The Impact of a Transition of Care Program on Acute Myocardial Infarction Readmission Rates

2018 ◽  
Vol 33 (5) ◽  
pp. 481-486 ◽  
Author(s):  
Jeffrey A. Marbach ◽  
Drew Johnson ◽  
Juergen Kloo ◽  
Amit Vira ◽  
Scott Keith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Care Coordination ◽  
Hospital Readmission ◽  
Standard Care ◽  
Conditional Logistic Regression ◽  
Care Program ◽  
Readmission Rates ◽  
Specific Care ◽  
The Impact

Hospital discharge is a high-risk time period, and acute myocardial infarction (AMI) patients often have early readmissions. The authors hypothesized that a multifaceted AMI care coordination program would reduce early hospital readmission rates. The outcomes of patients receiving care coordination (n = 304) were compared to patients receiving standard care (n = 192). Multivariable analyses of the outcomes were conducted by conditional logistic regression of propensity score matched sets. The primary outcome—hospital readmission within 30 days of discharge—occurred in 18% of standard care patients and 11.8% of care coordination patients. Patients receiving care coordination demonstrated a 48% reduction in odds of readmission within 30 days (odds ratio = 0.52; P = .04; 95% CI = 0.28-0.97). These results are the first to demonstrate that inclusion in an AMI-specific care coordination program is associated with a significantly lower risk of 30-day hospital readmission.

Abstract 14971: Impact of Medicare Diagnosis Code Expansion and Inclusion of Outpatient Data on Risk-adjusted 30-day Mortality and Readmission Rates After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lauren Gilstrap ◽  
Rishi Wadhera ◽  
Andrea Austin ◽  
Stephen A Kearing ◽  
Karen Joynt Maddox ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Adjustment ◽  
Average Increase ◽  
Diagnosis Code ◽  
Readmission Rates ◽  
Medicare Data ◽  
Diagnosis Codes ◽  
The Impact ◽  
Over Time

Introduction: In January 2011, the Center for Medicare and Medicaid Services increased the number of billing codes allowed per admission from 9 to 25. This caused an artificial increase in comorbidity burdens. Some have argued including outpatient data mitigates this problem. The aim of this study was to explore the impact of diagnosis code expansion, using inpatient and inpatient+outpatient data and evaluate potential solutions for conducting longitudinal studies of 30-day risk-adjusted outcome rates after acute myocardial infarction (AMI). Hypothesis: Limiting diagnosis codes and including outpatient data would produce the most stable estimates of risk-adjusted outcomes over time. Methods: We used 100% Medicare data to create a cohort of beneficiaries with AMI between 2008 and 2013. We used 4 methods to calculate the hierarchical condition categories/patient (HCC/pt) necessary for risk adjustment: 1) inpatient-only data, limited codes after 2011; 2) inpatient-only data, unlimited codes; 3) inpatient+ outpatient data, limited codes; 4) inpatient+outpatient data, unlimited codes. Results: Using inpatient-only data, expanding diagnosis codes increased the average HCC/pt by +0.23 HCC/pt. Using inpatient+outpatient data, the average increase was only +0.11 HCC/pt. (relatively 109% less, Figure A ). Between 2009-2013, AMI mortality was flat while readmissions declined ( Figure B ). For mortality, all 4 methods produced estimates that were, on average, +0.7% higher than unadjusted (raw) rates. For readmission, the closest to unadjusted and most stable over time was inpatient+outpatient data with limited codes. Conclusion: For studies that span January 2011, diagnosis codes should be limited to 9 after 2011 when using inpatient or combined inpatient and outpatient data.

scholarly journals Factors Predicting Hospital Readmission among Thais with Post Myocardial Infarction

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 415
Author(s):  
Chuthaporn Phemphul ◽  
Wirat Pansila ◽  
Nisakorn Vibulchai ◽  
Chaiyasith Wongvipaporn
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Readmission ◽  
Screening Tools ◽  
Post Myocardial Infarction ◽  
Readmission Rates ◽  
One Year ◽  
The Impact

Background: Readmission after an acute myocardial infarction is not only common and costly but can also impact patients’ quality of life and mortality. This retrospective observational study was conducted to determine the impact of sociodemographic variables, clinical variables, and hospital readmission among post-myocardial infarction patients in Thailand.  Few, if any, previous studies have investigated the factors predicting readmission rates over variable time periods. We aimed to provide such information to prevent readmission in the future.  Methods: Between October 1, 2014, to September 30, 2018 a total of 376 post-myocardial infarction patients of Roi-Et hospital were recruited for this study. The criteria of data collection concerned the rate of readmission, gender, comorbidities, anaemia, chronic kidney disease, complication, smoking, and type of myocardial infarction. A measurement period was seven-day, 30-day, six-month, and one-year of readmission. Data were analyzed using percentage, mean, standard deviation, and logistic regression analysis.   Results: The highest readmission rate at six-month, 30-day, seven-day, and one-year was 52.2%, 30.4%, 10.6%, and 6.8%, respectively. None of the predictors were significant for seven-day and one-year of readmissions. Meanwhile, hypertension comorbidity and anaemia were identified as the significant predictors for early 30-day readmission whereas atrial fibrillation complication, chronic kidney disease, and smoking were the significant predictors for late six-month readmission.   Conclusions: Multiple factors including HT comorbidity, anaemia, atrial fibrillation, chronic kidney disease, and smoking predict readmission among Thais with post myocardial infarction. This study demonstrated that rates and predictors of readmissions in short-term and long-term periods are different. Therefore, various screening tools and interventions are required.

