Association of Hospital Mortality and Readmission Rates in COPD Following Implementation of the Hospital Readmissions Reduction Program in the United States

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.

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Predictors of early readmission to hospital and mortality in patients with malignant ascites: Analysis of the nationwide readmissions database.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12057 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12057-12057

Author(s):

Omid Yazdanpanah ◽

Tanveer Mir ◽

Sohaip Kabashneh ◽

Ibrahim Azar ◽

Misako Nagasaka ◽

...

Keyword(s):

United States ◽

Health Care ◽

Pulmonary Embolism ◽

Hospital Mortality ◽

Health Care Disparities ◽

Hospital Readmissions ◽

Strong Association ◽

Malignant Ascites ◽

The United States ◽

Early Readmission

12057 Background: Malignant ascites accounts for 7 percent of ascites cases in the United States. It is a common manifestation of several solid tumors and is associated with poor prognosis with median survival of 3 months. Moreover, patients with malignant ascites are at risk of recurrent hospitalizations. Hospital readmissions are costly for health-care system and are regarded as a quality of care index. Nevertheless, predictive factors for hospital readmissions and mortality in patients with malignant ascites are limited. Understanding these factors can expedite development of strategies to reduce the readmission and health-care costs. Methods: Utilizing the Nationwide Readmissions Database (NRD), we conducted a retrospective cohort study on patients admitted with malignant ascites between 2016 and 2018 across the United States. We used multivariable logistic regression to determine the predictors of unplanned 30-days readmissions and mortality among patients with malignant ascites. Results: Out of 130,648 patients hospitalized with malignant ascites, 15,756 individuals (12.1%) were readmitted within next 30 days. Predictors of early readmission included pulmonary embolism (OR 2.40; 95% CI 1.55-3.74), complicated diabetes (OR 1.28; 95% CI 1.05-1.56) and having Medicaid insurance (OR 1.34; 95% CI 1.11-1.62). In-hospital mortality for patients with malignant ascites was 14.1%. The comorbidities associated with increased mortality were liver disease (OR 1.87; 95% CI 1.77-1.97), pulmonary embolism (OR 1.60; 95% CI 1.34-1.90), renal failure (OR 1.39; 95% CI 1.27-1.52), and congestive heart failure (OR 1.27; 95% CI 1.16-1.38). Patients with Medicaid insurance also had higher mortality (OR 1.21; 95% CI 1.12-1.32) among the payers. Conclusions: One in eight patients with malignant ascites was readmitted to the hospital within 30 days of discharge. By examining the risk factors leading to readmission, this study helped to identify the subpopulations of patients likely to become more ill. The strong association of pulmonary embolism with readmission and in hospital mortality suggests the benefit of prophylactic anticoagulation. Furthermore, higher readmission and mortality rate within Medicaid insurance population can open a new window in studying health care disparities.

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Faculty Opinions recommendation of In-Hospital Mortality after Surgical Lung Biopsy for Interstitial Lung Disease in the United States. 2000 to 2011.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726000519.793524892 ◽

2016 ◽

Author(s):

Jay H Ryu

Keyword(s):

United States ◽

Interstitial Lung Disease ◽

Hospital Mortality ◽

Lung Disease ◽

Lung Biopsy ◽

The United States ◽

Surgical Lung Biopsy

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Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

Physical Therapy ◽

10.1093/ptj/pzaa230 ◽

2021 ◽

Author(s):

Rachel A Prusynski ◽

Allison M Gustavson ◽

Siddhi R Shrivastav ◽

Tracy M Mroz

Keyword(s):

United States ◽

Systematic Review ◽

Patient Outcomes ◽

Hospital Readmissions ◽

The United States ◽

Skilled Nursing Facilities ◽

Functional Improvement ◽

Nursing Facilities ◽

Skilled Nursing ◽

The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

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Abstract 014: Evaluation of Readmission after Acute Myocardial Infarction for Patients Included in Medicare’s Hospital Readmissions Reduction Program

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.014 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Lila M Martin ◽

Ryan W Thompson ◽

Timothy G Ferris ◽

Jagmeet P Singh ◽

Elizabeth Laikhter ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Readmissions ◽

