A Need for Greater Collaboration

2017 ◽  
pp. 65-87
Author(s):  
Mariette Sourial ◽  
Jo Ann M. Bamdas ◽  
Angelica Constanzo ◽  
Marina E. Ishak
Keyword(s):  
Healthcare System ◽  
Interprofessional Education ◽  
Hospital Readmissions ◽  
The United States ◽  
Collaborative Practice ◽  
Health Providers ◽  
Readmission Rates ◽  
Comprehensive Overview ◽  
Hospital Readmission Rates ◽  
New Policies

Patient safety concerns have risen to such levels that multiple organizations and initiatives have been created to reduce hospital readmissions and medication errors in the United States healthcare system. Interprofessional education and collaborative practice (IPECP) has become a center of focus in healthcare education and the competency-based programs help health providers function more effectively as a team, train new university and college healthcare students to become ready for collaborative practice, and assist in making new policies and practices to improve today's healthcare system. This chapter provides a comprehensive overview of healthcare initiatives created to help lower hospital readmission rates and polypharmacy errors. These projects, programs, and initiatives optimize patient care while minimizing costs. With pharmacists, physicians, nurses, social workers, and other professionals and caregivers build better teams with improved communication and understanding each other's roles and responsibilities, the global healthcare system will overcome the numerous challenges.

A Need for Greater Collaboration

2017 ◽  
pp. 328-350
Author(s):  
Mariette Sourial ◽  
Jo Ann M. Bamdas ◽  
Angelica Constanzo ◽  
Marina E. Ishak
Keyword(s):  
Healthcare System ◽  
Interprofessional Education ◽  
Hospital Readmissions ◽  
The United States ◽  
Collaborative Practice ◽  
Health Providers ◽  
Readmission Rates ◽  
Comprehensive Overview ◽  
Hospital Readmission Rates ◽  
New Policies

Patient safety concerns have risen to such levels that multiple organizations and initiatives have been created to reduce hospital readmissions and medication errors in the United States healthcare system. Interprofessional education and collaborative practice (IPECP) has become a center of focus in healthcare education and the competency-based programs help health providers function more effectively as a team, train new university and college healthcare students to become ready for collaborative practice, and assist in making new policies and practices to improve today's healthcare system. This chapter provides a comprehensive overview of healthcare initiatives created to help lower hospital readmission rates and polypharmacy errors. These projects, programs, and initiatives optimize patient care while minimizing costs. With pharmacists, physicians, nurses, social workers, and other professionals and caregivers build better teams with improved communication and understanding each other's roles and responsibilities, the global healthcare system will overcome the numerous challenges.

Abstract WMP94: Readmission Within 30 days After Acute Ischemic Stroke, United States 2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Mary G George ◽  
Sallyann M Coleman King ◽  
Cathleen Gillespie ◽  
Robert Merritt
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
The United States ◽  
Artery Occlusion ◽  
Principal Diagnosis ◽  
Readmission Rates ◽  
The Cost

Introduction: Hospital readmissions contribute significantly to the cost of medical care and reflect the burden of disease. Limited data have been reported on national hospital readmission after acute ischemic stroke. Methods: Among 2013 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD), we identified acute ischemic stroke (AIS) hospitalizations using principal diagnosis ICD-9-CM codes. We provided national estimates of AIS non-elective readmission rates within 30 days. Results: In 2013, there were a total of 489,813 adult index AIS admissions in the United States. The readmission rate within 30 days for a new AIS as the principal diagnosis was 2.1% of index AIS admissions, and was 10.2% of all readmissions. The readmission rate for all non-elective reasons increased with age, with the lowest readmission rate (8.9%) among ages 18-44, and the highest (11.7%).among ages 85+. The readmission rate was higher among patients with public insurance (11.1%) as compared to private (7.4%) or others (7.9%). Recurrent AIS (20.2%) was the most common reason for readmission, including unspecified cerebral artery occlusion with infarction (ICD9-CM=434.91, 13.0%) and cerebral embolism with infarction (ICD9-CM=434.11, 3.1%). In addition, infections were among the most common causes (Septicemia 5.7%, UTI 2.7%, and pneumonia 2.2%) and TIA (2.4%). Conclusions: The findings have important implications for identifying groups and conditions at high-risk for readmission. The large number of recurrent AIS within 30 days of index AIS highlights the need for improved patient follow-up and secondary prevention treatment.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

Interprofessional Education

2020 ◽  
pp. 259-285
Author(s):  
Izhar Faisal ◽  
Saima Salam ◽  
Manisha Arora
Keyword(s):  
Developing Countries ◽  
Healthcare System ◽  
Health Professionals ◽  
Interprofessional Education ◽  
Institutional Support ◽  
Developed Countries ◽  
Collaborative Practice ◽  
Workplace Culture ◽  
Potential Barriers ◽  
Complete Overhaul

With an ever worsening shortage of healthcare workers, there has been a global shift towards strengthening of interprofessional education (IPE). IPE has existed as a powerful tool in developed countries, but in developing countries like India, it is still in its infancy. Several models of interprofessional education exist, yet India lags behind in implementing these models in academic curricula. Rudimentary curriculum, inefficient healthcare system, and maldistribution of health professionals are some of the potential barriers. A complete overhaul of the healthcare system along with progressive strategies of incorporation of IPE needs to be debated, and associated limitations need to be addressed. Adequate institutional support, well-constructed protocols, infrastructural revamp, and change of workplace culture are vital for IPE to succeed and be sustainable. This chapter provides an overview of IPE and collaborative practice in Indian settings and presents an account of an Indian institution utilizing IPP approach and highlights potential challenges in incorporating IPE in the academic curriculum.

