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

2018 ◽  
Vol 24 (1) ◽  
pp. 10-14 ◽  
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.

scholarly journals 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

2017 ◽  
Vol 53 (4) ◽  
pp. 266-271 ◽  
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.

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

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.

scholarly journals The impact of time to first antimicrobial dose on length of stay and 30-day hospital readmission in patients with lower limb cellulitis

2021 ◽  
Author(s):  
Ms Jaclyn L Bishop ◽  
Mr Mark Jones ◽  
Mr James Farquharson ◽  
Ms Kathrine Summerhayes ◽  
Ms Roxanne Tucker ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lower Limb ◽  
Hospital Readmission ◽  
Day Hospital ◽  
The Impact

scholarly journals Transitional care models for chronic patients: preliminary results from an umbrella review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M T Riccardi ◽  
M Cicconi ◽  
W Ricciardi ◽  
M M Gianino ◽  
G Damiani
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Setting ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Current Evidence ◽  
Chronic Patients ◽  
Care Models

Abstract Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p &lt; 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform. Key messages The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.

The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients

Medical Care ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michael Reaume ◽  
Ricardo Batista ◽  
Emily Rhodes ◽  
Braden Knight ◽  
Haris Imsirovic ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Home Care ◽  
Emergency Department Visits ◽  
Care Recipients ◽  
The Impact

scholarly journals Predicting 30-Day Readmission Rate in Inflammatory Bowel Disease Patients: Performance of LACE Index

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Lauren A George ◽  
Brendan Martin ◽  
Neil Gupta ◽  
Nikhil Shastri ◽  
Mukund Venu ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Readmission Rate ◽  
Risk Group ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Unplanned Readmission ◽  
Significant Difference ◽  
Inflammatory Bowel

AbstractBackground and AimsReadmission within 30 days in inflammatory bowel disease (IBD) patients increases treatment costs and serves as a quality indicator. The LACE (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency Department visits in past 6 months) index is used to predict the risk of unplanned readmission within 30 days. The aim of this study was to evaluate the accuracy of using the LACE index in IBD.MethodsCalculation of LACE index was done prospectively for IBD patients admitted to a single tertiary care center. Patient, disease, and treatment characteristics, as well as index hospitalization characteristics including indication for admission and disease activity measures were retrospectively recorded. Descriptive statistics and univariable exact logistic regression analyses were performed.ResultsIn total, 64 IBD patients were admitted during the study period. The 30-day readmission rate of IBD patients was 19% and overall median LACE index was 6, with IQR 6–7. LACE index categorized 16% of IBD patients in low-risk group, 82% in moderate risk group, and 2% in high-risk group. LACE index did not predict 30-day readmission (OR 1.35, CI: 0.88–2.18, P = 0.19). There was no significant difference in 30-day readmission rates with inpatient antibiotic or narcotic use, admission C-reactive protein (CRP), anemia, IBD duration, maintenance therapy, or prior IBD operation. For every 1 day increase in length of stay (LOS), patients were 8% more likely (OR: 1.08, 95% CI: 1.00–1.16) to be readmitted within 30 days (P = .05).ConclusionsLACE index does not accurately identify 30-day readmission risk in the IBD population. As increased LOS is associated with higher risk, there may be benefit for targeted strategic resource allocation via specialized services.

scholarly journals Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

2019 ◽  
Vol 10 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Brian L. Dial ◽  
Valentine R. Esposito ◽  
Richard Danilkowicz ◽  
Jeffrey O’Donnell ◽  
Barrie Sugarman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Multivariable Logistic Regression Analysis ◽  
Day Hospital ◽  
Readmission Rates ◽  
Factors Associated ◽  
Asa Score ◽  
Surgery Patient ◽  
Extended Length

Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

scholarly journals Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale

2017 ◽  
Vol 27 (4) ◽  
pp. 382-390 ◽  
Author(s):  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Silky Chotai ◽  
Deborah Pfortmiller ◽  
Jeffrey M. Sorenson ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Hospital Readmission ◽  
Inpatient Rehabilitation ◽  
Lumbar Spine Surgery ◽  
Day Hospital ◽  
Data Set ◽  
Inpatient Facility ◽  
Grading Scale

OBJECTIVEExtended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies.METHODSThe Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0–12 points), discharge to inpatient facility (0–18 points), and 90-day readmission (0–6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic).RESULTSA total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System class > III, Oswestry Disability Index score ≥ 70, diabetes, Medicare/Medicaid, nonindependent ambulation, and fusion. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and readmission in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups.CONCLUSIONSThe authors introduce the Carolina-Semmes grading scale that effectively stratifies the risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission for patients undergoing first-time elective 1- to 3-level degenerative lumbar spine surgery. This grading scale may be helpful in identifying patients who may require additional resource utilization within a global period after surgery.

scholarly journals Variation Among Hospitals in the Continuity of Care for Older Hospitalized Patients: a Cross-sectional Cohort Study

2021 ◽  
Author(s):  
James S. Goodwin ◽  
Shuang Li ◽  
Jie Zhou ◽  
Yong-Fang Kuo ◽  
Ann Nattinger
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Model ◽  
Continuity Of Care ◽  
Logistic Regression Model ◽  
Large Degree ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
The Impact

Abstract Background: Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital. Methods: We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3-6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model. Results: Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was >84.1%, vs. <24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status. Conclusions: Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.

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