Abstract 256: Readmission Avoidability in Acute Coronary Syndrome Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Maria Souphis ◽  
Rachel Sylvester ◽  
Alison Wiles ◽  
Meghana Subramanian ◽  
William Froehlich ◽  
...  
Keyword(s):  
Transitional Care ◽  
Drug Effects ◽  
Care Program ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
History Of ◽  
Definition Of ◽  
Avoidable Readmission ◽  
Cancer Complications ◽  
Avoidable Readmissions

Background: Readmissions for ACS are common, costly, and potentially preventable. According to Medicare 13.4% of AMI admissions were followed by a rehospitalization within 15 days. A 2007 MedPAC report declared 76% of 30-day readmissions preventable. These rates are used as quality indicators despite lack of consensus on the definition of avoidable and unavoidable readmissions. We sought to define these terms and to analyze the effect of these definitions on 30-day outcomes. Methods: BRIDGE (Bridging the Discharge Gap Effectively) is an NP-led transitional care program for cardiac patients within 14 days of discharge. Retrospective data were abstracted on ACS patients readmitted before their appointments between 2008-2010. All readmissions were characterized as avoidable or unavoidable. Definitions were developed from the literature and in concert with senior cardiologists. Avoidable readmission was defined as being the result of a patient or provider issue that if managed may have prevented the admission. Unavoidable readmissions were defined as a patient in need of acute care. Avoidability status was further divided as related or unrelated to the index diagnosis. Results: Of 1188 BRIDGE referrals 304 (25.6%) experienced ACS events. In comparison to the total ACS population, patients readmitted before their BRIDGE clinic appointment (BC) (n=21, 6.9%) tended to be older, female, and were less likely to have a history of a cath or AMI (Table 1). In this study, 81% (n=17) of early readmissions were deemed unavoidable and most (n=14, 66.7%) were attributed to non-ACS issues or disease progression. These unavoidable readmissions included patients with cancer complications, chest pain, or other non-related diagnoses. Only 19% (n=4) of the readmissions were declared avoidable as a result of patient lack of adherence or provider issues such as adverse drug effects. Conclusion: The majority of early (before BC) readmissions following an index hospitalization for ACS patients referred to BRIDGE were unavoidable and unrelated to ACS. A clear discrepancy is seen between the 76% preventable readmissions in the MedPAC report and the 19% preventable readmissions in this study. Distinctions between unavoidable and avoidable readmissions should inform the utility of 30-day readmission rates as quality metrics.

Abstract 097: Effects of BRIDGE Attendance on the Outcomes of Diabetic Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Caitlin Fette ◽  
Rachel Krallman ◽  
Colin McMahon ◽  
Daniel Montgomery ◽  
Jennifer Wang ◽  
...  
Keyword(s):  
Transitional Care ◽  
Care Program ◽  
Primary Diagnosis ◽  
Lower Mortality ◽  
Diabetic Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Discharge Outcomes

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.

Abstract 259: The Effects of Depression on BRIDGE Patients

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Jacob Carolan ◽  
Rachel Sylvester ◽  
Nathaniel Costin ◽  
Colin McMahon ◽  
Morgan Bradford ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Nurse Practitioner ◽  
Transitional Care ◽  
Care Program ◽  
Retrospective Data ◽  
Readmission Rates ◽  
History Of ◽  
Discharge Gap ◽  
History Of Depression

