Factors associated with 30-day readmission for patients hospitalized for seizures

BackgroundWe sought to determine the cumulative incidence of readmissions after a seizure-related hospitalization and identify risk factors and readmission diagnoses.MethodsWe performed a retrospective cohort study of adult patients hospitalized with a primary discharge diagnosis of seizure (International Classification of Diseases, Ninth Edition, Clinical Modification codes 345.xx and 780.3x) using the State Inpatient Databases across 11 states from 2009 to 2012. Hospital and community characteristics were obtained from the American Hospital Association and Robert Wood Johnson Foundation. We performed logistic regressions to explore effects of patient, hospital, and community factors on readmissions within 30 days of discharge.ResultsOf 98,712 patients, 13,929 (14%) were readmitted within 30 days. Reasons for readmission included epilepsy/convulsions (30% of readmitted patients), mood disorders (5%), schizophrenia (4%), and septicemia (4%). The strongest predictors of readmission were diagnoses of CNS tumor (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.9–2.4) or psychosis (OR 1.8, 95% CI 1.7–1.8), urgent index admission (OR 2.0, 95% CI 1.8–2.2), transfer to nonacute facilities (OR 1.7, 95% CI 1.6–1.8), long length of stay (OR 1.7, 95% CI 1.6–1.8), and for-profit hospitals (OR 1.7, 95% CI 1.6–1.8). Our main model's c-statistic was 0.66. Predictors of readmission for status epilepticus included index admission for status epilepticus (OR 3.5, 95% CI 2.6–4.7), low hospital epilepsy volume (OR 0.4, 95% CI 0.3–0.7), and rural hospitals (OR 4.8, 95% CI 2.1–10.9).ConclusionReadmission is common after hospitalization for seizures. Prevention strategies should focus on recurrent seizures, the most common readmission diagnosis. Many factors were associated with readmission, although readmissions remain challenging to predict.

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For-profit hospitals as anchor institutions in the United States: a study of organizational stability

BMC Health Services Research ◽

10.1186/s12913-021-07307-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Berkeley Franz ◽

Cory E. Cronin ◽

Vanessa Rodriguez ◽

Kelly Choyke ◽

Janet E. Simon ◽

...

Keyword(s):

Multivariable Analysis ◽

The United States ◽

Full Time ◽

American Hospital ◽

American Hospital Association ◽

Community Factors ◽

For Profit ◽

Anchor Institutions ◽

Significant Difference

Abstract Background Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. Methods This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. Results We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. Conclusions Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.

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Impact of ICD-9 to ICD-10 Coding Transition on Prevalence Trends in Neurology

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001046 ◽

2021 ◽

Vol 11 (5) ◽

pp. e612-e619

Author(s):

Ali G. Hamedani ◽

Leah Blank ◽

Dylan P. Thibault ◽

Allison W. Willis

Keyword(s):

Time Series ◽

Status Epilepticus ◽

Interrupted Time Series ◽

International Classification Of Diseases ◽

Disease Prevalence ◽

Rate Of Change ◽

International Classification ◽

Classification Of Diseases ◽

Icd 10

ObjectiveTo determine the effect of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding transition on the point prevalence and longitudinal trends of 16 neurologic diagnoses.MethodsWe used 2014–2017 data from the National Inpatient Sample to identify hospitalizations with one of 16 common neurologic diagnoses. We used published ICD-9-CM codes to identify hospitalizations from January 1, 2014, to September 30, 2015, and used the Agency for Healthcare Research and Quality's MapIt tool to convert them to equivalent ICD-10-CM codes for October 1, 2015–December 31, 2017. We compared the prevalence of each diagnosis before vs after the ICD coding transition using logistic regression and used interrupted time series regression to model the longitudinal change in disease prevalence across time.ResultsThe average monthly prevalence of subarachnoid hemorrhage was stable before the coding transition (average monthly increase of 4.32 admissions, 99.7% confidence interval [CI]: −8.38 to 17.01) but increased after the coding transition (average monthly increase of 24.32 admissions, 99.7% CI: 15.71–32.93). Otherwise, there were no significant differences in the longitudinal rate of change in disease prevalence over time between ICD-9-CM and ICD-10-CM. Six of 16 neurologic diagnoses (37.5%) experienced significant changes in cross-sectional prevalence during the coding transition, most notably for status epilepticus (odds ratio 0.30, 99.7% CI: 0.26–0.34).ConclusionsThe transition from ICD-9-CM to ICD-10-CM coding affects prevalence estimates for status epilepticus and other neurologic disorders, a potential source of bias for future longitudinal neurologic studies. Studies should limit to 1 coding system or use interrupted time series models to adjust for changes in coding patterns until new neurology-specific ICD-9 to ICD-10 conversion maps can be developed.