Index Hospitalization ◽

Readmission Rates ◽

Troponin Elevation ◽

Reduction Program ◽

Improve Accuracy ◽

Episodes Of Care ◽

Index Hospital

Introduction: Medicare’s Hospital Readmissions Reduction Program assesses financial penalties for hospitals based on risk-standardized readmission rates after specific episodes of care, including acute myocardial infarction (AMI). Whether the algorithm accurately identifies patients with AMI who have preventable readmission is unknown. Methods: Using administrative data from Medicare, we conducted physician-adjudicated chart reviews of all patients considered 30 day readmissions after AMI attributed to one hospital from July 2012-June 2015. We extracted information about revascularization during index hospitalization. For patients readmitted to the index hospital or an affiliate, we also extracted reason for readmission. Results: Of 199 admissions, 66 (33.2%) received PCI and 19 (9.6%) underwent CABG on index hospitalization. The remainder of patients did not receive any intervention, i.e. 39 patients (19.6%) were declined due to procedural risk, 15 (7.5%) because of goals of care and 14 (7.0%) refused revascularization. Forty-six patients (23.1%) had troponin elevation in the absence of an MI and did not have an indication for revascularization. The most common diagnoses of the 161 (80.9%) patients readmitted to the index hospital or an affiliate were infections and cardiac and non-cardiac chest discomfort (Table 1). Conclusions: Our results demonstrate that many AMI patients who count towards the Medicare penalty do not receive revascularization during the index hospitalization because of high procedural risk or patient preference. Focusing on these patients may improve readmission metric performance. Furthermore, adding administrative codes for prohibitive procedural risk may improve accuracy of the metric as a measure of quality.

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Abstract 514: Sex-Related Disparities in Outcomes After Myocardial Infarction Among Patients With Atrial Fibrillation: Evidence From a Nationwide Study

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.514 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Akintunde M Akinjero ◽

Oluwole Adegbala ◽

Tomi Akinyemiju

Keyword(s):

United States ◽

Myocardial Infarction ◽

Atrial Fibrillation ◽

Hospital Mortality ◽

Female Gender ◽

The United States ◽

Nationwide Study ◽

Adjusted Risk ◽

Targeted Interventions ◽

Significant Difference

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes.

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Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽

10.1161/str.44.suppl_1.a45 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Tenbit Emiru ◽

Malik M Adil ◽

Adnan I Qureshi

Keyword(s):

United States ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Clinical Characteristics ◽

The United States ◽

Treated Group ◽

Hospital Charges ◽

Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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Abstract 1: Readmission Rates Across All Insurance Types After Passage of the Hospital Readmissions Reduction Program: A Nationwide Analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.12.suppl_1.1 ◽

2019 ◽

Vol 12 (Suppl_1) ◽

Author(s):

Enrico G Ferro ◽

Eric A Secemsky ◽

Rishi K Wadhera ◽

Eunhee Choi ◽

Jordan B Strom ◽

...

Keyword(s):

Hospital Readmissions ◽

Readmission Rates ◽

Reduction Program

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Does Immediate Tissue Expander Placement Increase Immediate Postoperative Complications in Patients with Breast Cancer?

The American Surgeon ◽

10.1177/000313481508100225 ◽

2015 ◽

Vol 81 (2) ◽

pp. 143-149

Author(s):

Hossein Masoomi ◽

Keyianoosh Z. Paydar ◽

Gregory R. D. Evans ◽

Emily Tan ◽

Karen T. Lane ◽

...

Keyword(s):

Breast Cancer ◽

United States ◽

Hospital Mortality ◽

Breast Reconstruction ◽

Complication Rate ◽

Tissue Expander ◽

The United States ◽

Immediate Breast Reconstruction ◽

Perioperative Outcomes ◽

Immediate Reconstruction

The objectives of this study were to evaluate 1) the rate of immediate breast reconstruction; 2) the frequency of immediate tissue expander placement; and 3) to compare perioperative outcomes in patients who underwent breast reconstruction after mastectomy for breast cancer with immediate tissue expander placement (TE) with those with no reconstruction (NR). Using the Nationwide Inpatient Sample database, we examined the clinical data of patients with breast cancer who underwent mastectomy with or without immediate TE from 2006 to 2010 in the United States. A total of 344,253 patients with breast cancer underwent mastectomy in this period in the United States. Of these patients, 31 per cent had immediate breast reconstruction. We only included patients with mastectomy and no reconstruction (NR: 237,825 patients) and patients who underwent only TE placement with no other reconstruction combination (TE: 61,178 patients) to this study. Patients in the TE group had a lower overall postoperative complication rate (2.6 vs 5.5%; P < 0.01) and lower in-hospital mortality rate (0.01 vs 0.09%; P < 0.01) compared with the NR group. Fifty-three per cent of patients in the NR group were discharged the day of surgery compared with 36 per cent of patients in the TE group. Using multivariate regression analyses and adjusting patient characteristics and comorbidities, patients in the TE group had a significantly lower overall complication rate (adjusted odds ratio [AOR], 0.6) and lower in-hospital mortality (AOR, 0.2) compared with the NR group. The rate of immediate reconstruction is 31 per cent. TE alone is the most common type of immediate reconstruction (57%). There is a lower complication rate for the patients who underwent immediate TE versus the no-reconstruction cohort.

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