Background: Depression creates additional barriers to receiving transitional care. Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner-delivered cardiac transitional care program. We sought to determine if, 1) there was a difference in readmission rates of BRIDGE patients with depression (PWD) and those without depression (PWOD), and 2) if BRIDGE attendance lowered 30-day readmission rates in PWD. Methods: Retrospective data was abstracted for all patients referred to BRIDGE (June ’08 - Dec ’14). Readmission rates of PWD and PWOD were compared in both BRIDGE attenders and non-attenders. Results: Of 2446 patients, 577 (23.6%) had a history of depression. PWD were significantly younger (62.82 ± 14.04 v 66.17 ± 14.88, p<0.001), more likely to be female (55.6% v 39.1%, p<0.001), and less likely to attend their BRIDGE appointment (67.1% v 72.1%, p=0.010) than PWOD. Among BRIDGE attendees, PWD had significantly higher 60, 90, and 180 day readmission rates than PWOD (Table 1). Although 30 day readmissions were lower in PWD who attended BRIDGE, compared to PWD who did not attend BRIDGE, these results were not significant (10.5% v 12.6%, p=0.505), and this trend was not seen in 60, 90, and 180 day readmission rates. Conclusions: PWD are less likely to attend BRIDGE appointments and more likely to be readmitted. These results suggest that special attention needs to be given to PWD upon hospital discharge to ensure that proper transitional care is received and readmissions are avoided.

Abstract 339: Insights into Readmission Rates of Atrial Fibrillation Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Thomas Vasko ◽  
Rachel Sylvester ◽  
William Froehlich ◽  
Meghana Subramanian ◽  
Alison Wiles ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transitional Care ◽  
Care Program ◽  
Post Discharge ◽  
Readmission Rates ◽  
Bridge Program ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Care Models

Purpose and Background: Bridging the Discharge Gap Effectively (BRIDGE) is an NP-driven transitional care program for cardiovascular patients. It has demonstrated lower rates of readmission for patients with acute coronary syndrome who participated, but a similar benefit was not seen for atrial fibrillation (AF) patients. We sought to assess differences between AF patients who participated in the BRIDGE program and those who did not. Methods: Retrospective review of all patients referred to BRIDGE with a primary discharge diagnosis of AF was conducted (n=148). An equal number of BRIDGE attendees was randomly matched to non-attendees (n=36). Univariate techniques were used to compare groups. Results: Of 148 AF patients referred to BRIDGE, 84 (56.8%) attended BRIDGE, 36 (24.3%) saw cardiologists or PCPs for their first post-discharge follow-up, and 28 (18.9%) saw other providers or had unknown follow up. There was no significant difference in median time to follow up (12.5 days for attendees vs 9.0 days for non-attendees, p=0.503). Of the 72 patients reviewed, 17 (23.6%) were readmitted within 30 days (Table 1). Non-attendees were more likely (85.7% vs 40% p=0.134) to be readmitted with AF/related diagnoses as compared to attendees. More than half of 30-day readmissions for BRIDGE attendees were unrelated to AF (n=6, 60.0%). There was a trend toward greater incidence of comorbid CAD, HTN, CHF, or vascular disease among BRIDGE attendees, compared to non-attendees. Conclusion: Readmission patterns vary in AF patients; comorbid conditions play a role in early 30-day readmissions for AF patients despite adequate transitional care. NP-driven transitional care models, compared to traditional follow-up with a physician provider, may help identify additional issues related to comorbidities, leading to readmission. A larger sample is needed to better understand this dichotomy and to determine what measures can be taken to enhance the BRIDGE program for AF patients.

Abstract 338: BRIDGE: A Post-Discharge Transitional Care Model in over 1600 Cardiac Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Rachel Sylvester ◽  
Minnie Bluhm ◽  
William Froehlich ◽  
Meghana Subramanian ◽  
Alison Wiles ◽  
...  
Keyword(s):  
Transitional Care ◽  
Care Program ◽  
Clinic Visit ◽  
Cardiac Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Care Clinic ◽  
Charlson Comorbidity Score ◽  
History Of

