Costly Hospital Readmissions and Complex Chronic Illness

2008 ◽  
Vol 45 (4) ◽  
pp. 408-421 ◽  
Author(s):  
Bernard Friedman ◽  
H. Joanna Jiang ◽  
Anne Elixhauser
Keyword(s):  
Chronic Illness ◽  
Chronic Conditions ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Severity Of Illness ◽  
Inpatient Cost ◽  
Multiple Chronic Conditions ◽  
Design Strategies ◽  
Hospital Discharges ◽  
Complex Chronic Illness

People with multiple chronic conditions account for a large and disproportionate share of total health care costs. One aspect of the high cost for such patients is a relatively high number of hospital admissions per year. This study aims to clarify how the rate of hospital readmissions and hospital cost per person in a year depend on a patient's number of different chronic conditions (“complexity”), severity of illness, principal diagnosis at discharge, payer group, and other variables. We use a database of all hospital discharges for adults in six states. The number of different chronic conditions has a smoothly increasing effect on readmissions and cost per year, and there are notable differences by payer group. We offer illustrations of the potential savings from reducing total inpatient cost and readmissions in narrowly targeted populations with the most complex problems. The study's methods and descriptive data potentially could be useful for health plans and their sponsors (employers, government) when they design strategies to address the high cost of complex chronic illness.

Individual and Organizational Factors Associated With Hospital Readmission Rates: Evidence From a U.S. National Sample

2019 ◽  
Vol 39 (10) ◽  
pp. 1153-1158 ◽  
Author(s):  
Kyaien O. Conner ◽  
Hongdao Meng ◽  
Victoria Marino ◽  
Timothy L. Boaz
Keyword(s):  
Hospital Readmission ◽  
Chronic Conditions ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Severity Of Illness ◽  
Organizational Factors ◽  
The United States ◽  
Multiple Chronic Conditions ◽  
Important Indicator ◽  
Increased Risk

Objective: Hospital readmission rate is an important indicator for assessing quality of care in the acute and postacute settings. Identifying factors that increase risk for hospital readmissions can aid in the recognition of potential targets for quality improvement efforts. The main objective of this brief report was to examine the factors that predict increased risk of 30-day readmissions. Method: We analyzed data from the 2013 National Readmission Database (NRD). Results: The main factors that predicted increased risk of 30-day readmission were number of chronic conditions, severity of illness, mortality risk, and hospital ownership. Unexpectedly, discharge from a for-profit hospital was associated with greater risk for hospital readmission in the United States. Discussion and Conclusion: These findings suggest that patients with severe physical illness and multiple chronic conditions should be the primary targets for hospital transitional care interventions to help reduce the rate of unnecessary hospital readmissions.

scholarly journals Prioritizing Illness: Lessons in Self-Managing Multiple Chronic Diseases

2009 ◽  
Vol 34 (4) ◽  
pp. 983-1002 ◽  
Author(s):  
Sally Lindsay
Keyword(s):  
Chronic Illness ◽  
Chronic Conditions ◽  
Chronic Disease Management ◽  
Management Strategies ◽  
Chronic Illnesses ◽  
Multiple Chronic Conditions ◽  
Illness Trajectory ◽  
Biographical Disruption ◽  
Multiple Chronic Diseases ◽  
Multiple Conditions

Chronic disease management strategies are largely based on single disease models, yet patients often need to manage multiple conditions. This study uses the concepts of ‘chronic illness trajectory’ and ‘biographical disruption’ to examine how patients self-manage multiple chronic conditions and especially how they prioritize which condition(s) will receive the greatest attention. Fifty-three people with multiple chronic illnesses participated in one of 6 focus groups. The results suggest that people who were disrupted tended to be younger than 60, lived on their own, cared for other family members, or other barriers. Many participants anticipated subsequent illnesses given their age and prior experience with illness. In order to cope with their multiple illnesses most felt it was necessary to prioritize their ‘main’ illness. Their reasons for prioritizing a particular illness included: (1) the unpredictable nature of the disease; (2) the condition could not be controlled by tablets; and (3) the condition tended to set off the rest of their health problems. Social context played a key role in shaping patients’ biography and chronic illness trajectory.

scholarly journals Perceptions of Chronic Illness Care Among Veterans With Multiple Chronic Conditions

2016 ◽  
Vol 181 (5) ◽  
pp. 439-444 ◽  
Author(s):  
Salva N. Balbale ◽  
Bella Etingen ◽  
Alex Malhiot ◽  
Scott Miskevics ◽  
Sherri L. LaVela
Keyword(s):  
Chronic Illness ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Chronic Illness Care

scholarly journals Providing person-centred care for people with multiple chronic conditions: protocol for a qualitative study incorporating client and staff perspectives

