scholarly journals Incidence, Prediction, and Causes of Unplanned 30-Day Hospital Admission After Ambulatory Procedures

2020 ◽  
Vol 131 (2) ◽  
pp. 497-507 ◽  
Author(s):  
Bijan Teja ◽  
Dana Raub ◽  
Sabine Friedrich ◽  
Paul Rostin ◽  
Maria D. Patrocínio ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Day Hospital ◽  
Ambulatory Procedures

Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

2018 ◽  
Vol 33 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Nghi (Andy) Bui ◽  
Mobolaji Adeola ◽  
Rejena Azad ◽  
Joshua T. Swan ◽  
Kathryn S. Agarwal ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Day Hospital ◽  
Practice Experience

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient’s ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.

scholarly journals The Contribution of Pharmacogenetic Drug Interactions to 90-Day Hospital Readmissions: Preliminary Results from a Real-World Healthcare System

2021 ◽  
Vol 11 (12) ◽  
pp. 1242
Author(s):  
Sean P. David ◽  
Lavisha Singh ◽  
Jaclyn Pruitt ◽  
Andrew Hensing ◽  
Peter Hulick ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Hospital Admission ◽  
Drug Interactions ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Day Hospital ◽  
Limited Data ◽  
Study Population ◽  
The Relationship ◽  
Univariate Analyses

Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there are limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010 to 2020 in a study population (N = 10,104) who underwent sequencing with a 14-gene pharmacogenetic panel. The presence of at least one pharmacogenetic indicator for a medication prescribed within 30 days of hospital admission was considered a gene-x-drug interaction. Multivariable logistic regression analyzed the association between one or more gene-x-drug interactions with 90-day readmission. There were 2211/2354 (93.9%) admitted patients who were prescribed at least one CPIC medication. Univariate analyses indicated that the presence of at least one identified gene-x-drug interaction increased the risk of 90-day readmission by more than 40% (OR = 1.42, 95% confidence interval (CI) 1.09–1.84) (p = 0.01). A multivariable model adjusting for age, race, sex, employment status, body mass index, and medical conditions slightly attenuated the effect (OR = 1.32, 95% CI 1.02–1.73) (p = 0.04). Our results suggest that the presence of one or more CPIC gene-x-drug interactions increases the risk of 90-day hospital readmission, even after adjustment for demographic and clinical risk factors.

scholarly journals Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain

2020 ◽  
Author(s):  
Daniel Prieto-Alhambra ◽  
Elisabet Balló ◽  
Ermengol Coma ◽  
Núria Mora ◽  
María Aragón ◽  
...  
Keyword(s):  
Primary Care ◽  
Polymerase Chain Reaction ◽  
Hospital Admission ◽  
Nursing Home Residents ◽  
Outcome Studies ◽  
Day Hospital ◽  
Chain Reaction ◽  
Co Morbidity ◽  
Polymerase Chain ◽  
Outpatient Settings

Abstract Background Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates. Methods This was a population-based cohort study.   Data were obtained from Information System for Research in Primary Care (SIDIAP)—a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results.   Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality. Results We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45–54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6–15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75–84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)]. Conclusion COVID-19 infections were widespread in the community, including all age–sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.

Symptom Severity and Day Hospital Admission

1973 ◽  
Vol 24 (2) ◽  
pp. 102-104
Author(s):  
Richard C. Erickson ◽  
Frank I. Backus
Keyword(s):  
Hospital Admission ◽  
Symptom Severity ◽  
Day Hospital

scholarly journals Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110106
Author(s):  
Stefan H. Meyering ◽  
Chet D. Schrader ◽  
Darren Kumar ◽  
Yuan Zhou ◽  
Naomi Alanis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Classification Accuracy ◽  
Characteristic Curve ◽  
Hospital Readmissions ◽  
Day Hospital ◽  
Cardiac Events ◽  
Heart Score