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Hospital Religious Affiliation and Outcomes for High-Risk Infants

Medical Care Research and Review ◽

10.1177/1077558711432156 ◽

2011 ◽

Vol 69 (3) ◽

pp. 316-338 ◽

Cited By ~ 1

Author(s):

Melissa M. Garrido ◽

Kirk C. Allison ◽

Mark J. Bergeron ◽

Bryan Dowd

Keyword(s):

Health Care ◽

Religious Affiliation ◽

Perinatal Outcomes ◽

Extremely Low Birth Weight ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Annual Survey ◽

Not For Profit ◽

Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

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Accountable care organizations: a strategy for future success?

International Journal of Organization Theory and Behavior ◽

10.1108/ijotb-03-2018-0019 ◽

2018 ◽

Vol 21 (2) ◽

pp. 113-121

Author(s):

Jeffrey Harrison ◽

Aaron Spaulding ◽

Debra A. Harrison

Keyword(s):

Community Dynamics ◽

Accountable Care Organizations ◽

Accountable Care ◽

Healthcare Organizations ◽

American Hospital ◽

American Hospital Association ◽

Content Type ◽

For Profit ◽

Annual Survey ◽

Final Rule

Purpose The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO). Design/methodology/approach Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO. Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

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Survival Strategies for Tsunami of ICD-10-CM for Interventionalists: Pursue or Perish!

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e685 ◽

2015 ◽

Vol 5;18 (5;9) ◽

pp. E685-E712

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Pain Management ◽

Health Information ◽

International Classification Of Diseases ◽

The United States ◽

International Classification ◽

American Hospital ◽

Classification Of Diseases ◽

Icd 10 ◽

Interventional Pain Management

The unfunded mandate for the implementation of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is scheduled October 1, 2015. The development of ICD-10-CM has been a complicated process. We have endeavored to keep Interventional Pain Management doctors apprised via a variety of related topical manuscripts. The major issues relate to the lack of formal physician participation in its preparation. While the American Health Information Management Association (AHIMA) and American Hospital Association (AHA) as active partners in its preparation. Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) are major players; 3M and Blue Cross Blue Shield Association are also involved. The cost of ICD-10-CM implementation is high, similar to the implementation of electronic health records (EHRs), likely consuming substantial resources. While ICD-10, utilized worldwide, includes 14,400 different codes, ICD-10-CM, specific for the United States, has expanded to 144,000 codes, which also includes procedural coding system. It is imperative for physicians to prepare for the mandatory implementation. Conversion from ICD-9-CM to ICD-10-CM coding in interventional pain management is not a conversion of one to one that can be easily obtained from software packages. It is a both a difficult and time-consuming task with each physician, early on, expected to spend on estimation at least 10 minutes per visit on extra coding for established and new patients. For interventional pain physicians, there have been a multitude of changes, including creation of new codes and confusing conversion of existing codes. This manuscript describes a variety of codes that are relevant to interventional pain physicians and often utilized in daily practices. It is our objective that this manuscript will provide coding assistance to interventional pain physicians. Key words: ICD-9-CM (International Classification of Diseases, Ninth revision, Clinical Modification), ICD-10, ICD-10-CM (International Classification of Diseases, 10th Revision), Health Insurance Portability and Accountability Act (HIPAA), Health Information Technology (HIT)

