Cost of acute hospitalization and post-discharge follow-up care for meningococcal disease in the US

Background and Hypothesis: There is limited information regarding healthcare utilization and outcomes in children hospitalized for traumatic brain injury (TBI). Nearly 50% of adults hospitalized for trauma do not attend follow-up appointments, although completion of post-discharge care is associated with improved outcomes and decreased likelihood of subsequent emergency department (ED) visits. The Regestrief Institute Indiana Network for Patient Care (INPC) is a regional health information exchange (HIE) with health record data. This includes inpatient, outpatient, and ED visits, as well as imaging and lab data. The objective of this study is to use HIE data to assess long-term healthcare utilization, complications, and sequelae of pediatric patients hospitalized for TBI to see if follow-up compliance can identify patients at risk for post-TBI complications, including unplanned care, as well as long-term secondary health conditions. Methods: 387 patients treated at a pediatric level 1 trauma center in Indiana admitted for TBI were identified using trauma registry data. EHR data in the INPC on patients for two years post-discharged were analyzed. Associations between compliance with follow-up care instructions given at discharge/subsequent medical visits and longitudinal utilization/outcomes were examined using Fisher’s exact test. Results: After reviewing patient records, we found that 60.7% of patients received all follow-up care and 8.5% of patients received partial follow-up care, leaving 25.1% of patients receiving no follow up care and 5.7% of patients lost to follow-up after discharge. 12% of patients went to the ER for an injury-related issue and 6.2% of patients were readmitted. 19.4% of individuals experienced complications from injury while 12.4% of individuals had suspected sequela. Factors influencing recovery included race, age, insurance, injury severity, ICU admission, and ventilator usage. Implications and Importance: Using HIE data can identify factors of hospitalized children vulnerable to not achieving optimal recovery and determine what care is critical to improving long-term health and quality of life outcomes.

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ELDER MISTREATMENT FOLLOW-UP: CONNECTING EMERGENCY DEPARTMENTS AND COMMUNITIES

Innovation in Aging ◽

10.1093/geroni/igz038.291 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S75-S75

Author(s):

Alice Bonner ◽

Kristin Lees-Haggerty ◽

Debi Lang ◽

Bree Cunningham ◽

Jason Burnett ◽

...

Keyword(s):

Protective Services ◽

Post Discharge ◽

Elder Mistreatment ◽

Core Element ◽

Adult Protective Services ◽

Case Examples ◽

Ensure Patient Safety ◽

The Us ◽

Resource Levels

Abstract To effectively address elder mistreatment (EM) in the emergency department (ED) hospitals must have mechanisms that promote and, to the extent possible, ensure patient safety post-discharge. However, the realities of working within busy hospitals--limited staff time, financial resources, and EM-specific expertise--prevent many EDs from being able to dedicate staff for patient follow up or develop EM multi-disciplinary teams. The fourth core element of the NCAEM’s ED Care Model aims to address this need with a roadmap for leveraging existing community resources. The roadmap provides streamlined tools to help hospitals assess their needs, identify existing teams and resources in their community, and connect with Adult Protective Services and other organizations. In this presentation we will present these tools and share case examples from beginning stages of feasibility testing in hospitals across the US. We will discuss specific strategies for implementing the model in hospitals of differing types, sizes, and resource levels.

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Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168317 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8317

Author(s):

Xin Wang ◽

Kuimeng Song ◽

Lijin Chen ◽

Yixiang Huang ◽

Stephen Birch

Keyword(s):

Primary Care ◽

Hospital Discharge ◽

Discrete Choice ◽

Choice Experiment ◽

Primary Care Providers ◽

Care Providers ◽

Post Discharge ◽

Primary Care Settings ◽

Follow Up Care

Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.

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Community-Level Characteristics of Timely PCP Follow-Up Care and Post-Discharge ER Usage

Hospital Topics ◽

10.1080/00185868.2021.1955061 ◽

2021 ◽

pp. 1-8

Author(s):

Jordan Mitchell ◽

Xiao Li ◽

Phillip J. Decker

Keyword(s):

Community Level ◽

Post Discharge ◽

Follow Up Care

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Exploring Psychiatric Inpatients’ Beliefs About the Role of Post-discharge Follow-up Care in Suicide Prevention

Military Medicine ◽

10.1093/milmed/usy129 ◽

2018 ◽

Vol 184 (1-2) ◽

pp. e91-e100

Author(s):

Natalie Riblet ◽

Brian Shiner ◽

Robert Scott ◽

Martha L Bruce ◽

Danuta Wasserman ◽

...

