scholarly journals Age Based Trends for Unplanned Pediatric Rehospitalizations in the United States

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.

Hospital readmission rate for febrile neutropenia (FN) following high dose cytarabine (HiDAC) consolidation chemotherapy for acute myeloid leukemia (AML).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18513-e18513
Author(s):  
Caitlin Siebenaller ◽  
Tomas Radivoyevitch ◽  
Connie Cheng ◽  
Hetty Carraway ◽  
Sudipto Mukherjee ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Myeloid Leukemia ◽  
Readmission Rate ◽  
Treatment Cycle ◽  
High Dose ◽  
Consolidation Chemotherapy ◽  
Readmission Rates ◽  
Factors Associated ◽  
Hospital Readmission Rate ◽  
High Dose Cytarabine

e18513 Background: FN is an anticipated complication of consolidation with HiDAC for AML, though precise descriptions of incidence, type, and severity of infection leading to FN are lacking. Since AML patients (pts) with FN after HiDAC are routinely readmitted to the hospital, there is a likely impact on measures of quality and value in this population. Methods: Our primary aim was to define the rate of FN inpatient readmissions among all HiDAC cycles. Secondary aims included: estimating rates of all-cause readmissions, clinical (e.g., probable pneumonia per imaging) and microbiologically-documented infections, and identify pts-specific risk factors associated with readmission. Readmission per patient were modeled using Poisson regression, with means proportional to total cycles exposed, and logistic regression for the probability of FN per treatment cycle. Results: We identified 150 AML pts ≥ 18 years of age, who received at least one cycle of HiDAC consolidation (1000-3000 mg/m2 for six doses) in 2009-2016. The median age was 50 (range 19-69); 55% were female and 45% were male. For 417 HiDAC cycles analyzed (87% at 3000 mg/m2), all pts received flouroquinalone prophylaxis and the overall readmission rate was 49% (203/417), of which 86% (174/203) were for FN. Median time to FN hospital admission was 18 days (range 10-22) from the start of HiDAC. Of the 174 FN readmissions, 60% had documented infections. Of these infections, 35% were bacteremia, 29% other bacterial, 24% fungal, 6% sepsis, and 6% viral. Females had higher FN readmission rates (RR 1.7 (1.3, 2.4) p = 0.007), as did pts with higher BMI (RR 1.06 (1.01, 1.09) p = 0.005), while age and HiDAC dose were not associated with readmission. Only 34% of all readmissions were in the absence of a documented infection. Conclusions: The majority of FN readmissions were associated with clinical or microbiologically documented infections and are not avoidable. Females and pts with higher BMI were more likely to be readmitted. Readmission of AML pts following HiDAC is expected, and therefore, should be excluded from measures of value and quality.

scholarly journals Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

2020 ◽  
Author(s):  
Zhen Lin ◽  
Yinghong Zhai ◽  
Hedong Han ◽  
Yang Cao ◽  
Cheng Wu ◽  
...  
Keyword(s):  
The United States ◽  
Medical Advice ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Readmission Rates ◽  
Against Medical Advice ◽  
Medical Institutions ◽  
Vulnerable Patients ◽  
Significant Difference ◽  
Hospitalization Costs

Abstract Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

scholarly journals Reducing Stroke Readmission Through the Implementation of Telehealth

2021 ◽  
Author(s):  
◽  
Leilani Hermosura
Keyword(s):  
Readmission Rate ◽  
Hospital Setting ◽  
Outcome Data ◽  
Stroke Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Discharge Care ◽  
Practice Problem ◽  
The Impact

Practice Problem: Readmission occurs frequently among patients with stroke and because of this, the Centers for Medicare and Medicaid Services (CMS) have imposed programs to reduce 30-day readmissions among hospitals. The health care system must respond with transition of care, especially during the period of recent stroke to improve patient outcomes. PICOT: The PICOT question that guided this project was among patients with a recent diagnosis of stroke (P), what is the effect of a telehealth appointment with a nurse practitioner (NP) for post discharge follow-up (I), compared to a standard face-to-face clinic appointment (C), on 30-day readmissions rates (O), within two months (T)? Evidence: Stroke is the fourth leading cause of death and has a readmission rate of 14%. Past studies have demonstrated the effectiveness of telehealth in treating patients outside of the hospital setting, which suggests the potential of telehealth on post-discharge follow-up care. Intervention: To assess the impact of telehealth on 30-day readmission rates, stroke patients received a telehealth follow-up phone visit by a NP within ten days of being discharged to home. Outcome: Data was collected from participant’s electronic health records (EHR) and discharge databases from October 13 to November 13, 2020. Among participants, the implementation of telehealth visits demonstrated a reduced readmission rate of 6.25% for stroke patients. Conclusion: Telehealth is an effective, sustainable, and widely implementable strategy to provide post-discharge care to patients. This study outlined a framework to further analyze the effectiveness of telehealth visits in reducing 30-day readmission rates among stroke patients.

