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https://www.readbyqxmd.com/read/29148921/a-predictive-model-for-readmissions-among-medicare-patients-in-a-california-hospital
#1
Ian Duncan, Nhan Huynh
Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables)...
November 17, 2017: Population Health Management
https://www.readbyqxmd.com/read/29148348/increasing-trends-in-the-use-of-hospital-observation-services-for-older-medicare-advantage-and-privately-insured-patients
#2
Keith D Lind, Claire M Noel-Miller, Lindsey R Sangaralingham, Nilay D Shah, Erik P Hess, Pamela Morin, M Fernanda Bellolio
Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans' Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans-even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans-except for enrollees 65 and older, for whom it increased somewhat...
July 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148332/medicare-advantage-and-traditional-medicare-hospitalization-intensity-and-readmissions
#3
Rachel Mosher Henke, Zeynal Karaca, Teresa B Gibson, Eli Cutler, Marguerite L Barrett, Katharine Levit, Jayne Johann, Lauren Hersch Nicholas, Herbert S Wong
Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148301/provider-connectedness-to-other-providers-reduces-risk-of-readmission-after-hospitalization-for-heart-failure
#4
Alon Geva, Karen L Olson, Chunfu Liu, Kenneth D Mandl
Provider interactions other than explicit care coordination, which is challenging to measure, may influence practice and outcomes. We performed a network analysis using claims data from a commercial payor. Networks were identified based on provider pairs billing outpatient care for the same patient. We compared network variables among patients who had and did not have a 30-day readmission after hospitalization for heart failure. After adjusting for comorbidities, high median provider connectedness-normalized degree, which for each provider is the number of connections to other providers normalized to the number of providers in the region-was the network variable associated with reduced odds of readmission after heart failure hospitalization (odds ratio = 0...
July 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148231/employment-status-at-time-of-first-hospitalization-for-heart-failure-is-associated-with-a-higher-risk-of-death-and-rehospitalization-for-heart-failure
#5
Rasmus Rørth, Emil L Fosbøl, Ulrik M Mogensen, Kristian Kragholm, Anna-Karin Numé, Gunnar H Gislason, Pardeep S Jhund, Mark C Petrie, John J V McMurray, Christian Torp-Pedersen, Lars Køber, Søren L Kristensen
AIMS: Employment status at time of first heart failure (HF) hospitalization may be an indicator of both self-perceived and objective health status. In this study, we examined the association between employment status and the risk of all-cause mortality and recurrent HF hospitalization in a nationwide cohort of patients with HF. METHODS AND RESULTS: We identified all patients of working age (18-60 years) with a first HF hospitalization in the period 1997-2015 in Denmark, categorized according to whether or not they were part of the workforce at time of the index admission...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29148105/experiences-of-nurse-case-managers-within-a-central-discharge-planning-role-of-collaboration-between-physicians-patients-and-other-healthcare-professionals-a-sociocultural-qualitative-study
#6
Jorun E Thoma, Marion A Waite
AIMS AND OBJECTIVES: Purpose of this study was to gain knowledge of Nurse Case Managers' (NCM) experiences within the German acute care context of collaboration with patients and physicians in a discharge planning role. Further to learn about patients' assignment to the management of the NCMs. Explicitly, to explore critical incidences of interactions between NCM, patients and health care practitioner in discharge planning to understand the factor that contributes to effective collaboration...
November 17, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29146680/the-association-between-patient-experience-factors-and-likelihood-of-30-day-readmission-a-prospective-cohort-study
#7
Jocelyn Carter, Charlotte Ward, Deborah Wexler, Karen Donelan
OBJECTIVE: Hospital readmissions comprise nearly a third of US healthcare expenditures. Fifteen to 20 per cent of this spending is considered to be potentially preventable. Risk prediction models have suboptimal accuracy and typically exclude patient experience data. No studies have explored patient perceptions of the likelihood of readmission during index admission. Our objective was to examine associations between patient perceptions of care during index hospital admission and 30-day readmission...