Objective We aimed to examine the role of the HEART (history, EKG, age, risk factors, and troponin) score in the evaluation of six clinical outcomes among three groups of patients in the emergency department (ED). Methods We performed a retrospective observational study among three ED patient groups including White, Black, and Hispanic patients. ED providers used the HEART score to assess the need for patient hospital admission and for emergent cardiac imaging tests (CITs). HEART scores were measured using classification accuracy rates. Performance accuracies were measured in terms of HEART score in relation to four clinical outcomes (positive findings of CITs, ED returns, hospital readmissions, and 30-day major adverse cardiac events [MACE]). Results A high classification accuracy rate (87%) was found for use of the HEART score to determine hospital admission. HEART scores showed moderate accuracy (area under the receiver operating characteristic curve 0.66–0.78) in predicting results of emergent CITs, 30-day hospital readmissions, and 30-day MACE outcomes. Conclusions Providers adhered to use of the HEART score to determine hospital admission. The HEART score may be associated with emergent CIT findings, 30-day hospital readmissions, and 30-day MACE outcomes, with no differences among White, Black, and Hispanic patient populations.

scholarly journals Comparisons of 30-Day Admission and 30-Day Total Healthcare Costs Between Patients Who Were Treated With Oritavancin or Vancomycin for a Skin Infection in the Outpatient Setting

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Thomas P Lodise ◽  
Christina Palazzolo ◽  
Kerry Reksc ◽  
Elizabeth Packnett ◽  
Mark Redell
Keyword(s):  
Single Dose ◽  
Hospital Admission ◽  
Healthcare Costs ◽  
Cohort Analysis ◽  
Admission Rate ◽  
Outpatient Setting ◽  
Cost Driver ◽  
Day Hospital ◽  
Outpatient Prescription ◽  
Admission Rates

Abstract Objective Hospital admission is a key cost driver among patients with skin and soft tissue infections (SSTI). Data suggest that many SSTI patients are hospitalized unnecessarily and can be managed effectively and safely in an outpatient setting at a substantially lower cost. Oritavancin (ORI) is a single-dose treatment that has the potential to shift care from the inpatient to the outpatient setting. This study sought to compare the 30-day hospital admission rates and mean healthcare costs among SSTI patients who received outpatient ORI or vancomycin (VAN). Method Over a 1-year period, outpatient prescription claims for VAN and ORI among patients with SSTIs and no hospitalization in past 3 days were for VAN and ORI were analyzed using a retrospective cohort analysis of the Truven Health MarketScan Databases. Results During the study period, 120 and 6695 patients who received ORI and VAN, respectively, met inclusion criteria. Groups were well matched at baseline. After covariate adjustment, patients who received ORI had a significantly lower 30- day admission rate versus patients who received VAN (6.1% vs 16.2%, respectively; P = .003). Mean healthcare costs 30-day post index were comparable between ORI and VAN patients ($12 695 vs $12 717, respectively; P = 1.0). Conclusions Results suggest that ORI provides a single-dose alternative to multidose VAN for treatment of SSTI in the outpatient setting and may result in lower 30-day hospital admission rates.

scholarly journals The Contribution of Pharmacogenetic Drug Interactions to 90-Day Hospital Readmissions: Preliminary Results from a Real-World Healthcare System

2021 ◽  
Author(s):  
Sean P David ◽  
Lavisha Singh ◽  
Jaclyn Pruitt ◽  
Andrew Hensing ◽  
Peter Hulick ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Hospital Admission ◽  
Drug Interactions ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Day Hospital ◽  
Increased Risk ◽  
Study Population ◽  
The Relationship ◽  
Univariate Analyses

Clinical Pharmacogenomics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there is limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010-2020 in a study population (N=10,104) who underwent sequencing with a 14-gene pharmacogenetic panel. The presence of at least one pharmacogenetic indicator for a medication prescribed within 30 days of hospital admission was considered a gene-x-drug interaction. Multivariable logistic regression analyzed the association between one or more gene-x-drug interactions with 90-day readmission. There were 2,211/2,354 (93.9%) admitted patients who were prescribed at least one CPIC medication. Univariate analyses indicated that the presence of at least one identified gene-x-drug interaction increased risk of 90-day readmission by more than 40% (OR=1.42, 95% confidence interval (CI) 1.09-1.84)(p=0.01). A multivariable model adjusting for age, race, sex, employment status, body mass index, and medical conditions, slightly attenuated the effect (OR=1.33, 95% CI 1.02-1.75)(p=0.04). Our results suggest that the presence of one or more CPIC gene-x-drug interactions increases the risk of 90-day hospital readmission, even after adjustment for demographic and clinical risk factors.

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