30-day All-cause Readmission Rate Research Articles

The health and economic burden of rare endocrine disease: Often ignored, always important.

Rare endocrine diseases (RED) often pose chronic and life-threatening challenges, yet their economic costs and societal impact remains have not been precisely quantified. We obtained patient data from the 2018 Nationwide Inpatient Sample (NIS) and the Nationwide Readmissions Database (NRD), identifying RED patients through International Classification of Diseases, 10th revision codes. The difference of economic burden between RED patients and the control group, including hospital length of stay, hospitalisation costs, and readmission rates, was assessed using chi-square tests. We extracted 638 083 (2.98%) RED-related records from the NIS database. Compared to patients with common conditions, RED patients showed an exceedingly high burden of disease, including significantly extended hospital stays (P < 0.05), elevated total charges (P < 0.05), and heightened mortality rates (P < 0.05). They also had a substantially increased 30-day all-cause readmission rate based on the NRD database (P < 0.05). Although the different subgroups of RED patients had varying patterns of health care utilisation and economic burdens, they all surpassed those of patients with common conditions. There is a need for novel strategies aimed at mitigating the substantial RED-related burdens borne by individuals, families, and society in general, as well as funding for research and clinical trials.

Abstract 4145842: The Incidence, Predictors and Impact of 30-day Readmission of Takotsubo Cardiomyopathy Hospitalization: A Retrospective Nationwide Analysis

Objective: This study aimed to describe the recent readmission and mortality rates of unplanned 30-day all cause readmission after takotsubo cardiomyopathy hospitalization. Methods: We conducted an analysis of the 2020 Nationwide Readmission Database. Using the ICD-10 code, we identified hospitalizations for takotsubo cardiomyopathy. We excluded hospitalizations for age&lt;18years and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, Pearson χ2 tests were employed. We utilized multivariate Cox regression analyses to identify independent predictors of readmissions. Results: A total of 7554 patients were hospitalized for index admission for takotsubo cardiomyopathy, and 633 of them were readmitted. The 30-day all-cause readmission rate was 8.5% while specific takotsubo readmission rate was 0.4%. The mortality rate in the index admission was 1.9% and 5.5% in readmitted patients. The mean age of index admission was 67.6years vs 70.7 years in readmission, about 89.0% were female in index admission vs 85.0% in readmission cohorts. The most common reasons for readmission were hypertensive heart disease with heart failure, hypertensive heart disease and chronic kidney disease with heart failure, takotsubo syndrome, sepsis, NSTEMI, COPD exacerbation, acute kidney failure, pneumonia, atrial fibrillation. Readmissions had more acute kidney injury (20.6% vs 11.3%, p-value &lt;0.001) and atrial fibrillation (23.0% vs 13.0%, p &lt;0.001) compared to the index admission, however the index admission had more ventricular tachycardia (4.6% versus 1.8%, p=0.02) compared to readmission cohorts. Readmission had longer length of hospital stay (4.9 days vs 3.7 days, p&lt; 0.001), but less mean total hospital charge of (US$51039 vs US$60617, P =0.008). Older age, acute renal failure, pulmonary disease, coronary dissection, longer length of hospital stays and transfer to rehabilitation facility after discharge were identified as statistically significant predictors of readmissions. Conclusion: About one in twelve patients hospitalized with takotsubo cardiomyopathy were readmitted within 30days. Readmissions had a higher mortality rate; acute renal failure, pulmonary disease, coronary dissection were notable reasons for readmission. Understanding the predictors for readmission highlighted in this study would enable clinicians implement preventive strategies to improve the rate of takotsubo cardiomyopathy readmission

Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt Among Cirrhosis Patients With Recurrent Esophageal Variceal Bleeding.

