Hospital readmissions after pulmonary resection: post-discharge nursing telephone assessment identifies high risk patients

Objective: To assess the economic impact of MACE during cardiac catheterization procedures in both high and low risk patients and to apply literature estimates of MACE rates the iso-osmolar iodinated contrast media iodixanol versus low-osmolar contrast media (LOCM). Methods: We performed a retrospective analysis using the Premier Perspective™ database, which contains patient-level data including primary and secondary diagnosis and procedure codes. Inpatient adults without prior hemodialysis who underwent invasive cardiac catheterization procedures with contrast media during 2007-2008 were studied. MACE was defined as acute MI, ischemic heart disease, or angina. Resource utilization, re-admittance rate, length of stay (LOS), and cost were collected. High-risk patients were defined as have an AMI or angina as the admitting diagnosis. Aggregate MACE outcomes were then applied to MACE rates from multi-center studies found in the literature comparing iodixanol to LOCM. Results: Among 521,437 patients in the Premier Perspective™ undergoing CCP, 13,149 (2.52%) experienced a MACE. Of those experiencing MACE, high-risk patients had longer LOS, 4.2 vs. 3.3 days, p <0.0001, longer ICU LOS. 2.6 vs. 2.3 days, p= 0.0028, greater total costs, $15,020 vs. $12,413, p <0.0001, and a greater frequency of MACE readmission due to re-catheterization, 58.66% vs. 50.68%, p= <0.0001. For readmissions within 30 days post-discharge, LOS and cost remained statistically significant for high-risk patients, but ICU LOS was not significantly different. In applying literature-based MACE rates, isosmolar iodixanol versus LOCM iopamidol potentially saves on average $600 per patient in inpatient MACE-related costs but no difference for 30 days post-discharge MACE. Additionally, iodixanol may save up to $616 on average per patient vs. Ioxaglate in high-risk inpatient MACE-related costs, but no difference in non high-risk patients. Conclusions: MACE is a complication in CCP with substantial resource utilization, cost, and mortality associated with it. The iso-osmolar contrast agent iodixanol may reduce the rate of MACE in certain instances and therefore reduce the MACE-related cost and resource utilization associated with cardiac catheterization procedures.

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Impact of the Medicare hospital readmissions reduction program on vulnerable populations

BMC Health Services Research ◽

10.1186/s12913-019-4645-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Yunwei Gai ◽

Dessislava Pachamanova

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Vulnerable Populations ◽

Low Income ◽

Hospital Readmissions ◽

High Risk Patients ◽

Reduction Program ◽

Risk Patients ◽

Linear Probability

Abstract Background The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy’s overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. Methods Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010–2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. Results There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. Conclusions The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital’s patients and neighborhood.

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Treatment of Long-standing Thoracostoma and Bronchopleural Fistula without Pulmonary Resection in High Risk Patients

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199704000-00019 ◽

1997 ◽

Vol 99 (4) ◽

pp. 1046-1053 ◽

Cited By ~ 7

Author(s):

Thomas J. Francel ◽

Gilbert W. Lee ◽

Susan E. Mackinnon ◽

Alexander G. Patterson

Keyword(s):

High Risk ◽

Pulmonary Resection ◽

Bronchopleural Fistula ◽

High Risk Patients ◽

Risk Patients

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In response – additional support to high-risk patients can reduce hospital readmissions

Clinical Medicine ◽

10.7861/clinmedicine.10-2-202a ◽

2010 ◽

Vol 10 (2) ◽

pp. 202.2-203

Author(s):

Z Shalchi ◽

S Saso ◽

HK Li ◽

E Rowlandson ◽

RC Tennant

Keyword(s):

High Risk ◽

Hospital Readmissions ◽

High Risk Patients ◽

Risk Patients ◽

Additional Support

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Improving transitions from acute care to home among complex older adults using the LACE Index and care coordination

BMJ Open Quality ◽

10.1136/bmjoq-2019-000814 ◽

2020 ◽

Vol 9 (2) ◽

pp. e000814 ◽

Cited By ~ 1

Author(s):

Lesley Charles ◽

Lisa Jensen ◽

Jacqueline M I Torti ◽

Jasneet Parmar ◽

Bonnie Dobbs ◽

...

Keyword(s):

High Risk ◽

Acute Care ◽

Care Coordination ◽

Phase 1 ◽

Hospital Readmissions ◽

Acute Care Hospital ◽

Care Hospital ◽

High Risk Patients ◽

Phone Calls ◽

Risk Patients

BackgroundImproving transitions in care is a major focus of healthcare planning. The objective of this study was to determine the improvement in transitions from an intervention identifying complex older adult patients in acute care and supporting their discharge into the community.MethodsThis was a quality assurance study evaluating an intervention on high-risk patients admitted in an acute care hospital. In phase 1, the Length of Stay, Acuity of the Admission, Charlson Comorbidity Index Score, and Emergency Department Use (LACE Index) was selected to assess a patient’s risk for readmission and a standard discharge protocol was developed. In phase 2, the intervention was implemented: (1) all patients were screened for the risk of readmission using the LACE Index; and (2) the high-risk patients were provided care coordination including follow-up phone calls focused on medications, equipment and homecare services. Emergency department (ED) revisits and hospital readmissions were measured.ResultsThe LACE Index identified 433/1621 (27%) patients at high risk for readmission. Care coordination was achieved within 72 hours in 79% of patients. The 433 high-risk patients receiving the intervention, compared with a group without intervention (n=231), had lower lengths of stay (12.7 days vs 16.6 days); similar 7-day ED revisits (10.6% vs 10.8%) and 30-day ED revisits (30.5% vs 33.3%); lower 90-day readmissions (39.3% vs 44.6%); and lower 6-month readmissions (50.9% vs 58.4%). The 7-day and 30-day readmissions were similar in both groups.ConclusionsIdentifying complex patients at high risk for readmission and supporting them during transitions from acute care to home potentially decreases lengths of hospital stay and prevents short-term ED revisits and long-term readmissions.