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Abstract W P311: Demographic and Regional Characteristics Associated With Advanced Primary Stroke Center Designation

Stroke ◽

10.1161/str.45.suppl_1.wp311 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Catherine McDonald ◽

Steven Cen ◽

Lucas Ramirez ◽

William J Mack ◽

Nerses Sanossian

Keyword(s):

Univariate Analysis ◽

American Hospital ◽

American Hospital Association ◽

Healthcare Facilities ◽

For Profit ◽

Home Value ◽

Regional Factors ◽

Stroke Center ◽

Zip Code ◽

Hospital Characteristics

Background: Nationwide less than a third of eligible hospitals have achieved advanced certification in stroke, and there may be disparities affecting less affluent areas serving a higher proportion of minorities. We aimed to characterize demographic and regional factors associated with achievement of stroke center certification while controlling for hospital characteristics. Methods: We linked the 2011 American Hospital Association survey of hospital characteristics to the 2010 national census for population and household data by region. Emergency medical services stroke routing data was obtained from communication with state and county contact. Only hospitals with ≥ 25 beds and 24-hour emergency departments were evaluated. The Joint Commission, Healthcare Facilities Accreditation Program and DNV Healthcare websites were used to determine certification status of each hospital. We controlled for hospital bed size, teaching affiliation (AMA, ACGME), emergency department volume, rural designation, hospital type (governmental/for-profit/nonprofit), and trauma center designation in analysis. Results: Of the 3696 hospitals to complete the survey, the 3069 fulfilling study criteria included 908 PSC (31%) and 2161 non-PSC. In univariate analysis PSC hospitals were located in areas with greater population in immediate vicinity (29, 316 vs. 20,901, p<0.0001), greater proportion of minorities (73% white, 16% black, 15% Hispanic vs. 80%/12%/11%, p<0.0001), greater number of households per zip code (11,540 vs. 8050, p<0.0001) and a higher regional mean income ($52,112 vs. $46,262, p<0.0001) and higher home value ($234,000 vs. $170,000, p<0.0001). More PSC hospitals were located in regions with preferential EMS routing of stroke (52% vs. 40%). While controlling for hospital-based factors, the demographic and regional factors independently associated with hospital PSC designation were number of households per zip code (per 1000 households OR 1.1, 95%CI 1.0-1.2), increasing Hispanic population (every 10% increase OR 1.1, 1.0-1.2), and income per household (per $10,000 OR 1.2, 1.1-1.3). Conclusions: Hospitals achieving PSC designation are located in more affluent and densely populated areas with higher population of Hispanic residents.

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Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

American Journal of Public Health ◽

10.2105/ajph.2020.305695 ◽

2020 ◽

Vol 110 (9) ◽

pp. 1315-1317

Author(s):

Katy B. Kozhimannil ◽

Julia D. Interrante ◽

Mariana S. Tuttle ◽

Carrie Henning-Smith ◽

Lindsay Admon

Keyword(s):

United States ◽

Obstetric Care ◽

The United States ◽

Rural Hospitals ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Annual Survey ◽

Obstetric Services ◽

Delivery Obstetric

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.

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Mental Health and Chemical Dependency Services at US Cancer Centers

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7657 ◽

2021 ◽

Vol 19 (7) ◽

pp. 829-838

Author(s):

Shehzad K. Niazi ◽

Aaron Spaulding ◽

Emily Brennan ◽

Sarah K. Meier ◽

Julia E. Crook ◽

...

Keyword(s):

Mental Health ◽

Chemical Dependency ◽

Standard Of Care ◽

Psychosocial Needs ◽

Hospital System ◽

American Hospital ◽

American Hospital Association ◽

Cancer Centers ◽

For Profit ◽

Patients With Cancer

Background: It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers. Methods: The 2017–2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)–level characteristics. Results: Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18–2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31–3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02–1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97–0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86–0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98–1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30–6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78–6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14–2.29) and had more beds (OR, 1.02; 95% CI, 1.01–1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88–0.97) was associated with decreased odds of offering CD services. Conclusions: Patients’ ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.