Background: Current legislation imposes financial penalties for high 30-day readmissions for AMI. BRIDGE is a NP-led, post-discharge transitional care program for cardiac patients, aimed at ensuring prompt follow up (f/u; in 14 days) and care coordination. Herein we report the effect of BRIDGE on readmissions in over 1600 cases. Methods: Retrospective data was abstracted for patients referred to BRIDGE including demographics, comorbidities, medications, days to f/u, and 6-month outcomes by diagnosis. Results: Of 1955 patients referred to the BRIDGE clinic, 271 (13.9%) were excluded for adverse events prior to their visit (ED visit n=60, readmission n=193, or death n=14) or missing data (n=4). 1210 (71.9%) of patients from the remaining sample (n=1684) attended BRIDGE. Diagnoses included: ACS (n=462, 27.6%); angina (n=207, 12.4%); CAD (n=196, 11.7%); AFib (n=247, 14.7%); CHF (n=316, 18.9%); or other (n=256, 15.2%). With the exception of mental health disorders (35.4% v. 29.1%, p=.012) there were no baseline differences (including the Charlson Comorbidity Score) between non-attendees and attendees (Table 1). ACS attendees, compared to non-attendees, had a trend toward lower 30, 60, and 90 day readmission rates (Table 2). This was not observed for other diagnoses. Conclusions: A NP based transitional care clinic visit early post-discharge appears to reduce early readmissions for patients with an ACS, but in this study did not impact other cardiac conditions. Also, patients with a history of substance abuse or depression are significantly less likely to attend BRIDGE appointments. To avoid a lapse in care, these patients may need prompt f/u with their PCP or cardiologist to help reduce early readmissions.

Abstract 357: Effect of an Early Nurse Practitioner Based Transitional Care Program on Atrial Fibrillation Readmissions

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Redah Z Mahmood ◽  
Sherry M Bumpus ◽  
Daniel G Montgomery ◽  
Eva Kline-Rogers ◽  
James B Froehlich ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nurse Practitioner ◽  
Transitional Care ◽  
Tertiary Care ◽  
Care Program ◽  
Discharge Diagnosis ◽  
Chart Audit ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Ed Visits

Background: BRIDGE is a nurse practitioner (NP) based transitional care program for cardiac patients(pts) discharged from a large tertiary care health system. Attendance at the BRIDGE clinic has been shown to reduce early readmission and ED visits for acute coronary syndrome (ACS) pts. Little is known about causes of readmission for atrial fibrillation (AF) pts and whether an NP based program affects overall readmissions. Methods: Retrospective data on 1188 pts was abstracted from 2008 to 2010 for pts referred to BRIDGE. Early (30 day) readmission of pts with discharge diagnosis of AF underwent qualitative chart audit by a trained MD abstractor. When examining if BRIDGE affected readmissions, we excluded pts with ED visits/readmits prior to BRIDGE. Results: Median time to BRIDGE was 16 days. Of 1010 with complete data, 148 (15%) had a discharge diagnosis of AF; 110/148 (74%) AF pts attended BRIDGE. Thirty day readmission (30DR) for AF was 23% (34/148); 17/34 (57%) were sent to the ED by a MD or nurse. Attending BRIDGE had no effect on outcomes at all time points (table 1); 17 patients were readmitted before BRIDGE. Readmission at 6 months for AF was 41% for those who attended BRIDGE, 29% for those who did not (p=0.190). Table 2 details reasons for all 30DR in AF pts. Chart review demonstrated that all 30DR were appropriate, 83% (25/30) of non-elective readmissions were unavoidable, and of 5 potentially avoidable readmissions, 2 were due to patient non-compliance. Conclusions: 30-day readmission rates are high for pts recently discharged with a diagnosis of AF and most are unavoidable. A NP based transitional care clinic successful in reducing 30 day readmissions for ACS pts did not prevent either early or late readmissions in AF pts.

Abstract 098: The Prevalence of Racial and Socioeconomic Disparities in an Outpatient Transitional Care Clinic

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Khadijah Hussain ◽  
Colin McMahon ◽  
Rachel Krallman ◽  
Daniel Montgomery ◽  
Thane Feldeisen ◽  
...  
Keyword(s):  
Transitional Care ◽  
Poverty Line ◽  
Low Ses ◽  
Readmission Rates ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Improved Outcomes ◽  
Caucasian Patients ◽  
Ed Visits ◽  
Discharge Gap

