Risk Factors and Effects of Care Management on Hospital Readmissions Among High Users at an Academic Medical Center

2016 ◽  
Vol 17 (3) ◽  
pp. 134-139 ◽  
Author(s):  
Quang H. Pham ◽  
Sara X. Li ◽  
Brent C. Williams
Keyword(s):  
Hospital Readmission ◽  
Care Management ◽  
Medical Center ◽  
Academic Medical Center ◽  
Management Program ◽  
Complex Care ◽  
Intensive Care Management ◽  
Academic Medical ◽  
Care Management Program ◽  
The Mean

Few studies have examined predictors of hospital readmission among high-using patients enrolled in a behaviorally oriented intensive care management program. The purpose of this case control study was to describe risk factors and the effectiveness of a complex care management program for hospital readmission among vulnerable patients at a large academic medical center. One hundred sixty-three patients enrolled in the University of Michigan Complex Care Management Program (UM CCMP) were hospitalized between January 2014 and March 2015. Sixty were readmitted within 30 days of discharge. Among all patients, the mean age was 51.1 years, 38.7% were non-White, 81.5% had Medicaid and/or Medicare, 50.3% were without stable housing, and 27.6% had significant psychiatric illnesses. Although mostly not statistically significant, multivariable risk of readmission was increased by having twice the mean number of hospitalizations in the last 6 months (odds ratio [OR] = 1.44, 95% CI [1.00, 2.06]), having chronic pain on a scheduled narcotic (OR = 1.49, 95% CI [0.67, 3.35]), and going to a primary care physician within 30 days of discharge (OR = 1.35, 95% CI [0.63, 2.89]). Risk was decreased by going to a specialist (OR = 0.54, 95% CI [0.23, 1.27]) and receiving moderate-intensity CCMP intervention (OR = 0.48, 95% CI [0.20, 1.19]). Among hospitalized high-using patients enrolled in the UM intensive care management program, readmission is likely significantly influenced by medical, behavioral, and social challenges. Care management appears most effective in preventing readmission among patients with mid- rather than high- or low-level needs. These findings at a single program should be explored in further, larger studies.

Learnings From an Academic Medical Center in Hiring New RN Graduates Successfully Into Hospital Care Management

Nurse Leader ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 135-138
Author(s):  
Jennifer S. Mensik Kennedy ◽  
Ann Nielsen ◽  
Jennifer Leitch
Keyword(s):  
Hospital Care ◽  
Care Management ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals A Single Virtual Consult Reduces Severe Hyperglycemia in Patients Admitted with COVID19 Infection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A335-A335
Author(s):  
Diana Athonvarangkul ◽  
Felona Gunawan ◽  
Kathryn Nagel ◽  
Leigh Bak ◽  
Kevan C Herold ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Control Group ◽  
Post Intervention ◽  
Academic Medical ◽  
Treatment Plans ◽  
The Mean ◽  
Glucose Management ◽  
And Control ◽  
Glycemic Management

Abstract Diabetes and hyperglycemia are risk factors for morbidity and mortality in hospitalized patients with COVID19. Subspecialty consultative resources to help front-line clinicians treat these conditions is often limited. We implemented a “Virtual Hyperglycemia Surveillance Service (VHSS)” to guide glucose management in COVID19 patients admitted to our 1541-bed academic medical center. From April 22 to June 9, 2020, hospitalized adult patients with COVID19 and 2 or more blood glucose (BG) values greater than 250 mg/dl over 24-h were identified using a daily BG report. The VHSS reviewed BGs and treatment plans, then made recommendations for future glycemic management via a one-time note, visible to all providers. Some patients with re-admission or persistently elevated BG after 1 week received a second VHSS note. We compared BGs from 24-h pre- and 72-h post-intervention starting at 6AM on the day following VHSS review. We also evaluated for hypoglycemia, insulin infusion use and use of formal diabetes consults. A subgroup analysis was performed on patients in the intensive care unit (ICU). At the end of the intervention, we identified a retrospective control cohort admitted to the same hospital from March 21 to April 21, 2020 who met the inclusion criteria for a VHSS assessment. The VHSS group consisted of 100 patients with 126 individual VHSS encounters, and the control group comprised 50 patients. Baseline characteristics in the VHSS and control groups, respectively, were: mean age 62.5 vs 62.1 years, % male 58 vs 56, mean weight 91.4 vs 93.4 kg, BMI 31.8 vs 33.0 kg/m2, and HbA1c 9.1 vs 8.8 %. There were fewer patients in the ICU in the VHSS than control group (44% vs 66%). In the VHSS group, mean BG pre- vs. post-intervention was 260.3 ±21.7 and 227.4 ±25.3 mg/dl (p<0.001). In the control group, mean BG pre-and post- the day they met assessment criteria was 264.8 ± 6.5 mg/dl and 250.6 ± 8.6 mg/dl (p=0.18). There was no difference in the use of insulin infusions or diabetes consults between the two groups. More hypoglycemia (BG<70 mg/dl) occurred in the VHSS than control group (8.3% vs 0%, p=0.04). Within the VHSS group, the average change in BG was significantly greater in ICU than non-ICU patients (-51.8 ±8.7 vs -19.6 ±5.0 mg/dl, p<0.01) and the reduction in the % of BG over 250 mg/dl was also significantly greater in the ICU (-32.2% vs -16.8%, p=0.02). Implementation of a single virtual consult for severely hyperglycemic hospitalized COVID19 patients was associated with rapidly reduced BG concentrations, especially in the ICU. The mean reduction in BG with VHSS intervention was more than 2-fold greater than that observed in our control group. Glucose control remained suboptimal, however, suggesting the need for subsequent input from this specialty service.

