Hospital readmission and mortality after discharge with pediatric tracheostomy: A one-year population-based cohort study in Taiwan.

In order to (1) present the structure of Taiwan's National Health Insurance (NHI) research databases, along with the comparison with automated databases in other countries, (2) estimate the strengths and weaknesses of the NHI research databases, and (3) systematically review pharmacoepidemiology studies using the NHI research databases, we compared the characteristics of existing automated databases to reveal the strengths and weaknesses of the NHI research databases. In addition, the Medline was used as a tool to search pharmacoepidemiology studies using Taiwan's NHI research databases since 1997. The automated NHI research databases are very comparable with large research databases of other countries (US, Canada and UK). As a result, they serve as major resources for up to 11 pharmacoepidemiology studies published since 2002. However, these studies usually focused on the analysis of drug utilization pattern and drug utilization volume. As a result, there is still a huge lack of identification of potential drug safety issues using the NHI research databases. The construction of NHI research databases absolutely provides abundant research resources for scholars not only in medical fields but also in public health-related disciplines. Many studies using the NHI research databases have been published in international journals. Yet, researchers in Taiwan could make even greater progress toward thorough pharmacoepidemiology studies using the NHI research databases.

The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admission: a systematic review protocol

The readmission rate following hospitalization for chronic obstructive pulmonary disease (COPD) is surprisingly high, and frequent readmissions represent a higher risk of mortality and a heavy economic burden. However, information on all-cause readmissions in patients with COPD is limited. This study aimed to systematically summarize all-cause COPD readmission rates within 30 and 90 days after discharge and their underlying risk factors. Eight electronic databases were searched to identify relevant observational studies about COPD readmission from inception to 1 August 2022. Newcastle-Ottawa Scale was used for methodological quality assessment. We adopt a random effects model or a fixed effects model to estimate pooled all-cause COPD readmission rates and potential risk factors. A total of 28 studies were included, of which 27 and 8 studies summarized 30- and 90-day all-cause readmissions, respectively. The pooled all-cause COPD readmission rates within 30 and 90 days were 18% and 31%, respectively. The World Health Organization region was initially considered to be the source of heterogeneity. We identified alcohol use, discharge destination, two or more hospitalizations in the previous year, and comorbidities such as heart failure, diabetes, chronic kidney disease, anemia, cancer, or tumor as potential risk factors for all-cause readmission, whereas female and obesity were protective factors. Patients with COPD had a high all-cause readmission rate, and we also identified some potential risk factors. Therefore, it is urgent to strengthen early follow-up and targeted interventions, and adjust or avoid risk factors after discharge, so as to reduce the major health economic burden caused by frequent readmissions. This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022369894).

The outcomes of recent advancements in pediatric tracheostomy remain unclear. This study was conducted to identify the trends in pediatric tracheostomy in Taiwan. This population-based survey was conducted using data from Taiwan's National Health Insurance Research Database. We identified inpatients younger than 18 years who had undergone tracheostomy in Taiwan between 2000 and 2019. The study period was divided into subperiods (2000-2004, 2005-2009, 2010-2014, and 2015-2019). We analyzed patient characteristics and trends related to age, gender, hospital level, surgical indications, hospital stay duration, and mortality rates. The trends were analyzed for all pediatric patients (age <18 years) and infants (age <1 year). This study included 2465 pediatric patients (mean age: 8.7 ± 6.9 years; boys: 64%). The incidence of pediatric tracheostomy decreased from 3.3 events per 100,000 individuals in 2000 to 2.1 events per 100,000 individuals in 2019 (P for trend < .001). The proportion of infants who received tracheostomy increased from 22.8% in 2000-2004 to 32.5% in 2015-2019 (P for trend = .06). The proportion of pediatric patients who received tracheostomy at medical centers increased and those at regional hospitals or district hospitals decreased (74.7%-81.0% vs 25.3%-19.0%, P for trend = .003). The proportion of pediatric patients with trauma or brain injury as a surgical indication decreased from 36.6% to 28.7% (P for trend = .001). The duration of intensive care unit (ICU) stays increased from 30 days in 2000-2004 to 50 days in 2015-2019 (P for trend < .001), and that of hospital stay increased from 58 days in 2000-2004 to 71 days in 2015-2019 (P for trend = .001). The 5-year mortality rate slightly decreased from 38.0% in 2000-2004 to 33.3% in 2005-2009 and 31.0% in 2010-2014 (P for trend = .006). Our findings revealed that during the study period, the number of pediatric patients receiving tracheostomy decreased, but the proportion of infants receiving tracheostomy increased. The trends in pediatric tracheostomy indicated extended ICU stay, prolonged hospital stay, and reduced 5-year mortality rates.

Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles. To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures. Retrospective cohort analysis from Kaiser Permanente Southern California Region database. Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes. From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42-8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ≥ 10 (OR, 4.47, 95% CI = 2.54-7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05-1.19), cancer (OR 3.38, 95% CI = 1.61-7.10), 30-day readmission (OR 3.31, 95% CI = 1.34-8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40-44.17) predicted higher mortality risk. After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality.

