Abstract 2: Facility-level Variation in 30-day PCI Mortality, Readmission, and Costs in the VA Health Care System: Insights About Short-term Healthcare Value From The VA CART Program

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Steven M Bradley ◽  
Colin I O'Donnell ◽  
Gary K Grunwald ◽  
Thomas M Maddox ◽  
Stephan D Fihn ◽  
...  
Keyword(s):  
Health Care ◽  
Readmission Rate ◽  
Care Delivery ◽  
Low Cost ◽  
Level Variation ◽  
Short Term ◽  
Readmission Rates ◽  
Facility Level ◽  
Va Health Care System ◽  
Cost Figure

Background: Value in health care, defined as the health outcomes achieved per dollar spent, is emerging as a framework for improvement in health care delivery. We sought to describe facility-level variation in 30-day PCI mortality, readmission and costs. Methods: Using national data from the VA CART Program, we evaluated all patients who had PCI from 2008 to 2010. 30-day total patient costs, readmission, and mortality were attributed to the hospital where the PCI was performed. Risk standardized costs and outcomes were calculated using standardized covariates, adjusting for cardiac and non-cardiac comorbidities. Results: There were 60 hospitals (21,173 patients) that performed more than 20 PCIs during the study period with a mean of 353 PCIs. The unadjusted mean mortality rate was 2.5%, with no significant variation in facility-level risk standardized mortality. The unadjusted mean readmission rate was 10.6%. The risk standardized readmission rate ranged from 0.8 to 1.58 times the average, with 2 hospitals significantly below and 8 hospitals significantly above the risk standardized average. The facility-level median per patient total costs was $26,491 (IQR $20,943 to $31,866). The index hospitalization accounted for 42.4% of 30-day total costs, and readmission accounted for 5.6% of the 30-day total costs at the facility-level. Comparison of risk standardized costs identified 17 hospitals with lower than expected costs and 15 hospitals with higher than expected costs. Facilities with low readmission rates were not overrepresented among low cost facilities, suggesting readmissions are not a major contributor to facility-level 30-day cost (Figure). Conclusion: We observed no variation in facility-level 30-day PCI mortality despite large variation in cost. Although readmission rates varied, readmission accounted for less than 6% of 30-day cost and was not related to facility-level costs. Further studies are needed to determine factors associated with high-value PCI care, defined by low morbidity and mortality despite similar or lower costs.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Collin Bicknell ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Readmission Rate ◽  
High Impact ◽  
Short Term ◽  
Readmission Rates ◽  
Abdominal Aortic ◽  
High Readmission Rate ◽  
Trajectory Modelling

Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P<0.001), older age (P<0.001), and higher comorbidity score (P<0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P<0.001), heart failure (P = 0.01), peripheral vascular disease (P<0.001), female sex (P = 0.02), open repair (P<0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.

Human Factors–Based Mobile Application Design for Global Health

2018 ◽  
Vol 25 (6) ◽  
pp. 557-562 ◽  
Author(s):  
Tyson Schwab ◽  
John Langell
Keyword(s):  
Health Care ◽  
Global Health ◽  
Human Factors ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Mobile Apps ◽  
Low Cost ◽  
User Centered Design ◽  
App Development ◽  
Global Health Care

Background. The rapid adoption of smartphones and software applications (apps) has become prevalent worldwide, making these technologies nearly universally available. Low-cost mobile health (M-health) platforms are being rapidly adopted in both developed and emerging markets and have transformed the health care delivery landscape. Human factors optimization is critical to the safe and sustainable adoption of M-health solutions. The overall goal of engaging human factors requirements in the software app design process is to decrease patient safety risks while increasing usability and productivity for the end user. Methods. An extensive review of the literature was conducted using PubMed and Google search engines to identify best approaches to M-health software design based on human factors and user-centered design to optimize the usability, safety, and efficacy of M-health apps. Extracted data were used to create a health care app development algorithm. Results. A best practice algorithm for the design of mobile apps for global health care, based on the extracted data, was developed. The approach is based on an iterative 4-stage process that incorporates human factors and user-centered design processes. This process helps optimize the development of safe and effective mobile apps for use in global health care delivery and disease prevention. Conclusion. Mobile technologies designed for developing regions offer a potential solution to provide effective, low-cost health care. Applying human factors design principles to global health care app development helps ensure the delivery of safe and effective technologies tailored to the end-users requirements.

