retrospective data were abstracted for HF, ACS, and AF patients from 2008-2014. Patients were divided into cohorts based on presence or absence of DM and BRIDGE attendance versus non-attendance. Outcomes (readmissions, ED visits, death) within each primary diagnosis (HF, ACS, AF) were compared between DM and non-DM patients and between those who attended BRIDGE versus those who did not for all DM patients. Results: Of 2197 patients referred to BRIDGE, 723 (32.9%) had concomitant DM. DM patients had similar outcomes to non-DM patients for most post-discharge outcomes; however, DM ACS patients had higher readmission (42.2% v 29.6%, p<0.001) and death (10.5% v. 4.5%, p=0.001) rates within 6 months, and DM AF patients had higher readmission rates within 6 months (52.1% v 37.9%, p=0.006). HF patients with DM who attended BRIDGE had lower mortality rates within 6 months of discharge than those who did not (10.3% vs. 22.1%, p=0.014). No other significant differences in outcomes were seen between BRIDGE attendees and non-attendees. Conclusions: Though not significant, patients with DM had worse post-discharge outcomes than those without DM for all primary diagnoses. In the subset of DM patients, the 30-day readmission rate for ACS patients who attended BRIDGE was half of those who did not attend. Conversely, 30-day readmission rates for HF patients were greater if they attended. This may in part explain the significantly lower mortality rate among BRIDGE attenders with HF, where patients who needed readmission were identified during their BRIDGE appointment. Due to the high prevalence of DM, efforts to tailor transitional care for this population are needed.

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Can telephone follow-up improve post-discharge outcomes?

British Journal of Nursing ◽

10.12968/bjon.1996.5.22.1361 ◽

1996 ◽

Vol 5 (22) ◽

pp. 1361-1365 ◽

Cited By ~ 19

Author(s):

David Turner

Keyword(s):

Post Discharge ◽

Discharge Outcomes

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Declining length of hospital stay for acute myocardial infarction and post-discharge outcomes: a community-wide perspective

ACC Current Journal Review ◽

10.1016/j.accreview.2004.06.017 ◽

2004 ◽

Vol 13 (6) ◽

pp. 11

Author(s):

F.A Spencer ◽

D Lessard ◽

J.M Gore ◽

J Yarzebski ◽

R.J Goldberg

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Post Discharge ◽

Discharge Outcomes ◽

Wide Perspective

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Costs and Resource Utilization in Prolonged Critical Illness

10.1093/med/9780199653461.003.0008 ◽

2014 ◽

Author(s):

Christopher E Cox

Keyword(s):

Health Care ◽

Critical Illness ◽

Acute Care ◽

Patient Population ◽

Health Care Policy ◽

Patient Flow ◽

Prolonged Mechanical Ventilation ◽

Post Discharge ◽

Chronic Critical Illness ◽

Post Acute Care

Patients who have chronic critical illness, operationally defined as those requiring prolonged mechanical ventilation, are markedly increasing in number and commonly experience profound, persistent physical and psychological debilitation. This patient population consumes an extraordinary amount of health care resources attributed to both the acute hospitalization as well as complex post-discharge treatments provided across multiple post-acute care facilities. Currently, the US health care system incentivizes these patient flow dynamics. Health care policy changes addressing post-acute care payment are inevitable. This chapter highlights potential patient, family, physician, and systems targets for current and future interventions, designed to improve quality and reduce costs for this patient population.

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Critical Illness and Long-Term Outcomes Worldwide

10.1093/med/9780199653461.003.0002 ◽

2014 ◽

Author(s):

Neill KJ Adhikari

Keyword(s):

Critical Care ◽

Critical Illness ◽

Administrative Data ◽

Population Based ◽

Post Discharge ◽

Discharge Care ◽

Modelling Techniques ◽

Global Estimates ◽

The Cost

Interest in the global burden of critical illness and its sequelae are growing, but comprehensive data to describe the burden of acute and post-acute illness and the resources available to provide care are lacking. Challenges to obtaining population-based global estimates of critical illness include the syndrome-based definitions of critical illness, incorrect equating of ‘critical illness’ with ‘admission to an intensive care unit’, lack of reliable case ascertainment in administrative data, and short prodrome and high mortality of critical illness, limiting the number of prevalent cases. Estimates of the burden of post-critical illness morbidity are even less reliable, owing to the limited number of observational studies, inaccurate coding in administrative data, and the unclear attributable risk of these morbidities to critical illness. Modelling techniques will be required to estimate the burden of critical illness and disparities in access to critical care using existing data sources. Demands for critical care and post-discharge care for survivors are likely to increase because of urbanization, an ageing demographic, and ongoing wars, disasters, and pandemics, while the ability to assume the cost of increased critical care may be limited due to economic factors. Major public health questions remain unanswered regarding the worldwide burden of critical illness and its sequelae, variation in resources available for treatment, and strategies that are broadly effective and feasible to prevent and treat critical illness and its consequences.

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