Risk Factors for 24-Hour Mortality After Traumatic Rib Fractures Owing to Motor Vehicle Accidents: A Nationwide Population-Based Study

As we approach the end of the first decade of the 21st century, it is evident that the epidemic of heart failure has not abated, nor have concerns about the quality of care received by patients with this condition. Recent data from the American Heart Association1 and the Centers for Disease Control and Prevention2 reaffirm that the number of patients hospitalized with heart failure has grown steadily over the past 30 years. With aging of the US population, this trend will undoubtedly continue, but it is also noteworthy that the increase in heart failure hospitalizations over the past few decades is not limited to the Medicare population.2 Moreover, the outcome of heart failure patients after hospital discharge is not improving. Despite evidence-based guidelines, performance measures, quality improvement programs, and public reporting of hospital-level performance data, the number of patients dying or readmitted to hospitals within 30 days of hospital discharge has not declined3–6 and is equivalent in patients with depressed and those with preserved left ventricular systolic function.7 Hospital readmission is expensive and contributes to the increasing economic burden of heart failure, but this is often a preventable event. However, the characteristics of patients who will require rehospitalization have not been identified,5 and it is impossible to predict which patients will be readmitted. In many cases it is not the patient, but the healthcare system involving multiple providers and transitions of care, that makes the conditions ripe for high readmission rates. Article See p 29 The fundamental first step in identifying and correcting gaps in healthcare quality is setting standards of care through development of evidence-based clinical practice guidelines. From quality indicators emphasized in guidelines, clinical performance measures can be derived to evaluate the quality of care provided by hospitals and by individual practitioners. …

Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices. To calculate all-cause 30-day hospital readmission rates at the level of individual primary care practices and identify factors associated with variations in these rates. Retrospective analysis Seven primary care clinics affiliated with the University of California, San Francisco (UCSF). Adults ≥18 years old with a primary care provider (PCP) at UCSF MEASUREMENTS: All-cause 30-day readmission rates were calculated for primary care clinics for discharges between July 1, 2009 and June 30, 2012. We built a model to identify demographic, clinical, and hospital factors associated with variation in rates. There were 12,564 discharges for patients belonging to the 7 clinics, with 8685 index discharges and 1032 readmissions. Readmission rates varied across practices, from 14.9% in Human Immunodeficiency Virus primary care and 7.7% in women's health. In multivariable analyses, factors associated with variation in readmission rates included: male gender (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.05-1.40), Medicare insurance (OR: 1.31, 95% CI: 1.05, 1.64; Ref = private), Medicare-Medicaid dual eligible (OR: 1.26, 95% CI: 1.01-1.56), multiple comorbidities, and admitting services. Patients with a departed PCP awaiting transfer assignment to a new PCP had an OR of 1.59 (95% CI: 1.16-2.17) compared with having a current faculty PCP. Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions.

Hospital-Based, Acute Care Use Among Patients Within 30 Days of Discharge After Coronary Artery Bypass Surgery

Although the Hospital Readmission Reduction Program (HRRP) has reduced the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD) across hospitals, the effect of HRRP on hospital mortality remains unknown. Therefore, we examined the association between hospital readmissions and mortality rates for patients discharged with acute exacerbation of COPD (AECOPD). The all-cause hospital-specific 30-day risk-standardized mortality rate (RSMR) and the 30-day risk-standardized readmission rate (RSRR) for patients with COPD from 2010 to 2017 were obtained from the Hospital Compare website. Hospital service area (HSA) information was obtained from the Dartmouth Atlas of Healthcare. The longitudinal relationship between the mortality and readmission rates of a hospital was assessed using mixed linear models. Of the 3,685 hospitals analyzed, the unadjusted mean RSMRs increased from 7.8% to 8.4% during the study period at a yearly rate of 0.13 (95% CI = 0.12 to 0.14; P < .001), whereas the mean RSRRs declined from 20.7% to 19.6%. When examined according to the baseline readmission rate and interaction with time, each 1% higher-than-baseline readmission rate was associated with a smaller increase in mortality rate by 0.015% (95% CI = -0.02 to -0.01; P < .0001). Inclusion of change in readmissions in the model showed that each 1% decrease in readmission rate was associated with 0.04% (95% CI = -0.01 to -0.06; P = .008) increase in mortality. This hospital-level analysis of AECOPD showed that although the 30-day all-cause readmission rates declined, the mortality rates increased. Hospitals with lower readmission rates had higher mortality rates over time.

Epidemiology of pediatric tracheotomy: A population-based study using National Health Insurance Research Database in Taiwan

Home based cardiac rehabilitation: A retrospective cohort analysis on all-cause mortality and hospital readmission rates across sexes and races

Impact of Hospital Readmissions Reduction Program Policy on 30-Day and 90-Day Readmissions in Patients With Acute Myocardial Infarction: A 10-Year Trend From the National Readmissions Database

Is a Low Readmission Rate Indicative of a Good Hospital?

Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation