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https://www.readbyqxmd.com/read/28097761/shortened-hospital-length-of-stay-and-lower-costs-associated-with-rivaroxaban-in-patients-with-pulmonary-embolism-managed-as-observation-status
#1
Erin R Weeda, W Frank Peacock, Gregory J Fermann, Christopher W Baugh, Philip S Wells, Veronica Ashton, Concetta Crivera, Peter Wildgoose, Jeff R Schein, Craig I Coleman
BACKGROUND: Unlike rivaroxaban, treatment of patients with pulmonary embolism (PE) with warfarin requires parenteral bridging and coagulation monitoring that may prolong length-of-stay (LOS) and increase hospital costs. AIMS: The aim of this study was to compare LOS, hospital costs and readmissions in PE patients managed through observation stays treated with rivaroxaban or parenterally bridged warfarin. METHODS: Premier Hospital claims data from November 2012 to March 2015 were used to identify patients with a primary diagnosis code for PE managed through an observation stay and with ≥1 claim for a PE-related diagnostic test on day 0-2...
January 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28097305/enhanced-recovery-after-surgery-a-review
#2
Olle Ljungqvist, Michael Scott, Kenneth C Fearon
Importance: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28097296/long-term-postprocedural-outcomes-of-palliative-emergency-stenting-vs-stoma-in-malignant-large-bowel-obstruction
#3
Jonathan S Abelson, Heather L Yeo, Jialin Mao, Jeffrey W Milsom, Art Sedrakyan
Importance: Colonic stenting was introduced for palliation of malignant large-bowel obstruction (MLBO) more than 20 years ago but remains controversial. Objective: To compare outcomes after palliative stenting vs stoma creation in patients with MLBO requiring emergency management. Design, Setting, and Participants: This observational cohort study assessed 345 patients from New York State with an urgent or emergency admission to the hospital for obstruction secondary to colorectal cancer and who underwent stenting or stoma creation from October 1, 2009, through December 31, 2013...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28097288/secondary-analysis-of-an-electronic-surveillance-system-combined-with-multi-focal-interventions-for-early-detection-of-sepsis
#4
Bonnie L Westra, Sean Landman, Pranjul Yadav, Michael Steinbach
: To conduct an independent secondary analysis of a multi-focal intervention for early detection of sepsis that included implementation of change management strategies, electronic surveillance for sepsis, and evidence based point of care alerting using the POC AdvisorTM application. METHODS: Propensity score matching was used to select subsets of the cohorts with balanced covariates. Bootstrapping was performed to build distributions of the measured difference in rates/means...
January 18, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28096296/a-critical-asthma-standardized-clinical-and-management-plan-reduces-duration-of-critical-asthma-therapy
#5
Jackson Wong, Michael S D Agus, Dionne A Graham, Elliot Melendez
BACKGROUND AND OBJECTIVE: Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. METHODS: This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies...
January 17, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28095901/risk-assessment-tools-to-predict-location-of-discharge-and-need-for-supportive-services-for-medical-patients-after-discharge-from-hospital-a-systematic-review-protocol
#6
Daniel M Kobewka, Daniel McIsaac, Michaël Chassé, Kednapa Thavorn, Sunita Mulpuru, Luke T Lavallée, Shane English, Justin Presseau, Alan J Forster
BACKGROUND: Patients who are discharged from hospital after an acute medical illness often have impaired function that prevents them from returning to their previous place of residence. Assessing each patient's post-discharge needs takes time and resources but is important in order to reduce unplanned readmissions and adverse events post-discharge. METHODS/DESIGN: We will conduct a systematic review to synthesize the evidence on prognostic models and their reported accuracy in predicting the location of discharge after a medical admission to an acute care hospital...
January 17, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28095063/early-primary-care-follow-up-after-ed-and-hospital-discharge-does-it-affect-readmissions
#7
Sanjai Sinha, Joanna Seirup, Amanda Carmel
OBJECTIVES: After hospitalization, timely discharge follow-up has been linked to reduced readmissions in the heart failure population, but data from general inpatients has been mixed. The objective of this study was to determine if there was an association between completed follow-up appointments within 14 days of hospital discharge and 30-day readmission amongst primary care patients at an urban academic medical center. Index discharges included both inpatient and emergency room settings...