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Respiratory complications and 30-day unplanned hospital readmissions in patients with epilepsy

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000672 ◽

2019 ◽

Vol 9 (5) ◽

pp. 408-416

Author(s):

Radhika Parikh ◽

Romil Parikh ◽

Smit Patel ◽

Ninad Desai ◽

Tapan Mehta ◽

...

Keyword(s):

Health Care ◽

Status Epilepticus ◽

Demographic Data ◽

Hospital Readmissions ◽

International Classification Of Diseases ◽

Discharge Diagnosis ◽

Respiratory Complications ◽

Us Economy ◽

Classification Of Diseases ◽

Patients With Epilepsy

BackgroundTo help mitigate the burden of health care on US economy, public policymakers and health care legislation have been focusing on reducing hospital readmissions. Respiratory complications have been identified among the commonest of adverse events in neurologic patients. The goal of our study was to better understand respiratory complications and their contribution to rehospitalizations in patients with seizures.MethodsWe used the 2013 Nationwide Readmission Database to analyze unplanned 30-day readmission rate (30RR). The study population comprised of patients with index hospital discharge diagnosis of generalized convulsive epilepsy and status epilepticus. Patients under 18 years of age, who died during hospitalization or who had missing demographic data, were excluded. Patients hospitalized in December were also excluded due to lack of 30-day follow-up. The primary outcome of interest was 30-day readmission. The causes of readmission were determined by corresponding International Classification of Diseases, Ninth Revision, Clinical Modification codes.ResultsThe 30RR was highest in patients with index hospitalization discharge diagnosis of status epilepticus, followed by generalized convulsive epilepsy (intractable), followed by generalized convulsive epilepsy (nonintractable). While seizure was the most common reason for readmission, contribution of respiratory complications to readmissions was 7.85%, 12.39%, and 6.93%, respectively. Pneumonia/aspiration pneumonitis and respiratory insufficiency accounted for the majority of the readmissions in all subgroups.ConclusionsRespiratory complications are the leading nonseizure cause of 30-day unplanned readmissions in patients with generalized convulsive epilepsy and status epilepticus. Further research on identifying appropriate interventions to reduce readmissions from respiratory causes may improve outcomes for patients in these epilepsy subgroups.

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The Impact of IRS Tax Policy on Hospital Community Benefit Activities

Medical Care Research and Review ◽

10.1177/1077558717703215 ◽

2017 ◽

Vol 76 (2) ◽

pp. 167-183 ◽

Cited By ~ 1

Author(s):

Valerie A. Yeager ◽

Alva O. Ferdinand ◽

Nir Menachemi

Keyword(s):

Community Health ◽

Secondary Data ◽

Community Benefit ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Not For Profit ◽

Tax Exempt ◽

Quasi Experimental ◽

The Impact

The Internal Revenue Service (IRS) recently introduced tax code revisions requiring stricter oversight of community benefit activities (CBAs) conducted by tax-exempt, not-for-profit hospitals. We examine the impact of this tax requirement on CBAs among these hospitals relative to for-profit and government hospitals that were not subject to the new policy. We employed a quasi-experimental, difference-in-difference study design using a longitudinal observational approach and used secondary data collected by the American Hospital Association (years 2006-2010 including 20,538 hospital year observations). Findings show a significant increase in the reporting of 7 of the 13 CBAs among tax-exempt, not-for-profit hospitals compared with other hospitals after the policy change. Examples include partnering to conduct community health assessments ( b = 0.035, p = .002) and using capacity assessments to identify unmet community health needs ( b = 0.041, p = .001). Recent tax revisions are associated with increases in reported CBAs among tax-exempt, not-for-profit hospitals. As the debate continues regarding tax exemption status for not-for-profit hospitals, policy makers should expand efforts for enhanced accountability.

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