November 16, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29146432/predictors-of-hospital-length-of-stay-and-30-day-readmission-in-cervical-spondylotic-myelopathy-patients-an-analysis-of-3057-patients-using-the-acs-nsqip-database
#8
Peter G Passias, Cyrus M Jalai, Nancy Worley, Shaleen Vira, Saqib Hasan, Samantha R Horn, Frank A Segreto, Cole A Bortz, Andrew P White, Michael Gerling, Virginie LaFage, Thomas Errico
BACKGROUND: Hospital length of stay (LOS), 30-day readmission rate, and other metrics are increasingly being used to evaluate quality of surgical care. The factors most relevant to cervical spondylotic myelopathy (CSM) are not yet established. OBJECTIVE: To identify peri-operative factors associated with extended LOS and/or 30-day readmission following elective surgery for CSM. METHODS: Surgical CSM patients at institutions represented by the American-College-of-Surgeons-National-Surgical-Quality-Improvement-Program (ACS-NSQIP) from 2010-2012 were included...
November 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29146073/robotic-assisted-transanal-polypectomies-is-there-any-indication
#9
Marcos Gómez Ruiz, Carmen Cagigas Fernández, Joaquín Alonso Martín, Lidia Cristobal Poch, Carlos Manuel Palazuelos, Francisco Javier Barredo Cañibano, Manuel Gómez Fleitas, Julio Castillo Diego
OBJECTIVES: Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. METHODS: Between February 2014 and October 2015, 9patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality...
November 13, 2017: Cirugía Española
https://www.readbyqxmd.com/read/29145548/supported-discharge-teams-for-older-people-in-hospital-acute-care-hospital-a-randomised-controlled-trial
#10
Matthew Parsons, John Parsons, Paul Rouse, Avinesh Pillai, Sean Mathieson, Rochelle Parsons, Christine Smith, Tim Kenealy
Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. Objective: To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs...
November 14, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29145414/five-year-survival-and-associated-factors-in-women-treated-for-cervical-cancer-at-a-reference-hospital-in-the-brazilian-amazon
#11
Saul Rassy Carneiro, Marcela de Araújo Fagundes, Pricila de Jesus Oliveira do Rosário, Laura Maria Tomazi Neves, Givago da Silva Souza, Maria da Conceição Nascimento Pinheiro
Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belém, Pará, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016...
2017: PloS One
https://www.readbyqxmd.com/read/29143480/telephone-discharge-support-for-frail-vulnerable-older-people-discharged-from-hospital-impact-on-readmission-rates-participant-and-general-practitioner-feedback
#12
Claire P Heppenstall, Hugh C Hanger, Timothy J Wilkinson, Michelle Dhanak
OBJECTIVE: To assess the use and acceptability to older participants and general practitioners (GPs) of telephone support postdischarge to reduce readmissions. METHODS: A prospective cohort study of older people after discharge from a specialist geriatric unit, and comparison with a previous cohort. Telephone follow-up calls were made fortnightly for three months. Structured questionnaires were used to obtain feedback from participants and GPs. RESULTS: Readmission rates were high, 40%, despite the intervention...
November 15, 2017: Australasian Journal on Ageing
https://www.readbyqxmd.com/read/29141781/heart-failure-with-preserved-borderline-and-reduced-ejection-fraction-5-year-outcomes
#13
Kevin S Shah, Haolin Xu, Roland A Matsouaka, Deepak L Bhatt, Paul A Heidenreich, Adrian F Hernandez, Adam D Devore, Clyde W Yancy, Gregg C Fonarow
BACKGROUND: Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction (EF). OBJECTIVES: This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF ≤40%). METHODS: Data from GWTG-HF (Get With The Guidelines-Heart Failure) were linked to Medicare data for longitudinal follow-up...
October 31, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29139194/advantages-of-care-for-patients-with-hip-fractures-in-the-acute-geriatric-unit-hip-study-anoia
#14
Enric Duaso, Francesc Formiga, Patrícia Marimón, Montserrat Sandiumenge, Maria Teresa Salgado, Victor Murga, Andrés Gamboa, Carlos Rodriguez, Jaume Castellà, Enrique Escalante, Célia Lumbreras, Anna Tarrida, Ramón Sellarès
AIM: Hip fracture as a result of bone fragility is characterized by poor health outcomes in the medium and long term. Our goal was to compare a new orthogeriatric model with the old trauma model and evaluate improvements in clinical management. METHODS: We carried out a comparative unicentric study, a historical sample (trauma model) collected from 1 June 2007 to 31 May 2010, versus a prospective sample (orthogeriatric model) collected from 1 June 2010 until 31 May 2013...
