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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/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
#4
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
#5
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
#6
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/29145414/five-year-survival-and-associated-factors-in-women-treated-for-cervical-cancer-at-a-reference-hospital-in-the-brazilian-amazon
#7
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
#8
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
#9
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/29137576/perioperative-assessment-of-older-surgical-patients-using-a-frailty-index-feasibility-and-association-with-adverse-post-operative-outcomes
#10
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
#11
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/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#12
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
#13
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/29133263/prospective-evaluation-of-pasireotide-in-patients-undergoing-pancreaticoduodenectomy-the-washington-university-experience
#14
Ismael Dominguez-Rosado, Ryan C Fields, Cheryl A Woolsey, Gregory Williams, Timothy A Horwedel, J Bart Rose, Chet W Hammill, Maria B Doyle, William C Chapman, Steven M Strasberg, William G Hawkins, Dominic E Sanford
BACKGROUND: Pasireotide is a newer generation somatostatin analogue which led to a significant reduction in pancreatic fistula after pancreatectomy in a single-center randomized controlled trial. We sought to determine if pasireotide reduces the incidence of pancreatic fistula and other complications following pancreaticoduodenectomy at our high volume center. STUDY DESIGN: All patients between April 2011 and January 2017 undergoing pancreaticoduodenectomy were prospectively followed and their complications graded using the Modified Accordion Grading System (MAGS) in our institutional complications database...
November 10, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29132688/temporal-trends-in-outpatient-management-of-incident-pulmonary-embolism-and-associated-mortality
#15
Adi J Klil-Drori, Janie Coulombe, Samy Suissa, Andrew Hirsch, Vicky Tagalakis
INTRODUCTION: In clinical trial settings, outpatient management of pulmonary embolism (PE) is feasible and safe, but less is known on its use in routine care. We determined trends in outpatient management of PE and associated mortality in a large non-select patient population. METHODS: All residents of Quebec, Canada with a first-ever work-up for suspected PE in the emergency department (ED) over 10years were included. Patients could transition to outpatient management and from unconfirmed to confirmed PE in a time-varying fashion...
November 6, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29132369/impact-of-pharmacist-led-medication-management-in-care-transitions
#16
Seungwon Yang
BACKGROUND: When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients' medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients' medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions...
November 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29131897/comparison-of-hospital-resource-use-and-outcomes-among-hospitalists-primary-care-physicians-and-other-generalists
#17
Jennifer P Stevens, David J Nyweide, Sha Maresh, Laura A Hatfield, Michael D Howell, Bruce E Landon
Importance: A physician's prior experience caring for a patient may be associated with patient outcomes and care patterns during and after hospitalization. Objective: To examine differences in the use of health care resources and outcomes among hospitalized patients cared for by hospitalists, their own primary care physicians (PCPs), or other generalists. Design, Setting, and participants: This retrospective study analyzed admissions for the 20 most common medical diagnoses among elderly fee-for-service Medicare patients from January 1 through December 31, 2013...
November 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29131098/implementation-of-a-new-high-volume-circular-stapler-in-stapled-anopexy-for-hemorrhoidal-disease-is-patient-s-short-term-outcome-affected-by-a-higher-volume-of-resected-tissue
#18
Brechtje A Grotenhuis, Joost Nonner, Eelco J R de Graaf, Pascal G Doornebosch
BACKGROUND: Stapled anopexy is a safe technique for the treatment of hemorrhoids but carries a higher risk of recurrence, which might be caused due to the limited volume of resected tissue. In this study, we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients' short-term postoperative outcome. METHODS: Between 2011 and 2015, stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3©-stapler versus n = 116 high-volume CHEX©-stapler)...
November 2, 2017: Digestive Surgery
https://www.readbyqxmd.com/read/29131092/value-of-intraoperative-parathyroid-hormone-assay-during-parathyroidectomy-in-dialysis-and-renal-transplant-patients-with-secondary-and-tertiary-hyperparathyroidism
#19
Amr El-Husseini, Kevin Wang, Annick Edon, David Saxon, Florence Lima, David Sloan, B Peter Sawaya
BACKGROUND: In dialysis and renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the value of intraoperative parathyroid hormone (ioPTH) during parathyroidectomy (PTX) and its association with long-term PTH levels are unknown. The present study aims at evaluating the relationship of ioPTH with long-term PTH levels post-PTX in dialysis and renal transplant patients in a single-center study. METHODS: The ioPTH was measured in 57 dialysis patients (33 females and 24 males) and 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 for refractory HPT...
November 9, 2017: Nephron
https://www.readbyqxmd.com/read/29130989/preoperative-nutritional-optimization-for-crohn-s-disease-patients-can-improve-surgical-outcome
#20
Yael Dreznik, Nir Horesh, Mordechai Gutman, Aviad Gravetz, Imri Amiel, Harel Jacobi, Oded Zmora, Danny Rosin
BACKGROUND: Preoperative preparation of patients with Crohn's disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome. METHODS: A retrospective, cohort study including all Crohn's disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients' characteristics and clinical and surgical data were recorded and analyzed...
November 1, 2017: Digestive Surgery
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