January 17, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28093901/does-hospital-readmission-following-colorectal-cancer-resection-and-enhanced-recovery-after-surgery-impact-on-long-term-survival
#8
Nathan J Curtis, Emma Noble, Emad Salib, Rob Hipkiss, Emily Meachim, Richard Dalton, Andrew Allison, Jonathan Ockrim, Nader K Francis
BACKGROUND: Hospital readmission is undesirable for patients and care providers as this can impact short-term recovery and carries financial consequences. It is unknown if readmission has long term implications. AIM: To investigate the impact of thirty day readmission on long term overall survival following colorectal cancer resection within enhanced recovery after surgery (ERAS) care and explore the reasons, severity and details of readmission episodes. METHODS: A dedicated, prospectively populated database was reviewed...
January 17, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28093346/impact-of-obesity-on-complications-and-30-day-readmission-rates-after-cranial-surgery-a-single-institutional-study-of-224-consecutive-craniotomy-craniectomy-procedures
#9
Amanda Sergesketter, Aladine A Elsamadicy, Oren N Gottfried
BACKGROUND: the prevalence of obesity is growing at a disparaging rate in the United States. While prior studies have associated obesity with increased surgical complications and readmission rates, the impact of obesity on surgical outcomes after cranial surgery remains understudied. The aim of this study is to assess the effect obesity has on complication and 30-day readmission rates after cranial surgery. METHODS: The medical records of 224 (Non-Obese: n=164, Obese: n=60) consecutive patients undergoing either craniotomy or craniectomy at a major academic institution in 2011 were reviewed...
January 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28090224/computerized-tomography-guided-paracentesis-an-effective-alternative-to-bedside-paracentesis
#10
Vinaya Gaduputi, Hassan Tariq, Chaitanya Chandrala, Sailaja Sakam, Naeem Abbas, Sridhar Chilimuri
BACKGROUND: Ascites remains the most common cause of hospitalization among patients with decompensated cirrhosis. Paracentesis is a relatively safe procedure with low complication rates. Computerized tomography (CT)-guided therapeutic paracentesis could be a safe and effective alternative to unaided or aided (ultrasonogram-guided) bedside paracentesis. In this retrospective study, we aimed to compare the efficacy, safety, and cost-effectiveness of CT-guided paracentesis with bedside paracentesis...
February 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28089404/the-schhs-hip-fracture-clinical-network-experience-improving-care-and-outcomes-through-an-interprofessional-approach
#11
Gillian Puckeridge, Morné Terblanche, Debbie Massey
BACKGROUND: Hip fractures are a major global health care issue, with the 1.26 million estimated cases in 1990 predicted to increase to 4.5 million by 2050. Varying models of care have been developed to improve outcomes following fragility hip fractures. Most of these care models embrace an interprofessional approach to care. Specialist orthopedic nurses play an important role in the management of fragility hip fracture patients and their contribution to the interprofessional health care team is an important predictor of patient outcomes...
December 18, 2016: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28089185/joint-replacement-volume-positively-correlates-with-improved-hospital-performance-on-centers-for-medicare-and-medicaid-services-quality-metrics
#12
Rachel A Sibley, Vanessa Charubhumi, Lorraine H Hutzler, Albit R Paoli, Joseph A Bosco
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP)...
December 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28088603/hospital-readmissions-after-surgery-how-important-are-hospital-and-specialty-factors
#13
Robert H Hollis, Laura A Graham, Joshua S Richman, Melanie S Morris, Hillary J Mull, Tyler S Wahl, Edith Burns, Laurel A Copeland, Gordon L Telford, Amy K Rosen, Kamal F Itani, Jeffrey Whittle, Todd H Wagner, Mary T Hawn
BACKGROUND: Hospital readmission rates after surgery may represent an overall hospital effect or a combination of specialty and patient effects. We hypothesized that hospital readmission rates for procedures within specialties were more strongly correlated than rates across specialties within the same hospital. STUDY DESIGN: For general, orthopedic, and vascular specialties at Veterans Affairs hospitals during 2008-2014, 30-day risk-adjusted readmission rates were estimated for six high-volume procedures and each specialty...
