30-day readmission among gastrointestinal cancer patients in Texas.

121 Background: 30 day readmission has become an important metric in healthcare delivery. Policymakers have started to factor in readmission rates in their recommendations on reimbursement algorithms. It is unclear whether these methods are applicable to cancer patients. More studies are needed in order to understand readmission in the context of cancer patients. A few studies have found that the elderly and those with gastrointestinal (GI) malignancies are at risk. Methods: We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data to describe the patterns of 30 day unplanned readmission among GI cancer patients in Texas. Only short stays to acute care hospitals were included in the study. Claims data were analyzed for a period of 2 years from the date of cancer diagnosis. Modified Poisson regression model was used to identify factors associated with the outcome. Results: 30,199 patients aged 66 and above were included in our study. The incidence of unplanned readmission in our cohort was 15%. The top 10 reasons for readmission were fluid and electrolyte disorders, secondary malignancies, complications of surgical procedures and medical care, congestive heart failure, intestinal obstruction, pneumonia, sepsis, GI hemorrhage, urinary tract infections, and complications of device, implant or graft. After multivariate analysis, age >80 (OR 0.79, 0.73-0.85), regional (1.19, 1.11-1.27) and distant disease (1.16, 1.07-1.25), living in less affluent neighborhoods (1.10, 1.01-1.19), and increasing comorbidity index (p<0.0001) were associated with 30 day readmission. Esophageal cancer carried the highest risk for 30 day readmission (1.53, 1.38-1.70). Conclusions: Most of the top reasons for readmission appear to be cancer-related. This means that most of these readmissions are likely not preventable. This should be taken into consideration by policymakers when making recommendations. There are, however, some that may be amenable to outpatient management. This further underlines the importance of primary care involvement in the management of cancer patients. Risk factors identified can help risk–stratify patients who may need early follow up post-discharge, in order to prevent early readmission.

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Age Based Trends for Unplanned Pediatric Rehospitalizations in the United States

10.1101/2021.11.13.21266306 ◽

2021 ◽

Author(s):

Nupur Amritphale ◽

Amod Amritphale ◽

Deepa Vasireddy ◽

Mansi Batra ◽

Mukul Sehgal ◽

...

Keyword(s):

Hospital Readmission ◽

Readmission Rate ◽

Age Groups ◽

The United States ◽

Unplanned Readmission ◽

Post Discharge ◽

Readmission Rates ◽

Discharge Care ◽

Hospital Readmission Rate ◽

Bowel Diseases

BACKGROUND AND OBJECTIVES: Hospital readmission rate helps to highlight the effectiveness of post- discharge care. There remains a paucity of plausible age based categorization especially for ages below one year for hospital readmission rates. METHODS: Data from 2017 Healthcare cost and utilization project National readmissions database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. RESULTS: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant comorbidities leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages 1-4 yrs, dehydration, asthma and bronchitis were negative predictors of unplanned readmission. CONCLUSIONS: Thirty-day unplanned readmissions remain a problem leading to billions of tax-payer-dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

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Abstract 340: Thirty-day Repeat Hospitalizations for Patients Treated with Prasugrel Compared to Ticagrelor following Acute Coronary Syndrome: Findings from a Large Hospital Charge Master Database

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.340 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

George W Vetrovec ◽

Cynthia Larmore ◽

Cliff Molife ◽

Mitch DeKoven ◽

Swapna Karkare ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Claims Data ◽

Coronary Intervention ◽

Hospital Charge ◽

Post Discharge ◽

Readmission Rates ◽

Large Hospital ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Base Study

Background: This retrospective, real-world claims data base study in patients (pts) with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) demonstrated that prasugrel (pras) was non-inferior to ticagrelor (ticag) for 30 day safety and effectiveness outcomes. This report provides further evaluation between pras vs ticag of 30 day readmission rates for myocardial infarction (MI), revascularization (revasc), and bleeding. Methods: IMS Patient-Centric Data Warehouse claims data was used to identify ACS-PCI pts ≥18 years old with at least one in-hospital claim for pras or ticag between 8/1/11-4/30/13. The groups were propensity matched (PM) based upon demographic and clinical characteristics using index and prior hospitalization records dating back to 1/1/2008. Relative risk (RR) and 95% confidence interval (CI) were estimated to assess binary endpoints. Non-inferiority was computed by comparing the mean from a normal distribution of log (RR) with log (1.2), a predefined non-inferiority margin. Three cohorts were predefined: ACS-PCI (primary), ACS-PCI without prior TIA or stroke (label), ACS-PCI pts without prior TIA or stroke and if age ≥75 years with evidence of diabetes or prior MI (core). Results: Prior to PM, the primary cohort included 16,098 pts; 13,134 (82%) on pras, 2,964 (18 %) on ticag. Compared to pras, ticag pts were older, more often female, had increased cardiovascular risk factors, and more often treated at a teaching hospital. Unstable angina was seen more often in pras pts with no difference in STEMI or NSTEMI between the 2 groups. Using PM pts (table), pras was non-inferior to ticag in the primary cohort for rehosp for MI, revasc, and bleeding at 30 days post discharge. Rehosp for MI and bleeding was significantly lower with pras vs ticag while rehosp for revasc was lower, but not significantly. Results for the label and core cohorts had the same directionality as the primary cohort. Conclusion: Rehosp for MI, revasc or bleeding was non-inferior for pras compared to ticag at 30 days post discharge. Pts treated with pras had lower 30 day rehosp rates, particularly related to readmission for MI, compared with ticag. Although limited by selection bias, these results support the clinical utility of pras, regardless of cohort, to limit 30 day rehosp for pts undergoing PCI for ACS.