Background: Bridging the Discharge Gap Effectively (BRIDGE) is a cardiac transitional care clinic. BRIDGE has demonstrated improved patient outcomes for some populations. This study sought to determine if differences in outcomes (readmissions, ED visits, death) exist for Caucasian and non-Caucasian patients based on BRIDGE attendance and socioeconomic status (SES). Methods: Data on patients referred to BRIDGE from 2008-2014 were analyzed. Patients were split into two cohorts (Caucasian and non-Caucasian) and outcomes for each were independently compared by BRIDGE attendance and SES. Non-low SES was defined as income > $48,600 (200% poverty line for a family of 4) and low SES was income ≤ $48,600. Demographics and outcomes were compared between groups. Results: Of 2964 patients, 15.1% were non-Caucasian (n=448). Caucasians were significantly older than non-Caucasians (66.16±14.29 v 59.14±14.75, p<0.001), and were more likely to have primary diagnoses of acute coronary syndrome (28.2% v 23.5%, p=0.039) or atrial fibrillation (16.8% v 9.3%, p<0.001). Among Caucasian patients, BRIDGE attenders had significantly lower 30-day readmission rates (8.6% v 11.3%, p=0.038) and fewer ED visits within 6 months (1.80±1.3 v 2.10±2.0, p=0.049). Non-Caucasians, however, were more likely to have an ED visit within 6 months (40.9% v 33.7%, p=0.012; data not shown). Non-Caucasians of low SES were more likely to be readmitted within 6 months (40.5% v 29.5%, p=0.029) and less likely to attend BRIDGE (64.9% v 76.4%, p=0.016) than non-low SES non-Caucasians. There were no significant differences between non-low and low SES Caucasian patients. Among BRIDGE attenders, 6-month mortality rates were significantly lower for both groups (Caucasian: 5.2% v 10.8%, p<0.001; non -Caucasian: 4.3% v 10.7%, p=0.013). Conclusions: BRIDGE attendance was associated with improved outcomes in Caucasians that were not seen in non-Caucasians, with the exception of reduced mortality. Also, SES appears to impact non-Caucasians more than Caucasians, with low SES non-Caucasians having higher readmission rates and lower BRIDGE attendance than non-low SES non-Caucasians. Differences seen may be biased due to unevenly distributed groups (i.e. age and diagnosis). Efforts to target these vulnerable populations are warranted to reduce disparities.

scholarly journals Assessing 30-day avoidable readmission rates: Is it an appropriate tool to manage emergency department quality of care?

2020 ◽  
Vol 9 (3) ◽  
pp. 11
Author(s):  
Agri Fabio ◽  
Eggli Yves ◽  
Fabrice Dami
Keyword(s):  
Quality Indicator ◽  
Low Cost ◽  
Hospital Readmissions ◽  
Healthcare Providers ◽  
Quality Level ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Avoidable Readmission ◽  
Record Review ◽  
Avoidable Readmissions

Objective: Quality indicators, based on administrative data, are being increasingly used to assess avoidable hospital readmission rates. Their potential to identify areas for improvement at low cost is attractive, but their performance in emergency departments (EDs) has been criticised.Methods: Hospital readmissions were categorised as potentially avoidable or non-avoidable, by a computerised algorithm (SQLape®, version 2016 - Striving for Quality Level and analysing of patient expenditures). Half-yearly rates were reported between July 2015 and June 2016. Two senior physicians conducted a medical record review on 100 randomly selected cases from an ED, flagged as potentially avoidable readmissions (PAR). Results were then discussed with the algorithm’s designer.Results: The algorithm screened 2,182 eligible emergency visits - 105 cases (4.8%), were deemed potentially avoidable by the algorithm. Among 100 randomly selected cases, nine exclusions were due to coding issues and four due to false positives. Overall (N = 87), 20/87 (23%) of readmissions were directly related to sole emergency care, 31/87 (36%) related to healthcare providers other than the ED, and 23/87 (26%) were of mixed provision, while 13/87 (15%) were attributed to the course of the disease.Conclusions: The study confirms the need for a better understanding of the algorithm’s measurement and of its reported results. Careful interpretation is required before a sound conclusion can be made. Indeed, it is apparent that the 30-day PAR quality indicator rate reflects a wider parameter of care than hospitals alone, who understandably tend to concentrate on their own, direct liability of care. In particular the 30-day PAR quality indicator is not well-suited to evaluate ED performance.