January 11, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28087182/multimorbidity-and-acute-heart-failure-in-internal-medicine
#14
F Martínez, L Martínez-Ibañez, G Pichler, A Ruiz, J Redon
AIMS: To analyse the characteristics of hospitalized patients for AHF, with special attention to the clustering of morbidities. METHODS AND RESULTS: Clinical records of patients, admitted in Internal Medicine due to AHF, during three years, were reviewed. The characteristics of patients-episodes were registered and key indicators of performance. Multiple correspondence analysis (MCA) was used to assess the distribution of morbidities. LR models were used to study clinical variables related with death or readmission...
January 5, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28087180/a-comparison-of-hfref-vs-hfpef-s-clinical-workload-and-cost-in-the-first-year-following-hospitalization-and-enrollment-in-a-disease-management-program
#15
T M Murphy, D F Waterhouse, S James, C Casey, E Fitzgerald, E O'Connell, C Watson, J Gallagher, M Ledwidge, K McDonald
BACKGROUND: Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype. METHODS: 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%)...
December 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28087088/discharge-teaching-readiness-for-discharge-and-post-discharge-outcomes-in-parents-of-hospitalized-children
#16
Marianne E Weiss, Kathleen J Sawin, Karen Gralton, Norah Johnson, Carol Klingbeil, Stacee Lerret, Shelly Malin, Olga Yakusheva, Rachel Schiffman
PURPOSE: This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). DESIGN/METHODS: In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital...
January 10, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28079871/the-relationship-between-the-rising-cesarean-delivery-and-postpartum-readmission-rates
#17
M A Clapp, J N Robinson, S E Little
OBJECTIVE: This study seeks to determine if the increasing rate of postpartum readmissions is related to the increasing rate of cesarean delivery. STUDY DESIGN: Readmitted patients were identified in the State Inpatient Databases of California, Florida and New York from 2004 to 2011. Relevant maternal comorbidities, pregnancy complications and intrapartum events were collected using ICD-9 diagnosis and procedure codes. The effects of cesarean delivery were first examined via univariate logistic regression to calculate the odds of readmission by year for patients who had delivered via cesarean section...
January 12, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28079709/meaningful-use-of-electronic-health-records-by-outpatient-physicians-and-readmissions-of-medicare-fee-for-service-beneficiaries
#18
Mark A Unruh, Hye-Young Jung, Joshua R Vest, Lawrence P Casalino, Rainu Kaushal
BACKGROUND: Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions. OBJECTIVE: To evaluate the impact of outpatient physicians' participation in Meaningful Use on readmissions. SUBJECTS AND RESEARCH DESIGN: The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010-2012)...
January 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28079682/comparing-short-term-complications-of-inpatient-versus-outpatient-single-level-anterior-cervical-discectomy-and-fusion-an-analysis-of-6940-patients-using-the-acs-nsqip-database
#19
Ryan Khanna, Robert B Kim, Sandi K Lam, George R Cybulski, Zachary A Smith, Nader S Dahdaleh
STUDY DESIGN: Multicenter propensity score-adjusted retrospective cohort study. OBJECTIVE: To determine baseline 30-day complication rates for anterior cervical discectomy and fusion (ACDF) and compare clinical complications for patients undergoing single-level ACDFs between inpatient and outpatient settings. SUMMARY OF BACKGROUND DATA: ACDF remains the most common procedure in the treatment of a variety of cervical disc pathologies, making it a focus of quality improvement initiatives...
January 10, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28074757/advanced-practice-nurse-transitional-care-model-promotes-healing-in-wound-care
#20
Carole Mackavey
: Optimally, transition in health care should be seamless and incorporate a well-thought-out patient-centered discharge plan; yet, many hospitalized patients are unprepared for discharge, thereby compromising patient safety and quality of care. Transition of care should include a broad range of time-limited services designed to ensure health care continuity to avoid poor outcomes among at-risk populations. This case study demonstrates that advanced practice nurses (APNs) are in the perfect position to bridge the existing gap, reduce readmissions, and improve patient health...
September 1, 2016: Care Management Journals: Journal of Case Management ; the Journal of Long Term Home Health Care
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