The Effects of a Practice Guideline on Endoscopic Sinus Surgery at an Academic Center

1997 ◽  
Vol 11 (2) ◽  
pp. 161-166 ◽  
Author(s):  
Michael G. Stewart ◽  
Edward J. Hillman ◽  
Donald T. Donovan ◽  
Sarper H. Tanli
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
Care Delivery ◽  
Hospital Costs ◽  
Sinus Surgery ◽  
Care Process ◽  
Short Term ◽  
Academic Center ◽  
Median Hospital

Practice guidelines (PG) (or clinical pathways) are increasingly important tools for standardizing health care delivery, improving efficiency, monitoring quality, and controlling costs. Health services researchers divide the delivery of health care into three stages: structure, process, and outcome. PGs are a technique to standardize the process of health care delivery, which may result in improved clinical outcomes or may maintain clinical outcomes while increasing process efficiency and decreasing costs. We describe the development and implementation of a PG for endoscopic sinus surgery at an academic center, and report preliminary results on the effects of the PG on the health care process. The PG was developed using a multidisciplinary combination of consensus-building and evidence-based techniques. Initially, participation in the PG was voluntary and at the attending physician's discretion. One year after implementation of the PG, 41 patients had been enrolled by members of the medical school's full-time faculty. Process and short-term outcome variables on those patients were compared to a random sample of 50 patients treated by the same physicians, but not using the PG. There was no evidence of selection bias into the PG based on demographics, severity of sinusitis, or the presence of comorbid factors. There were no differences in time spent in the operating room, postanesthesia care unit, or day surgery observation unit, between patients using the PG and not using the PG. However, patients not using the PG had a significantly higher rate of unplanned admission. Patients using the PG had significantly lower median hospital costs and charges than did patients not using the PG. In addition, median hospital costs and charges decreased steadily for all patients (not just those using the PG), simultaneous with the development and implementation of the PG. There were no differences in short-term clinical outcomes between PG and non-PG patients. In summary, the development and implementation of a PG for endoscopic sinus surgery resulted in lower hospital costs and charges while maintaining acceptable short-term clinical outcomes. PGs have important implications for improving the efficiency of the health care process.

scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study

10.2196/18038 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18038
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

Background High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. Objective The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. Methods We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. Results We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. Conclusions Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. Trial Registration ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

scholarly journals Essential drug use patterns in primary health care in Tamil Nadu

2017 ◽  
Vol 4 (12) ◽  
pp. 4389
Author(s):  
Sashidharan C. ◽  
Gopalakrishnan S.
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
State Government ◽  
Tamil Nadu ◽  
Care Delivery ◽  
Low Cost ◽  
Health Care Delivery System ◽  
Care Needs ◽  
Essential Drugs

Tamil Nadu is one among the few States in India to implement the concept of essential drugs in the health care delivery system. Essential drugs are those that satisfy the health care needs of the majority of the population, meant to treat commonly prevalent diseases, they should therefore be safe, effective and should be available at low cost at all times, in adequate amounts and in the appropriate dosage forms. Essential drugs are critically required for the management of 90-95% of commonly occurring disease conditions in our country. The Tamil Nadu medical services corporation (TNMSC) was established in 1994 by the Tamil Nadu State Government in order to scientifically procure, store and distribute quality drugs based on the Essential drugs concept to all levels of health care delivery system in the State at low cost. This article is meant to identify the benefits of using essential drugs in the health care delivery system in Tamil Nadu. 

scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

BACKGROUND High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. OBJECTIVE The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. METHODS We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. RESULTS We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. CONCLUSIONS Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. CLINICALTRIAL ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

780 A Systematic Review and Meta-analysis of 30-day Readmission Rates Following Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S224-S224
Author(s):  
Ludwik Branski ◽  
Christian Tapking ◽  
Gabriel Hundeshagen ◽  
Alexis Boson ◽  
Victoria G Rontoyanni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Health Care ◽  
Health Care Providers ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Random Effect ◽  
Total Body Surface Area ◽  
Care Providers ◽  
Readmission Rates

Abstract Introduction Unplanned hospital readmissions in surgical areas account for high costs and have become an area of focus for health care providers and insurance companies. The aim of this systematic review is to identify the rate and common reasons for unplanned 30-day readmission following burns. Methods This study was performed following the PRISMA guidelines. Pubmed, Web of Science and CENTRAL databases were searched for publications without date or language restrictions. Extracted outcomes included 30-day readmission rate and reasons for readmission. Pooled 30-day readmission rate was estimated from weighted individual study estimates using random-effect models. Pooled estimates for risk factors are reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of eight studies were included into qualitative analysis and six (four adults, two children) into quantitative analysis. The overall readmission rate was 7.4% (95% CI 4.1 - 10.7) in adults and 2.7% (95% CI 2.2 - 3.2) in children. Based on two studies in 112,312 adult burn patients, burn size greater than 20% total body surface area (TBSA) was not a significant predictor of readmission rate (OR 1.75, 95% CI 0.64 – 4.75; NS). The most common reasons were infection/sepsis, wound healing complications, and pain in both adults and children. Conclusions Unplanned readmissions following burns are generally low and appear more common in adults than in pediatric patients. However, only few studies are reporting on 30-day readmission rates following burns. Evidence is limited to support a significant association between greater burn size and higher readmission rates. Applicability of Research to Practice Since cost effectiveness and utilized hospital capacity are becoming an area of focus for improvement in health care, future studies should assess the risk factors of unplanned readmission following burns. Follow-up assessments and outpatient resources, even if not underlined by this data, could reduce readmission rates.

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