Development and usability of a digital healthcare management ecosystem to reduce hospital readmissions. (Preprint)

2020 ◽  
Author(s):  
Prem Prakash Sharma ◽  
Christine Hsieh ◽  
Khalid Aljabri ◽  
Vishnu Vardhan ◽  
Elizabeth Bisio ◽  
...  
Keyword(s):  
Patient Engagement ◽  
The United States ◽  
Healthcare Management ◽  
Unplanned Readmission ◽  
Proof Of Concept ◽  
Post Discharge ◽  
Evaluation Period ◽  
Testing Period ◽  
Discharge Care ◽  
Digital Healthcare

BACKGROUND Among 36 million hospitalizations that occur each year in the United States, >5 million return for unplanned readmission within 30 days of discharge. Although, prevention of readmission due to clinical and procedural factors are considered, there has not been a sufficient focus on improving patient engagement to reduce readmissions. Poor patient engagement by the hospital clinical team results in the lack of knowledge of the disease and treatment in patients that further lead to inadequate self-managed care for recovery during the post-discharge period. OBJECTIVE The objective of this study was to assess proof-of-concept of a digital healthcare management ecosystem that allow human and digital interactions to reduce unplanned readmissions by providing comprehensive post-discharge care to individuals discharged after major surgery. METHODS Post-discharge care was through digitized tailored care pathways provided by 19 care coaches (1 for 50 patients) supported by a digital expert medical team. We tested our digital ecosystem from January 01, 2019 to December 31, 2019 in cardiac and orthopedic surgery departments, Fortis Hospital, Bangalore, India. The first six months was the testing period where the system was deployed, tested in real-world, and refined using feedback. The testing period was followed by six months of evaluation period. RESULTS A total of 152 patients were provided digital care during testing and 648 patients during the evaluation period. During a 30-day follow up after discharge, 80/800 (10%) communicated clinical complaints, and 39 were readmitted (4.9%). CONCLUSIONS Our results demonstrate feasibility and proof-of-concept of a comprehensive digital post-discharge care ecosystem, a unique innovative solution to reduce unplanned readmission rates and subsequently reduce healthcare costs. However, an important part of effectiveness of post-discharge care remains in testing our solution in large clinical studies

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

scholarly journals SURG-26. READMISSION FOLLOWING RESECTION FOR PATIENTS WITH BRAIN METASTASES IN THE UNITED STATES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi245-vi245
Author(s):  
Rupesh Kotecha ◽  
Muni Rubens ◽  
Sergio Gonzalez-Arias ◽  
Vitaly Siomin ◽  
Matthew Hall ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Disease ◽  
Significant Proportion ◽  
The United States ◽  
Patient Specific ◽  
Unplanned Readmission ◽  
Readmission Rates ◽  
Operative Care ◽  
Nationally Representative

Abstract OBJECTIVE Up to 30% of cancer patients will develop brain metastasis during the course of their systemic disease with a significant proportion undergoing resection of at least one lesion. The objective of the present study was to characterize the rates, predictors, and costs of 30-day readmissions following craniotomy for brain metastases using a nationally representative database. METHODS This study was a retrospective analysis of data from the Nationwide Readmissions Database (NRD) from 2010–2014. We included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rates. Secondary outcomes included predictors and costs of readmissions. RESULTS During the study period, there were 44,846 index hospitalizations for patients who underwent resection of brain metastasis. Among this cohort, 17.8% (n=7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the study period (P=0.286). The odds of unplanned readmission were significantly greater in patients with thromboembolic complications (aOR, 1.53; 95% CI: 1.18–2.01), patients with Elixhauser comorbidities >3 (aOR, 1.35; 95% CI: 1.22–1.50), male patients (adjusted odds ratio [aOR], 1.29; 95% CI: 1.17–1.42), patients with an initial length of stay ≥5 days (aOR, 1.02; 95% CI: 1.01–1.03). The median per-patient cost for 30-day unplanned readmission was $11,109 and this accounted for a total cost of $132.1 million during the study period. CONCLUSIONS Unplanned readmissions after resection for brain metastases involve substantial healthcare expenditures. Though there have been many interventions for improving surgical quality, post-operative care, and cost metrics, unplanned readmission rates have not changed. Key patient-specific variables and high rates of comorbidities should be considered to focus our efforts on patient selection for resection, and for strengthening existing interventions for high-risk patients.

Abstract WMP94: Readmission Within 30 days After Acute Ischemic Stroke, United States 2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Mary G George ◽  
Sallyann M Coleman King ◽  
Cathleen Gillespie ◽  
Robert Merritt
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
The United States ◽  
Artery Occlusion ◽  
Principal Diagnosis ◽  
Readmission Rates ◽  
The Cost

Introduction: Hospital readmissions contribute significantly to the cost of medical care and reflect the burden of disease. Limited data have been reported on national hospital readmission after acute ischemic stroke. Methods: Among 2013 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD), we identified acute ischemic stroke (AIS) hospitalizations using principal diagnosis ICD-9-CM codes. We provided national estimates of AIS non-elective readmission rates within 30 days. Results: In 2013, there were a total of 489,813 adult index AIS admissions in the United States. The readmission rate within 30 days for a new AIS as the principal diagnosis was 2.1% of index AIS admissions, and was 10.2% of all readmissions. The readmission rate for all non-elective reasons increased with age, with the lowest readmission rate (8.9%) among ages 18-44, and the highest (11.7%).among ages 85+. The readmission rate was higher among patients with public insurance (11.1%) as compared to private (7.4%) or others (7.9%). Recurrent AIS (20.2%) was the most common reason for readmission, including unspecified cerebral artery occlusion with infarction (ICD9-CM=434.91, 13.0%) and cerebral embolism with infarction (ICD9-CM=434.11, 3.1%). In addition, infections were among the most common causes (Septicemia 5.7%, UTI 2.7%, and pneumonia 2.2%) and TIA (2.4%). Conclusions: The findings have important implications for identifying groups and conditions at high-risk for readmission. The large number of recurrent AIS within 30 days of index AIS highlights the need for improved patient follow-up and secondary prevention treatment.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

scholarly journals Risk factors for acute psychiatric readmission

1997 ◽  
Vol 21 (10) ◽  
pp. 600-603 ◽  
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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