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148 Lipid Targeting Post-Stroke—Targeting Who?

Age and Ageing ◽

10.1093/ageing/afab030.109 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C Micallef ◽

K Bingham ◽

J M Barber

Keyword(s):

High Risk ◽

Management Program ◽

Health Board ◽

Treatment Intensification ◽

Post Discharge ◽

Term Care ◽

Lipid Management ◽

High Risk Patients ◽

Post Stroke ◽

Risk Patients

Abstract Introduction Frailer patients are at high risk of complications from drugs like statins. Other less frail patients may be undertreated. The Treat Stroke to Target trial showed that high risk patients with atherosclerosis and/or ischaemic heart disease (IHD) who were treated to an LDL level of less than 1.8 mmol/L had a 22% relative risk reduction in major cardiovascular events compared to those with a higher target. In our Quality Improvement. Project We estimated the numbers of post-stroke cases who might safely benefit from a targeted, pharmacist led intensive lipid management program. Methods 500 consecutive ischaemic stroke cases with a modified Rankin score (mRS) of 0–3 were identified from the Scottish Stroke Care Audit Database. Those discharged to long term care or dead at the time of data collection were excluded. Data collected was age, evidence of atherosclerosis on vascular imaging, co-morbid IHD, LDL at index admission and between 1 month to 1 year post-stroke, anti-lipid treatment at discharge and up to 1 year post-stroke. Atrial fibrillation patients were included if other risk criteria were met. Results The mean age of the 500 cases was 70. From this group, 297 (60%) met the entry criteria for “Treat to Stroke Target”. 190 (64%) cases had LDL checked post-discharge. 87 cases failed to reach the RCP Stroke Guidance of a 40% reduction in LDL Cholesterol. 66 (22%) of cases had LDL >1.8 mmol/L on most recent check and potentially should have been treated to target. Of the 83 cases excluded due to mRS >3 or significant dependency, 70 cases (84%) were discharged on a statin and importantly 34 (48%) of these died within 1 year of their stroke. Conclusions Based on annual stroke admissions in our health board, around 86–117 high risk patients could benefit from a virtual lipid treatment intensification clinic.

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113. Improving Transitions-of-Care for Patients Discharged on High-Risk Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.315 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S171-S171

Author(s):

Ryan Zabrosky ◽

Ellen C Rubin ◽

Erica Liu ◽

Karrine Brade ◽

Hope Serafin ◽

...

Keyword(s):

Infectious Disease ◽

High Risk ◽

Antimicrobial Therapy ◽

Hospital Readmissions ◽

Transitions Of Care ◽

Post Discharge ◽

Healthcare Improvement ◽

Medication Counseling ◽

Risk Patients

Abstract Background Providing effective transitions-of-care (TOC) services improves outcomes for patients discharged on high-risk medications. Literature has shown that successful TOC for certain antimicrobials reduces hospital readmissions, medication errors, and improves post-discharge follow-up and laboratory monitoring. Prior to this quality improvement (QI) initiative, there was no formal TOC process for patients discharged on high-risk antimicrobial therapy (HAT) at our institution. Without standardization, only 55.1% of patients discharged on HAT had successful TOC. The aim of this initiative was to develop and implement a TOC protocol in at least 90% of patients discharged on HAT. Methods This QI initiative utilized the Institute of Healthcare Improvement model for improvement. A workgroup of key stakeholders developed a protocol to identify and standardize TOC services provided to patients discharged on HAT. Successful protocol completion was achieved if the following process metrics were evaluated, obtained, and documented prior to discharge: baseline laboratory values, pharmacokinetic monitoring, appropriate intravenous access, drug-drug interactions, medication availability, discharge medication counseling, and formal pharmacist documentation in a discharge note. Outcome metrics included referral to outpatient infectious disease (ID) follow-up, 90-day readmissions, and successful TOC. Balancing metrics included pharmacist time and protocol initiation for patients not discharged on HAT. Results Between October 2020 and May 2021, 218 patients met protocol inclusion criteria. Of these, 203/218 (93.1%) were appropriately identified with the new TOC process. The protocol was successfully followed in 78.9% of patients identified. Readmission rates were 42.8%, which was unchanged from baseline. Inpatient ID involvement increased from 80.9% to 95.7% and referral to outpatient ID follow-up from 59% to 94.8%. Conclusion This newly developed TOC protocol successfully identifies patients discharged on HAT, improves provision of TOC services to these high-risk patients, and significantly improves the rate of infectious disease involvement while inpatient and after discharge. Disclosures All Authors: No reported disclosures

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