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030581 ◽  
Author(s):  
Annette Peart ◽  
Virginia Lewis ◽  
Christopher Barton ◽  
Ted Brown ◽  
Julie White ◽  
...  
Keyword(s):  
Health Service ◽  
Integrated Care ◽  
Chronic Conditions ◽  
Phenomenological Study ◽  
Hospital Admissions ◽  
Ethics Committees ◽  
Multiple Chronic Conditions ◽  
Semistructured Interview ◽  
Care Programme ◽  
Human Research Ethics

IntroductionChronic conditions are associated with over one-third of potentially avoidable hospitalisations. Integrated care programmes aim to help people with chronic conditions to self-manage their health, thus avoiding hospital admissions. While founded on principles of person-centred care, the experiences of people with multiple chronic conditions in integrated care programmes are not widely known. Our study will explore how person-centred care is incorporated into an integrated care programme for people with multiple chronic conditions.Methods and analysisThis is a qualitative phenomenological study being conducted from March 2018 to June 2019, in a large metropolitan health service in Melbourne, Australia. Participants will be programme clients (and/or their carers) and staff working in the programme. We will interview staff about their experiences of the programme. Recruited staff will assist with recruitment of clients who recently completed an episode of care, to participate in a semistructured interview in their home. We will also analyse the medical records of interviewed clients, and observe outpatient clinics connected to the programme, based on the findings of the interviews. We will analyse all data using thematic analysis, with overarching themes representing staff and client perspectives of person-centred care.Ethics and disseminationEthical approval was granted by Monash Health (HREC/18/MonH/33) and Monash University (12260) Human Research Ethics Committees. Our study will provide a comprehensive exploration of person-centred care in an integrated care programme. It will add information to person-centred care literature on participants’ perceptions of what works and why, including barriers and enablers to person-centred care in a complex environment. Findings of this study will be disseminated via publications, conferences and presentations to the health service participants.

Profile of Hospital Charges for Chronic Conditions by Health Status and Severity Level

2009 ◽  
Vol 21 (2) ◽  
pp. 196-204 ◽  
Author(s):  
Sasithorn Thanapop ◽  
Supasit Pannarunothai ◽  
Virasakdi Chongsuvivatwong
Keyword(s):  
Health Status ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Respiratory Diseases ◽  
Severity Of Illness ◽  
Health Expenditures ◽  
Hospital Charges ◽  
Multiple Chronic Conditions ◽  
Chronic Patients ◽  
Severity Level

The objective of this study is to identify charges for common chronic patients, by health status and severity of illness. Patients having 4 common chronic diseases—diabetics, hypertension, chronic lower respiratory diseases, and chronic renal failure—from 4 provinces were included (between 2002 and 2004). Patients were classified into clinically defined and health plan categories; charges were analyzed according to core health status and severity level of the chronic disease groups. Patients classified as single chronic condition (69.8%) had mean annual charges between 4089 and 7461 baht. Patients with multiple chronic conditions (30.2%) had mean annual charges varying, by health status and severity, from 611 to 16 794 baht, accounting for 40% of the total charges. Distribution of charges varied across health status groups. 1 USD = 35.1 baht The percentages of chronic health expenditures vary according to health status and severity of illness. This analysis can be used to identify patients for various purposes.

scholarly journals Understanding the impact and causes of ‘failure to attend’ on continuity of care for patients with chronic conditions

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247914
Author(s):  
Amy-Louise Byrne ◽  
Adele Baldwin ◽  
Clare Harvey ◽  
Janie Brown ◽  
Eileen Willis ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Public Hospitals ◽  
Multiple Chronic Conditions ◽  
Outpatient Services ◽  
Nurse Navigator ◽  
Hospital Utilisation ◽  
The Impact ◽  
Causes Of Failure

Aim To understand the impact and causes of ‘Failure to Attend’ (FTA) labelling, of patients with chronic conditions. Background Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient’s capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase ‘Failure to Attend’ has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term ‘appointment did not proceed.’

Opportunities to optimize ehealth technology for patients with multiple chronic conditions

2013 ◽  
Author(s):  
Donna M. Zulman ◽  
Emily Jenchura ◽  
Danielle Cohen ◽  
Eleanor Lewis ◽  
Steven M. Asch
Keyword(s):  
Chronic Conditions ◽  
Multiple Chronic Conditions
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