Abstract 136: The Relationship of Changing Hospital Readmission Rates and Mortality Rates After Hospitalization for Heart Failure, Acute Myocardial Infarction, and Pneumonia

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kumar Dharmarajan ◽  
Yongfei Wang ◽  
Susannah Bernheim ◽  
Zhenqiu Lin ◽  
Leora Horwitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Hospital Readmission ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Monthly Changes ◽  
Monthly Change

Background: It is unknown if financial pressures to reduce hospital readmission rates following passage of the Affordable Care Act (ACA) have had the unintended effect of increasing mortality rates after hospitalization. We therefore examined correlations between paired changes in hospital 30-day readmission rates and 30-day mortality rates among Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008 to 2014. Methods: We used linear regression to calculate monthly changes in hospitals’ 30-day risk-adjusted readmission rates (RARRs) and 30-day risk-adjusted mortality rates (RAMRs) after discharge for HF, AMI, and pneumonia from 2008 to 2014. Adjustment was made for patient age, sex, comorbidities, hospital length of stay, and season. We then examined the correlation of hospitals’ paired monthly changes in 30-day RARRs and monthly changes in 30-day RAMRs after discharge. Results: From 2008 to 2014, we identified 2,962,554, 1,229,939, and 2,544,530 hospitalizations for HF, AMI, and pneumonia at 5,016, 4,772, and 5,057 hospitals, respectively. Hospital 30-day RARRs declined for all three conditions from 2008 to 2014; the monthly change in RARRs was -0.053 (95% CI -0.055, -0.051) for HF, -0.044 (95% CI -0.047, -0.041) for AMI, and -0.033 (95% CI -0.035, -0.031) for pneumonia. In contrast, the monthly change in hospital 30-day RAMRs after discharge varied by admitting condition and was 0.008 (95% CI 0.007, 0.010) for HF, -0.003 (95% CI -0.006, -0.001) for AMI, and 0.001 (95% CI -0.001, 0.003) for pneumonia. The correlation between monthly changes in hospitals’ 30-day RARRs and 30-day RAMRs after discharge was 0.060 for HF (p<0.001), 0.059 for AMI (p=0.003), and 0.106 for pneumonia (p<0.001). Representative data showing the poor correlation in hospitals’ paired monthly changes in 30-day RARRs and 30-day RAMRs for AMI is shown in the Figure. Conclusion: Changes in hospital readmission rates for HF, AMI, and pneumonia were poorly correlated with changes in mortality rates after hospitalization between 2008 and 2014. These findings suggest that financial incentives to improve hospitals’ readmission performance have not increased mortality after hospitalization.

Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

2021 ◽  
pp. 205343452110016
Author(s):  
Daphne Chakurian ◽  
Lori Popejoy
Keyword(s):  
Care Coordination ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Care Quality ◽  
Integrative Review ◽  
Labor Costs ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Care Models ◽  
The Impact

Introduction Care coordination reduces care fragmentation and costs while improving health care quality. Transitional care programs, guided by tested models are an important component of effective care coordination, and have been found to reduce adverse events and prevent hospital readmissions. Using the Care Coordination Atlas as a framework, this article reports an integrative review of two transitional care models including analysis of model components, implementation factors, and associated 30-day all-cause hospital readmission rates. Methods Integrative review methodology. PubMed and Scopus databases were searched from January 2015 to July 2020. Fourteen studies set in 18 skilled nursing facilities and 50 hospitals were selected for data extraction and analysis. Results The ReEngineered Discharge model had five components and the Better Outcomes by Optimizing Safe Transitions model had eight components in the nine Care Coordination Atlas domains. Communication dominated activities in both models while neither addressed accountability/responsibility. Implementation was influenced by leadership commitment to understanding complexity of the models, culture change, integration of models into workflows, and associated labor costs. Model implementation studies consistently reported improvements in facilities’ 30-day all-cause hospital readmission rates. Discussion The Care Coordination Atlas was a useful framework to guide analysis of transitional care models. Leadership commitment to and participation in model implementation is vital. The models do not focus beyond the immediate post-discharge period limiting the impact on chronic disease management. Frameworks such as the Care Coordination Atlas are useful to help guide development of care coordination activities and associations with readmission rates.

scholarly journals Effects of occupational exposure to respirable quartz dust on acute myocardial infarction