Abstract 20028: Improved Outcomes with IT-enabled Care Management Following Coronary Revascularization

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Daniel J Elliott ◽  
Paul Kolm ◽  
William Weintraub ◽  
Sharon Anderson ◽  
Patty Resnik ◽  
...  
Keyword(s):  
Care Management ◽  
Medical Center ◽  
Coronary Revascularization ◽  
Baseline Period ◽  
Management Program ◽  
First Year ◽  
Intervention Period ◽  
Quality Of Life Scale ◽  
Patient Reported ◽  
Care Management Program

Objective: Hospitals are increasingly responsible for the longitudinal care of patients discharged from their institution. We report preliminary results from an IT-enabled care management program for patients following coronary revascularization at a large regional medical center. Methods: The program consisted of patient education, telephonic management, and integration with community providers. The intensity of the intervention was tailored to patient risk of subsequent utilization. We used hierarchical logistic regression to compare severity-adjusted all-cause non-elective 30-day readmissions to our institution for all patients discharged in the first year (April 2013 - April 2014) with the baseline period (January 2010 - March 2013). We used mixed effects models to compare patient responses to the Care Transitions Measure-3 (CTM-3), a CMS-endorsed measure of transition quality, and the Seattle Angina Questionnaire-7 (SAQ-7) following discharge, both of which were collected as part of routine care management. Results: We enrolled 1,542 revascularized patients in the first year, including 1,188 with PCI and 354 with CABG. The overall rate of readmission for PCI was 7.5% in the baseline period and 8.0% in the intervention period. After adjusting for patient factors, the adjusted rate of readmission was 8.9% and 6.8% (adjusted RR 0.77 [0.76 - 0.78]). The unadjusted rates for CABG were 12.6 and 12.9; with adjusted rates of 13.3 and 10.8 in the baseline and intervention period, respectively (adjusted RR 0.81 [0.8 - 0.83]). The CTM-3 score improved from 67.4±13.3 to 78.8±16.8 for PCI and from 72.7±12.7 to 75±20.7 for CABG during the intervention period (p < 0.001 for both). The SAQ domains all improved significantly during the course of the program, with improvements in Quality of Life Scale from 64±27 to 92±14 for PCI and 60±34 to 92±14 (p<0.001). Conclusions: A care management program was associated with improved process and outcome measures, including significant improvements in patient-reported outcomes, when compared to historical controls. Interdisciplinary care management programs can play a significant role in improving care, including in non-integrated healthcare environments.

scholarly journals Risk of ionizing radiation exposure from CT scans in the Neuro ICU - a patient safety blind spot?

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2489
Author(s):  
Avinash B. Kumar ◽  
Roy C. Neeley
Keyword(s):  
Mechanical Ventilation ◽  
Patient Safety ◽  
Ionizing Radiation ◽  
Radiation Exposure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Ct Scans ◽  
Academic Medical ◽  
The Mean ◽  
Ct Studies