November 15, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/29137576/perioperative-assessment-of-older-surgical-patients-using-a-frailty-index-feasibility-and-association-with-adverse-post-operative-outcomes
#15
H Lin, N M Peel, I A Scott, D L Vardesh, P Sivalingam, R L McBride, J J Morong, M J Nelson, R E Hubbard
This study aimed to examine the feasibility of using a frailty index (FI) based on comprehensive geriatric assessment (CGA), to assess the level of frailty in older surgical patients preoperatively and to evaluate the association of FI-CGA with poorer postoperative outcomes. Two hundred and forty-six patients aged ≥70 years undergoing intermediate- to high-risk surgery in a tertiary hospital were recruited. Frailty was assessed using a 57-item FI-CGA form, with fit, intermediate frail, and frail patients defined as FI ≤0...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29137556/all-cause-30-day-readmissions-among-persons-with-intellectual-and-developmental-disabilities-and-mental-illness
#16
Robert Balogh, Elizabeth Lin, Kristin Dobranowski, Avra Selick, Andrew S Wilton, Yona Lunsky
OBJECTIVE: Early hospital readmissions within 30 days of discharge are common and costly. This research describes predictors of all-cause, 30-day hospital readmissions among persons with intellectual and developmental disabilities (IDD), a group known to experience high rates of hospitalization. METHODS: A cohort of 66,484 adults with IDD from Ontario, Canada, was used to create two subgroups: individuals with IDD only and those with IDD and mental illness. The rates of hospital readmission were determined and contrasted with a comparison subgroup of people without IDD who have mental illness...
November 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29135772/can-composite-measures-provide-a-different-perspective-on-provider-performance-than-individual-measures
#17
Michael Shwartz, Amy K Rosen, James F Burgess
BACKGROUND: Composite measures, which aggregate performance on individual measures into a summary score, are increasingly being used to evaluate facility performance. There is little understanding of the unique perspective that composite measures provide. OBJECTIVE: To examine whether high/low (ie, high or low) performers on a composite measures are also high/low performers on most of the individual measures that comprise the composite. METHODS: We used data from 2 previous studies, one involving 5 measures from 632 hospitals and one involving 28 measures from 112 Veterans Health Administration (VA) nursing homes; and new data on hospital readmissions for 3 conditions from 131 VA hospitals...
December 2017: Medical Care
https://www.readbyqxmd.com/read/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#18
P Maxwell Courtney, Brian Darrith, Daniel D Bohl, Nicholas B Frisch, Craig J Della Valle
BACKGROUND: Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29134688/neutropenic-fever-during-peripheral-blood-progenitor-cell-mobilization-is-associated-with-decreased-cd34-cell-collection-and-increased-apheresis-collection-days
#19
Jack Khouri, Lisa Rybicki, Navneet Majhail, Matt Kalaycio, Edward Copelan, Brad Pohlman, Brian Hill, Robert Dean, Aleksandr Lazaryan, Betty Hamilton, Steven Andresen, Ronald Sobecks, Brian Bolwell, Hien Liu
BACKGROUND: Peripheral blood progenitor cell (PBPC) mobilization with chemotherapy in addition to Granulocyte-Colony Stimulating Factor (G-CSF) improves cell collection compared to G-CSF alone; however, it is associated with increased risk of neutropenic fever (NF). METHODS: We analyzed risk factors for post-priming NF and NF association with autologous stem cell transplant outcomes. Between 1998 and 2008, 593 adult patients with lymphoma underwent PBPC mobilization with etoposide and G-CSF...
November 14, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/29133331/malnutrition-and-its-association-with-readmission-and-death-within-7-days-and-8-180-days-postdischarge-in-older-patients-a-prospective-observational-study
#20
Yogesh Sharma, Michelle Miller, Billingsley Kaambwa, Rashmi Shahi, Paul Hakendorf, Chris Horwood, Campbell Thompson
OBJECTIVE: The relationship between admission nutritional status and clinical outcomes following hospital discharge is not well established. This study investigated whether older patients' nutritional status at admission predicts unplanned readmission or death in the very early or late periods following hospital discharge. DESIGN, SETTING AND PARTICIPANTS: The study prospectively recruited 297 patients ≥60 years old who were presenting to the General Medicine Department of a tertiary care hospital in Australia...
November 12, 2017: BMJ Open
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