2019 ◽  
Vol 76 (6) ◽  
pp. 370-375 ◽  
Author(s):  
Johannes Gellissen ◽  
Dagmar Pattloch ◽  
Matthias Möhner
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Occupational Exposure ◽  
Conditional Logistic Regression ◽  
Cumulative Exposure ◽  
Uranium Miners ◽  
Small Subgroup ◽  
Quartz Dust ◽  
Matched Case ◽  
The Impact

ObjectivesThe aim of this study is to investigate the effects of occupational exposure to respirable quartz (RQ) on first acute myocardial infarction (AMI). RQ causes pulmonary diseases like silicosis and has also been linked to cardiovascular diseases. Inflammation is hypothesised as the underlying pathway.MethodsWe performed a 1:3 matched case–control study nested in a cohort of male uranium miners. We included cases (identified from hospital records and validated according to WHO criteria) who had suffered their first AMI while still employed and <65 years of age. Controls were matched by date of birth and Wismut recruitment era. RQ exposure was derived from a job-exposure matrix. We performed a conditional logistic regression adjusted for smoking, metabolic syndrome and baseline erythrocyte sedimentation rate. Subgroups by date of birth and Wismut recruitment era were analysed to minimise the impact of pre-exposures.ResultsThe study base comprised 292 matched sets. The cumulative exposure ranged from 0 to 38.9 mg/m3-years RQ. The adjusted OR of the highest RQ tertile (>14.62 mg/m3-years) was 1.27 (95% CI 0.82 to 1.98). However, for miners born after 1928 and hired in the earliest recruitment era (1946–1954), a significantly elevated risk was seen in the highest RQ tertile (OR=6.47 [95% CI 1.33 to 31.5]; 50 matched sets).ConclusionsAn impact of quartz dust on first AMI was observed only in a small subgroup that had virtually no pre-exposure to RQ. Further studies on the basis of complete occupational history are required to substantiate this finding.

scholarly journals The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salvatore Soldati ◽  
Mirko Di Martino ◽  
Alessandro Cesare Rosa ◽  
Danilo Fusco ◽  
Marina Davoli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medication Adherence ◽  
Cardiac Rehabilitation ◽  
Hospital Readmission ◽  
Lazio Region ◽  
All Cause Mortality ◽  
St Elevation ◽  
The Impact

Abstract Background Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI). Methods This is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period. Results A total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91). Conclusions Our findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients.

Feasibility of hybrid telerehabilitation as component of a novel comprehensive care program after acute myocardial infarction in a one-year follow-up preliminary experience of a single center

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Piotrowicz ◽  
P Orzechowski ◽  
I Kowalik ◽  
R Piotrowicz
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Functional Capacity ◽  
Care Program ◽  
Comprehensive Care ◽  
Monitoring Center ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Health Fund Background. A novel comprehensive care program after acute myocardial infarction (AMI) „KOS-zawał" was implemented in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid telerehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of this program. The purpose of the pilot study was to evaluate a feasibility, safety and patients’ acceptance of HTR as component of a novel care program after AMI and to assess mortality in a one-year follow-up. Methods The study included 55 patients (LVEF 55.6 ± 6.8%; aged 57.5 ± 10.5 years). Patients underwent a 5-week HTR based on Nordic walking, consisting of an initial stage (1 week) conducted within an outpatient center and a basic stage (4-week) home-based telerehabilitation five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise training. The influence on physical capacity was assessed by comparing changes in functional capacity (METs) from the beginning and the end of HTR. Patients filled in a questionnaire in order to assess their acceptance of HTR at the end of telerehabilitation. Results HTR resulted in a significant improvement in functional capacity and workload duration in exercise test (Table). Safety: there were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the monitoring center. Prognosis all patients survived in a one-year follow-up. Conclusions Hybrid telerehabilitation is a feasible, safe form of rehabilitation, well accepted by patients. There were no deaths in a one-year follow-up. Outcomes before and after HTR Before telerehabilitation After telerehabilitation P Exercise time [s] 381.5 ± 92.0 513.7 ± 120.2 &lt;0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 &lt;0.001 Heart rate rest [bpm] 68.6 ± 12.0 66.6 ± 10.9 0.123 Heart rate max effort [bpm] 119.7 ± 15.9 131.0 ± 20.1 &lt;0.001 SBP rest [mmHg] 115.6 ± 14.8 117.7 ± 13.8 0.295 DBP rest [mmHg] 74.3 ± 9.2 76.2 ± 7.3 0.079 SBP max effort [mm Hg] 159.5 ± 25.7 170.7 ± 25.5 0.003 DBP max effort [mm Hg] 84.5 ± 9.2 87.2 ± 9.3 0.043 SBP systolic blood pressure, DBP diastolic blood pressure.

Correction to: The impact of epicardial adipose tissue in patients with acute myocardial infarction

2021 ◽  
Author(s):  
Christoph Fisser ◽  
Stefan Colling ◽  
Kurt Debl ◽  
Andrea Hetzenecker ◽  
Ulrich Sterz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
The Impact
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