scholarly journals Reduction of 30-Day Hospital Readmissions after Patient-centric Telephonic Medication Therapy Management Services

2016 ◽  
Vol 51 (11) ◽  
pp. 907-914 ◽  
Author(s):  
Daryl E. Miller ◽  
Teresa E. Roane ◽  
Karen D. McLin
Keyword(s):  
Hospital Discharge ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Medication Therapy Management ◽  
Medication List ◽  
Readmission Rates ◽  
Therapy Management ◽  
Medication Therapy ◽  
Hospital Readmission Rates ◽  
Significant Difference

Background Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. Objective To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. Methods A retrospective chart analysis ( n = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. Results The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio, 1.04; 95% CI, 0.68–1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Conclusion Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.

scholarly journals Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

2019 ◽  
Vol 36 (2) ◽  
pp. 47-53
Author(s):  
Julie B. Cooper ◽  
Elizabeth Jeter ◽  
Cory John Sessoms
Keyword(s):  
Internal Medicine ◽  
Hospital Readmission ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
General Internal ◽  
Hospital Readmission Rates ◽  
Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

Right TraC™ Post-Hospitalization Care Transitions Program to Reduce Readmissions for Hemodialysis Patients

2017 ◽  
Vol 45 (6) ◽  
pp. 532-539 ◽  
Author(s):  
Rebecca L. Wingard ◽  
Kathryn McDougall ◽  
Billie Axley ◽  
Andrew Howard ◽  
Cathleen O''Keefe ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Information Exchange ◽  
Repeated Measures ◽  
Hospital Readmissions ◽  
Care Transitions ◽  
Readmission Rates ◽  
Hospitalization Rates ◽  
Hospital Readmission Rates ◽  
Nonrandomized Trial

Background: Hemodialysis (HD) patients have high hospitalization rates. This nonrandomized trial tested the effect of a bundle of renal-specific “Right TraC™” strategies on 30-day all-cause readmission rates and, secondarily, 90-day readmissions and overall admissions among HD patients. Methods: Twenty-six Fresenius clinics in West Virginia, Ohio, and Kentucky participated in the interventions. Eighteen matched clinics served as controls; intervention clinics also served as their own controls. We deployed the intervention in 3 incremental phases focused on patient information exchange, post-hospital follow-up, and telephonic case management. Thirty-day hospital readmissions per patient year (ppy) were calculated by dividing the total number of readmissions within 30 days of index admission by the total number of patient-years in baseline (2012) and remeasurement (2014) periods. We also compared readmission rates from 2010 to 2015. We used repeated measures Poisson regression to compare outcomes between groups and time periods. Results: From 2012 to 2014, 30-day all-cause readmissions ppy declined for Right TraC clinics (from 0.88 to 0.66 [p < 0.001]; for controls, from 0.73 to 0.61 [p = 0.16]). Difference in change between groups was nonsignificant (p = 0.26). Overall admissions ppy declined: for Right TraC clinics from 2.51 to 1.97 (p < 0.001); for controls from 2.14 to1.92 (p = 0.21); difference in change between groups was significant (p = 0.01). For 2010, 2011, and 2012, Right TraC clinic 30-day readmissions ppy were unchanged: 0.89, 1.00, 0.88 (p = 0.61 and p = 0.49); they declined to 0.66 (p < 0.001) in 2014 (intervention year); rose to 0.70 (p = 0.06) in 2015 (interventions discontinued). Conclusion: We conclude that Right TraC interventions may have been helpful in reducing hospital readmission rates.

scholarly journals Successful hospital readmission reduction initiatives: Top five strategies to consider implementing today

2018 ◽  
Vol 7 (5) ◽  
pp. 16 ◽  
Author(s):  
Bita A. Kash ◽  
Juha Baek ◽  
Ohbet Cheon ◽  
Nana E. Coleman ◽  
Stephen L. Jones
Keyword(s):  
Hospital Readmission ◽  
Discharge Planning ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Readmission Rates ◽  
Effective Interventions ◽  
Hospital Readmission Rates ◽  
Weighted Means ◽  
Pubmed Database

Only one quarter of U.S. hospitals demonstrated low enough levels of 30 day readmission rates to avoid penalties imposed by the Hospital Readmissions Reduction Program (HRRP) in 2016. Previous work describes interventions for reducing hospital readmission rates; however, without a comprehensive analysis of these interventions, healthcare leaders cannot prioritize strategies for implementation within their healthcare environment. This comparative study identifies the most effective interventions to reduce unplanned 30-day readmissions. The MEDLINE-PubMed database was used to conduct a systematic review of existing literature about interventions for 30-day readmission reduction published from 2006 through 2017. Data were extracted on hospital type, setting, disease type, intervention type, study sample, and impact level. Of 4,886 citations, 508 articles were reviewed in full-text, and 90 articles met the inclusion criteria. Based on the three analytic methodologies of means, weighted means, and pooled estimated impact level, the most effective interventions to reduce unplanned 30-day admissions were identified as collaboration with clinical teams and/or community providers, post-discharge home visits, telephone follow-up calls, patient/family education, and discharge planning. Commonly, all five interventions identify patient level engagement for success. The findings reveal the need for shared accountability towards desired outcomes among health systems, providers, and patients while providing hospital leaders with actionable strategies that can effectively reduce 30-day readmission rates.

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