Keyword(s):

Suicide Prevention ◽

Psychiatric Inpatients ◽

Post Discharge ◽

Follow Up Care

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Abstract TP456: Coated-platelets Levels After Subarachnoid Hemorrhage Predict Post-discharge Short-term Cognitive Outcome

Stroke ◽

10.1161/str.47.suppl_1.tp456 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Bappaditya Ray ◽

Vijay M Pandav ◽

Eleanor A Mathews ◽

David M Thompson ◽

Aminata A Traore ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Acute Phase ◽

Delayed Cerebral Ischemia ◽

Cognitive Outcome ◽

Short Term ◽

Post Discharge ◽

Acute Hospitalization ◽

Symptomatic Vasospasm

Introduction: Delayed cerebral ischemia (DCI) is a determinant of short-term and long-term morbidity after subarachnoid hemorrhage (SAH). DCI is likely due to neurohumoral activation and inflammation-thrombosis cross-talk during the acute phase. Coated-platelets (CP), a subset of procoagulant platelets, contribute to systemic thrombogenicity and are associated with recurrent ischemic stroke. Hypothesis: We hypothesized that high CP levels during first 3 weeks of SAH (acute hospitalization) would be associated with worse short-term clinical outcome. Methods: A prospective cohort of 28 patients with post-discharge clinical follow-up (average 12 weeks) was studied. Outcomes were assessed using modified Rankin Scale (mRS) and Montreal Cognitive Outcome Assessment (MOCA). Blood samples to measure CP levels were performed - 1) during acute hospitalization and 2) at follow-up visit (defined as patient’s baseline). Trend of CP during acute hospitalization was analyzed against weighted mean baseline CP level to test hypothesis. Results: Average age of cohort was 52.6±12.2 years with 71.5% women. During acute phase 9 (32.1%) patients developed symptomatic vasospasm and 14 (50%) had DCI on imaging. Baseline CP levels did not differ (p=0.118) between patients with MOCA ≥26 (41.3%, n=13) and MOCA <26 (29.5%, n=15). However, patients with MOCA <26 had significantly higher CP levels during first 5 days than baseline (50.4% vs 29.5%, p=0.0004). These levels decreased by 1.77%/day from 6-21 days as compared to 1.55%/day for patients with MOCA ≥26 (p=0.723). In contrast, 20 (71.4%) patients with mRS 0-2 had average baseline CP levels of 37.3% vs 8 (28.6%) with mRS 3-6 having CP levels of 31.7%. For patients with mRS 0-2 and mRS 3-6, CP levels increased from baseline during first 5 days after SAH by 10.3% and 16.5% respectively (not statistically significant). Rate of CP decrease during 6-21 days was 1.43%/day and 2.02%/day (p=0.259) for mRS 0-2 and mRS 3-6 respectively. Conclusion: Elevated CP levels during the acute phase of SAH are strongly associated with lower MOCA scores at 12 weeks but not with higher mRS assessment. These results suggest that increased thrombogenicity after SAH leads to cognitive impairment despite good physical outcomes.

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Personalized Risk-Stratified Cancer Follow-Up Care: Its Potential for Healthier Survivors, Happier Clinicians, and Lower Costs

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djy232 ◽

2019 ◽

Vol 111 (5) ◽

pp. 442-448 ◽

Cited By ~ 18

Author(s):

Deborah K Mayer ◽

Catherine M Alfano

Keyword(s):

Health Care ◽

Primary Care Providers ◽

The United States ◽

Care Providers ◽

Health Care Workforce ◽

The Us ◽

Follow Up Care ◽

The Face ◽

Personalized Approach

Abstract The growth in the number of cancer survivors in the face of projected health-care workforce shortages will challenge the US health-care system in delivering follow-up care. New methods of delivering follow-up care are needed that address the ongoing needs of survivors without overwhelming already overflowing oncology clinics or shuttling all follow-up patients to primary care providers. One potential solution, proposed for over a decade, lies in adopting a personalized approach to care in which survivors are triaged or risk-stratified to distinct care pathways based on the complexity of their needs and the types of providers their care requires. Although other approaches may emerge, we advocate for development, testing, and implementation of a risk-stratified approach as a means to address this problem. This commentary reviews what is needed to shift to a risk-stratified approach in delivering survivorship care in the United States.

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