Introduction: The exposure to ionizing radiation has increased significantly with the wide availability of computed tomography (CT) scans and portable imaging technology. We examine the pattern of use of inpatient diagnostic imaging and radiation exposure in the neuro-intensive care unit (Neuro ICU, N-ICU) patient population at a large academic medical center. Methods: We retrospectively evaluated all patients admitted to the Neuro ICU at our academic medical center from January 1 to December 31, 2013. The number and type of CT studies was collected, and the corresponding estimated radiation dose was calculated. We limited the evaluation to CT scans, which accounts for the majority of radiation exposure. Data were electronically collected and cross-referenced to the patients’ electronic medical records (EMR) and radiology records. Radiation dose estimates were calculated based on published reference values and conversion factors (CT head (2mSv)), CT angiography of the head and neck (7-10 mSv), Ct Chest /Abd/pelvis ( 10 mSv), CT cerebral perfusion analysis (3.3 mSv). Results: In the calendar year 2013, we had a total of 2353 admission encounters (F=1078). The mean age on admission was 56.55Y ± 16.7. The mean length of ICU stay was 6.3 days. Mechanical ventilation was initiated on 420 patients with a mean length on mechanical ventilation 5.09 days. 2028 CT scans were completed of which approximately 60% were head CT without contrast (n=1209). 379 patients had multiple CT studies. The mean number of studies was 3.8 ± 2. The number of patients with more thanthree3 studies during their ICU stay was 159.  The maximum number of studies on a single patient was 21. Conclusion: Patients in the Neuro ICU are at a risk for significant exposure to ionizing radiation. Radiation exposure must be factored into the culture of quality and patient safety in the ICU.

Impact of Anticipatory Batching of Pharmacy Compounded Sterile Products on Time to Nurse Administration

2021 ◽  
pp. 089719002110271
Author(s):  
Sophia Pathan ◽  
Danine Sullinger ◽  
Laura J. Avino ◽  
Samuel E. Culli
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medication Administration ◽  
Patient Specific ◽  
Nursing Services ◽  
Academic Medical ◽  
Secondary Endpoints ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Background: Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic medical center, intravenous medications were historically compounded on a patient-specific basis. In 2020, the pharmacy began batching frequently-utilized medications. This analysis explored the impact of compounded sterile batching on pharmacy and nursing services. Methods: This pre- and post-interventional study compared data from February through March 2020 with a seasonally matched period from 2019. The primary endpoint was difference in time to administration of urgent (STAT) medications. Secondary endpoints included timeframes for a pharmacy technician to prepare, a pharmacist to check, and a nurse to administer the medications, as well as reprinted labels and estimated waste. Results: On average, it took one hour and 43 minutes to administer a STAT medication in 2019 and one hour and 57 minutes in 2020 ( p = 0.122). It took about four hours to administer routine medications in 2019 and 2020 ( p = 0.488). The number of labels reprinted decreased from 616 in 2019 to 549 in 2020 ( p = 0.195), relating to decreased missing doses. The mean time to check and send a medication decreased from 2019 to 2020 for STAT orders ( p < 0.001), and there was no difference in wasted medications looking at all orders in this time. Conclusion: Anticipatory batching decreased time to prepare, check, and send medications, though there was no effect on waste or on time to administration. Future studies can examine the correlation between pharmacy operations and medication administration.

scholarly journals Following Up on Clinical Recommendations in Transitions from Hospital to Nursing Home

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Lisa B. Caruso ◽  
Soe Soe Thwin ◽  
Gary H. Brandeis
Keyword(s):  
Nursing Home ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Medical Center ◽  
Academic Medical Center ◽  
National Data ◽  
Home Setting ◽  
Hospital Readmission Rate ◽  
Academic Medical ◽  
Nursing Home Setting

Following up on recommendations made at the time of a hospital discharge is important to patient safety. While data is lacking, specifically around the transition of patient to nursing home, it has been postulated that missed items such as laboratory tests may result in adverse patient outcomes. To determine the extent of this problem, a retrospective cohort study of subjects discharged from an academic medical center and admitted to nursing homes (NH) was followed to determine the type of discharge recommendations and the rate of completion. In addition, for the purpose of generalizability, the 30-day hospital readmission rate was calculated. 152 recommendations were made on 51 subjects. Almost a quarter of the recommendations made by the hospital discharging team were not acted upon. Furthermore, for the majority of those recommendations that were not acted upon, a reason could not be determined. In concert with national data, 20% of the subjects returned to the hospital within 30 days. Further investigation is warranted to determine if an association exists between missed recommendations and hospital readmission from the nursing home setting.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care

2018 ◽  
Vol 160 (2) ◽  
pp. 339-342 ◽  
Author(s):  
Elizabeth A. Hobbs ◽  
Joshua A. Hanson ◽  
Robert G. Nicholas ◽  
Benjamin R. Johnson ◽  
Karen A. Hawley
Keyword(s):  
Patient Care ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pediatric Malignancy ◽  
Academic Medical ◽  
The Mean ◽  
Pathologic Analysis ◽  
Mean Charge

Objective This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Study Design Retrospective chart review from 2005 through 2016. Setting Academic medical center. Subjects and Methods Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. Results From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Conclusions Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

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