Abstract 16265: Acute Coronary Syndrome in Patients With Familial Hypercholesterolemia: Incidence, Predictors, and Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Babikir Kheiri ◽  
Sergio Fazio ◽  
Timothy F Simpson ◽  
Mohammed Osman ◽  
Sudarshan Balla ◽  
...  
Keyword(s):  
High Risk ◽  
Familial Hypercholesterolemia ◽  
Circulatory Support ◽  
Cardiac Complications ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Coronary Syndromes ◽  
Male Sex

Introduction: Individuals with Familial Hypercholesterolemia (FH) are at high risk for ASCVD events. However, little is known about the incidence, predictors, and outcomes of admissions for acute coronary syndromes (ACS) in this population. Objectives: To describe the in-hospital outcomes, readmission rates, and predictors of recurrent ACS in the FH population. Methods: Utilizing the National Readmission Databases from 10/2016 to 12/2017, we identified individuals with FH (ICD-10 E78.01) admitted with ACS. The primary outcome was in-hospital complications, which was compared using propensity-score matching (PSM 1:3). Multivariate logistic regression was performed to identify the predictors of 30-day readmissions. Results: There were a total of 1,697,513 ACS admissions during the study period (non-FH=1,969,979 and FH=534). Individuals admitted for ACS with FH were younger (median age 57 vs 69), had fewer comorbidities (hypertension, diabetes mellitus, and heart failure), were more likely to present with STEMI (32.8% vs 22.6%; p<0.01) and more likely to undergo multi-vessels revascularization (CABG 12.7% vs 5.9%, p<0.01; multivessel PCI 11.4% vs 7.6%, p<0.01) than patients without FH. After PSM, FH patients more commonly experienced in-hospital VT arrest [11.8% vs 8.0%; p<0.01] and required more frequent mechanical circulatory support [8.6% vs 3.3%; p<0.01]) compared to those without FH. Although FH patients who survived the initial index admission (97.9%) had lower 30-day readmission rates than non-FH patients (9.3% vs 15.1%; p<0.01), readmission was more frequently for cardiovascular disease (81.5% vs 46.5%; p<0.01). Predictors of 30-day readmission were young age, male sex, diabetes, history of CAD, and smoking (p<0.01). Conclusions: Individuals with FH admitted with ACS are younger, have fewer comorbidities, and more frequently present with STEMIs compared to those without FH. FH patients were more likely to suffer in-hospital cardiac complications. These results highlight the high-risk status of ACS and post-ACS care in FH patients.

Towards the digital land reclamation

2020 ◽  
pp. 5-9
Author(s):  
Sergey Vasil'ev ◽  
Vyacheslav Schedrin ◽  
Aleksandra Slabunova ◽  
Vladimir Slabunov
Keyword(s):  
Retrospective Analysis ◽  
Land Reclamation ◽  
Practical Experience ◽  
Maximum Effect ◽  
Optimal Management ◽  
Scientific Potential ◽  
History Of ◽  
Definition Of ◽  
Further Development ◽  
Full Cooperation

The aim of the research is a retrospective analysis of the history and stages of development of digital land reclamation in Russia, the definition of «Digital land reclamation» and trends in its further development. In the framework of the retrospective analysis the main stages of melioration formation are determined. To achieve the maximum effect of the «digital reclamation» requires full cooperation of practical experience and scientific potential accumulated throughout the history of the reclamation complex, and the latest achievements of science and technology, which is currently possible only through the full digitalization of reclamation activities. The introduction of «digital reclamation» will achieve greater potential and effect in the modernization of the reclamation industry in the «hightech industry», through the use of innovative developments and optimal management decisions.

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