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Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

10.21203/rs.3.rs-73159/v1 ◽

2020 ◽

Author(s):

Zhen Lin ◽

Yinghong Zhai ◽

Hedong Han ◽

Yang Cao ◽

Cheng Wu ◽

...

Keyword(s):

The United States ◽

Medical Advice ◽

Unplanned Readmission ◽

Post Discharge ◽

Readmission Rates ◽

Against Medical Advice ◽

Medical Institutions ◽

Vulnerable Patients ◽

Significant Difference ◽

Hospitalization Costs

Abstract Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

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Framed messages effects on readmissions

Journal of Hospital Administration ◽

10.5430/jha.v5n4p95 ◽

2016 ◽

Vol 5 (4) ◽

pp. 95

Author(s):

Angela P. Halpin ◽

Felicia S. Hodge

Keyword(s):

Hospital Readmissions ◽

Severity Index ◽

The Elderly ◽

Framing Effects ◽

Control Group ◽

Post Discharge ◽

Readmission Rates ◽

Double Blind ◽

Negative Messages ◽

The Impact

Objective: As the eighth leading cause of death in the US, pneumonia (PN) is relevant to the health of the elderly and young. Accountability for readmission is part of the Affordable Care Act’s Hospital Readmissions Reduction Program (RRP), which levies penalties for readmissions. We examined communication using framing effects which can motivate patients’ decisions collaboratively with providers for post discharge care and readmissions prevention. Communication strategies (CS) can facilitate decision-making (DM) about health care choices. The project’s aims were to (1) compare CS of framing effects (positive or negative messages) on the readmission outcome 30 days post discharge; (2) assess PN readmissions decrease 30 days post discharge when CS include the patient/family in decisions about transitions; (3) determine the impact of between patients and HCPs agreement for post hospital care, and (4) examine confounding effects between framing effects and readmission rates of age, PN severity index (PSI), and the number of diagnoses.Methods: A double-blind randomized control trial (RCT) used parallel assignment of 153 PN patients to one of three arms to test the communication framing effects using power analysis, odds ratio, Fischer’s exact and ANOVA. Arm A was the Intervention positive framing group (n = 44), arm B was the Intervention Negative framing group (n = 65), and arm C was the control group (n = 44).Conclusions: Findings suggest that framed messages aid in the reduction of PN readmission rates in hospitals. DM strategies incorporates education and understanding of risk by the patient, so the healthcare teams can encourage and improve readmission outcomes.

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SURG-09. SURGICAL AND PERI-OPERATIVE CONSIDERATIONS FOR BRAIN METASTASES: A NATIONWIDE ANALYSIS

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.144 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i32-i32

Author(s):

Saksham Gupta ◽

Alexandra Giantini Larsen ◽

Hassan Dawood ◽

Luis Fandino ◽

Erik Knelson ◽

...

Keyword(s):

Brain Metastases ◽

Cohort Analysis ◽

Medical Complications ◽

Unplanned Readmission ◽

Cardiac Events ◽

Post Discharge ◽

Improvement Project ◽

Improve Risk Stratification ◽

Cerebrospinal Fluid Diversion ◽

Tract Infections

Abstract BACKGROUND: Brain metastases are the most frequent brain tumors in adults, whose management remains nuanced. We aim to improve risk stratification for brain metastases patients who might be candidates for surgical resection. METHODS: We conducted a nationwide, retrospective cohort analysis of adult patients who received craniotomy for resection of brain metastasis using the 2012–2015 American College of Surgeons National Surgical Quality Improvement Project databases. Our primary outcomes of interest were post-operative medical complications, reoperation, readmission, and mortality. RESULTS: 3500 cases were included, of which 17% were considered frail and 24% were infratentorial. The most common 30-day medical complications were pneumonia (4%), venous thromboembolism (VTE;3%), and urinary tract infections (2%). Cardiac events and cerebrovascular accidents tended to occur in the early post-operative period, while VTEs and infections occurred in a more delayed fashion. Reoperation and unplanned readmission occurred in 5% and 12% of patients, respectively. Infratentorial approach and frailty were associated with reoperation before discharge (OR 2.0 for both; p=0.01 and p=0.03 respectively), but not after discharge. Frail patients were especially at risk for surgical evacuation of hematoma (OR 3.6). Infratentorial approaches conferred heightened risk for readmission for hydrocephalus (OR 5.1, p=0.02) and reoperation for cerebrospinal fluid diversion (OR 7.1, p< 0.001). Overall 30-day mortality was 4%, with nearly three-quarters occurring after discharge. Pre-frailty and frailty were associated with increased odds for post-discharge mortality (OR 1.7 and 2.7, p< 0.05), but not pre-discharge mortality. We developed a model to predictors of death, which identified frailty, thrombocytopenia, and high American Society of Anesthesiologists score as the strongest predictors of 30-day mortality (AUROC 0.75). CONCLUSION: Optimization of metrics contributing to patient frailty and heightened surveillance in patients with infratentorial metastases may be considered in the peri-operative period.

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