Hospital-Level Factors Related to 30-Day Readmission Rates

2016 ◽  
Vol 32 (1) ◽  
pp. 48-57 ◽  
Author(s):  
Joanne R. Campione ◽  
Scott A. Smith ◽  
Russell E. Mardon
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Repeated Measures ◽  
Readmission Rate ◽  
Healthcare Research ◽  
Hospital Level ◽  
Readmission Rates ◽  
Discharge Data ◽  
The Mean

This study investigates the relationship between inpatient quality of care as measured by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicator (PSI) composite and all-cause, hospital-wide, 30-day readmission rates. Discharge data from 4 statewide databases were analyzed. Linear, repeated-measures regressions were performed to predict hospital-level 30-day readmission rates. The mean readmission rate was 12.9%, and the mean PSI composite ratio was 0.95 among 524 hospitals with 2592 observations. In the hospital-level analysis, the risk-adjusted AHRQ PSI composite was not significantly associated with hospital 30-day readmission rate after controlling for hospital-level characteristics, patient case mix, and sociodemographics. Inpatient quality of care appears to have less influence on hospital readmission rates than do clinical and socioeconomic factors. However, these results suggest that a patient safety composite measure that includes postdischarge complications would provide more information to assist hospitals and communities in understanding the association between quality of care and readmission rates.

scholarly journals Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

2019 ◽  
Vol 130 (5) ◽  
pp. 1692-1698 ◽  
Author(s):  
Mitchell P. Wilson ◽  
Andrew S. Jack ◽  
Andrew Nataraj ◽  
Michael Chow
Keyword(s):  
Multivariate Analysis ◽  
Quality Of Care ◽  
Readmission Rate ◽  
Univariate Analysis ◽  
Surrogate Marker ◽  
Readmission Rates ◽  
Factors Associated ◽  
Neurosurgical Patients ◽  
Avoidable Readmissions

OBJECTIVEReadmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.METHODSA retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions.RESULTSA total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4–5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4–5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3–4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3–0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4–22.8).CONCLUSIONSAlmost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessing predictors of avoidable readmissions is warranted.

scholarly journals Nurses’ Perceptions on the Implementation of a Safe Drug Administration Protocol and Its Effect on Error Notification

2021 ◽  
Vol 18 (7) ◽  
pp. 3718
Author(s):  
Francisco Miguel Escandell-Rico ◽  
Juana Perpiñá-Galvañ ◽  
Lucía Pérez-Fernández ◽  
Ángela Sanjuán-Quiles ◽  
Piedras Albas Gómez-Beltrán ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Adverse Events ◽  
Intervention Group ◽  
Surgical Units ◽  
Event Notification ◽  
The Mean ◽  
Nurses Perceptions ◽  
Administration Protocol

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses’ perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.

scholarly journals Patient Safety Indicator-12 Rarely Identifies Problems with Quality of Care in Perioperative Venous Thromboembolism

2019 ◽  
pp. 75-80
Author(s):  
Nicole Held ◽  
Benjamin Jung ◽  
Lori Sommervold ◽  
Siddhartha Singh ◽  
Lisa Baumann Kreuziger
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Venous Thromboembolism ◽  
Pay For Performance ◽  
Bleeding Risk ◽  
Healthcare Research ◽  
Patient Safety Indicators ◽  
Prevention Methods ◽  
Healthcare Associated

BACKGROUND: Patient safety indicators (PSI) were developed for hospitals to screen for healthcare-associated adverse events. PSIs are believed to be preventable and have become a part of major pay-for-performance programs. PSI-12 captures perioperative venous thromboembolism (VTE), which contributes to morbidity and mortality of hospitalized patients. We aimed to evaluate PSI-12 events at our institution to identify areas for improvement of perioperative VTE prevention. METHODS: We identified PSI-12 events from June 2015 to June 2017 using the Agency for Healthcare Research and Quality software version 5. Events were reviewed using our electronic medical record to identify further details of each event. RESULTS: A total of 154 perioperative VTE cases were analyzed in the 2-year period. Pulmonary embolism (PE) occurred in 62.9% of cases, deep venous thrombosis (DVT) in 24%, and concurrent DVT/PE in 12.9%. The mean age of patients was 56 years old. Deficiencies in guideline-appropriate prophylaxis were identified in only 17 (11%) of cases. Unfractionated heparin was used in 61 cases, enoxaparin in 31 cases, and nine events occurred on therapeutic anticoagulation. Mechanical prophylaxis was used in 51 cases because of bleeding risk, thrombocytopenia, and/or liver associated coagulopathy. Four events occurred prior to the index procedure, with another eight cases occurring intraoperatively, or on the day of the procedure. CONCLUSIONS: PSI-12 has several limitations in identifying quality of care issues in perioperative VTE. While it may be useful as a screening tool, further research for improvements are needed if it will remain one of the key measures in pay-for-performance.

scholarly journals Multi-level models for heart failure patients’ 30-day mortality and readmission rates: the relation between patient and hospital factors in administrative data

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Afsaneh Roshanghalb ◽  
Cristina Mazzali ◽  
Emanuele Lettieri
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Public Hospitals ◽  
Unplanned Readmission ◽  
Hospital Level ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Multi Level ◽  
Hospital Factors

Abstract Background This study aims at gathering evidence about the relation between 30-day mortality and 30-day unplanned readmission and patient and hospital factors. By definition, we refer to 30-day mortality and 30-day unplanned readmission as the number of deaths and non-programmed hospitalizations for any cause within 30 days after the incident heart failure (HF). In particular, the focus is on the role played by hospital-level factors. Methods A multi-level logistic model that combines patient- and hospital-level covariates has been developed to better disentangle the role played by the two groups of covariates. Later on, hospital outliers in term of better-than-expected/worst-than-expected performers have been identified by comparing expected cases vs. observed cases. Hospitals performance in terms of 30-day mortality and 30-day unplanned readmission rates have been visualized through the creation of funnel plots. Covariates have been selected coherently to past literature. Data comes from the hospital discharge forms for Heart Failure patients in the Lombardy Region (Northern Italy). Considering incident cases for HF in the timespan 2010–2012, 78,907 records for adult patients from 117 hospitals have been collected after quality checks. Results Our results show that 30-day mortality and 30-day unplanned readmissions are explained by hospital-level covariates, paving the way for the design and implementation of evidence-based improvement strategies. While the percentage of surgical DRG (OR = 1.001; CI (1.000–1.002)) and the hospital type of structure (Research hospitals vs. non-research public hospitals (OR = 0.62; CI (0.48–0.80)) and Non-research private hospitals vs. non-research hospitals OR = 0.75; CI (0.63–0.90)) are significant for mortality, the mean length of stay (OR = 0.96; CI (0.95–0.98)) is significant for unplanned readmission, showing that mortality and readmission rates might be improved through different strategies. Conclusion Our results confirm that hospital-level covariates do affect quality of care, and that 30-day mortality and 30-day unplanned readmission are affected by different managerial choices. This confirms that hospitals should be accountable for their “added value” to quality of care.

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety

2005 ◽  
Vol 20 (5) ◽  
pp. 239-252 ◽  
Author(s):  
Marlene R. Miller ◽  
Peter Pronovost ◽  
Michele Donithan ◽  
Scott Zeger ◽  
Chunliu Zhan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Performance Measurement

Abstract P258: Racial Disparity in 90-Day Post-Stroke Readmission - An MUSC Perspective

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Pratik Y Chhatbar ◽  
Jihad S Obeid ◽  
Yujing Zhao ◽  
Daniel T Lackland ◽  
Robert J Adams
Keyword(s):  
South Carolina ◽  
Quality Of Care ◽  
African Americans ◽  
Emergency Room ◽  
International Classification Of Diseases ◽  
University Of South Carolina ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Classification Of Diseases

Background: Readmissions after acute hospitalizations are a cause of both risk and expense, and many of them are potentially preventable. Importantly, risk-standardized hospital readmission rates are sometimes used as a yardstick of the quality of care offered. However, racial variability in readmissions might involve factors beyond quality of care and has not been studied extensively. Objective: To identify differences in readmissions between African Americans and other races and determine preventable readmissions from a pragmatic viewpoint. Methods: We obtained deidentified data from Medical University of South Carolina (MUSC) Electronic Data Warehouse (EDW) on adult admissions with index diagnosis considered as an ischemic stroke (or closely related) using International Classification of Diseases, Ninth Revision (ICD-9) codes 433.x, 434.x, 436.x, 437.x between January 2011 and June 2014. Of these, we determined readmission and reason for readmission over 90-day period. Readmission can be hospital or emergency room readmission. We obtained race as the only linked demographic. Results: Of the 1953 patients admitted with index diagnoses of stroke, 765 (39%), 1148 (59%) and 50 (1%) were African Americans, Caucasians and others, respectively. At 90-days, 256 patients were readmitted as in-patient, of which 128 (50%), 126 (49%) and 2 (1%) were African Americans, Caucasians and others, respectively. On the other hand, 241 patients visited Emergency Room, of which 175 (73%), 65 (26%) and 1 (1%) were African Americans, Caucasians and others, respectively. On adjusting readmissions to index admissions, 17%, 11% and 4% of African Americans, Caucasians and others, respectively, were readmitted in hospital, while 23%, 6% and 2% of African Americans, Caucasians and others, respectively, visited Emergency Room over 90-days period. Conclusions: 90-days readmission rates involve African Americans in a disproportionate manner. This demands further investigation on the etiology of readmission and the care offered.

scholarly journals Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

2015 ◽  
Vol 8 (6) ◽  
pp. 75 ◽  
Author(s):  
Mu'taman Jarrar ◽  
Hamzah Abdul Rahman ◽  
Mohammad Sobri Don
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health Plan ◽  
Care Service ◽  
Health Care Service ◽  
Working Environment ◽  
Annual Reports ◽  
Related Factors ◽  
Global Initiatives

<p><strong>BACKGROUND &amp; OBJECTIVE:</strong> Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.</p><p><strong>DESIGN:</strong> A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.</p><p><strong>RESULTS: </strong>The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10<sup>th</sup> Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.</p><p><strong>CONCLUSION: </strong>There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.</p>

scholarly journals Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

2010 ◽  
Vol 8 (4) ◽  
pp. 449-455 ◽  
Author(s):  
Telma de Almeida Busch Mendes ◽  
Paola Bruno de Araújo Andreoli ◽  
Leny Vieira Cavalheiro ◽  
Claudia Talerman ◽  
Claudia Laselva
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Physical Therapy ◽  
Confidence Interval ◽  
Pulse Oximetry ◽  
Patient Care ◽  
Physical Therapists ◽  
Severe Damage ◽  
Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

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