Background Transjugular intrahepatic portosystemic shunt (TIPS) has been shown to reduce the risk of rebleeding among patients with recurrent esophageal variceal bleeding. However, the impact of TIPS on survival remains uncertain.This study took on this challenge to determine if TIPS has any impact on all-cause inpatient mortality during the hospitalization in which it is performed and if it impacts all-cause 30-day readmission rates when compared to patients who only undergo esophageal variceal banding (EVB) for recurrent esophageal variceal bleeding. Methods This was a retrospective cohort study using the Healthcare Cost and Utilization Project - National Readmission Database 2019. All adult patients who had a diagnosis of cirrhosis, were hospitalized once for esophageal variceal bleeding requiring EVB in 2019, and then were hospitalized again later in the year for recurrent esophageal variceal bleeding requiring either TIPS or EVB were included. This second hospitalization in which patients either received TIPS or EVB only was considered as the index hospitalization.Patients with missing data and patients who were discharged in December were excluded. The primary outcome was all-cause 30-day readmission rates among patients who either received TIPS or EVB only.The secondary outcomes included: (i) incidence of all-cause inpatient mortality; and (ii) length of hospital stay during index hospitalization. Patients who underwent TIPS were matched with patients who underwent EVB only on age, sex, and baseline comorbidities. After propensity score matching, survival analysis was performed to compare the all-cause 30-day readmission rates after the index hospitalization, between patients who either received TIPS or EVB only during the index hospitalization. χ2 test was used to compare the inpatient mortality. As the data did not have a normal distribution, the Wilcoxon signed-rank test was used to compare the length of index hospitalization between patients who either received TIPS or EVB only. The alpha criterion was set at 0.05 for all statistical tests. Results This study found no difference in all-cause 30-day readmission rates between patients who underwent either TIPS or EVB only for recurrent esophageal variceal bleeding (hazard ratio: 1.24, 95%CI: 0.73-2.12, P = 0.4). In the exploratory analysis, it was noted that the rate of recurrent esophageal variceal bleeding, among patients who were readmitted within 30 days was lower in the TIPS group (13.3%) when compared to the EVB group (50%) with a risk ratio of 0.27 (95%CI: 0.10-0.72, P = 0.003). Although it was not statistically significant, the inpatient mortality rate during the index hospitalization appeared to be lower in the TIPS group when compared to the EVB group (4.2% vs 10.08%, respectively). Patients who underwent TIPS were hospitalized three days longer than patients who underwent EVB only. Conclusion TIPS does not reduce all-cause 30-day readmission rates but is associated with reduced 30-day readmission rates secondary to recurrent esophageal variceal bleeding. TIPS shows a modest survival advantage during index hospitalization when compared to EVB only.

Readmission Rate, Predictors, Outcomes, and Burden of Readmission of Hepatorenal Syndrome in the United States: A Nationwide Analysis.

Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30-day readmission rates after HRS-related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States. We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The primary outcome was all-cause 30-day readmission rate. Secondary outcomes were inpatient mortality rate, predictors of readmission, and resource utilization. We identified 245 850 hospitalizations of patients admitted for HRS in the United States from 2016 to 2019. Of these, 214 890 met the inclusion criteria. Mean age was 59.16 years, and 61.31% were males. Medicare was the most common primary payer (44.82%) followed by Medicaid (25.58%). The readmission rate was 24.6% within 30 days of discharge from index hospitalization. The most common cause of readmission was alcoholic cirrhosis with ascites (14.87%), followed by sepsis (9.32%) and unspecified hepatic failure (9%). The in-hospital mortality rate for index hospitalization was 29.52% and 14.35% among those readmitted within 30 days. The mean length of stay (12.33 days vs. 7.15 days, p < 0.01) and hospitalization costs ($44 903 vs. $22 353, p < 0.01) were higher for index hospitalizations than readmissions. Our study demonstrated that all-cause 30-day readmission and in-hospital mortality rates after the development of HRS were strikingly high. This warrants health policies and interventions at the institutional level, including close post-hospital discharge follow-up, to decrease readmission rates, improve patient outcomes, and reduce cost burden.

Psychological Risk Factors on Hematopoietic Stem Cell Transplantation Patients: Insights From National Readmission Database Analysis.

Psychosocial risk factors (PSRFs) have emerged as important nontraditional risk factors for poor medical outcomes but have not been well-studied in the field of hematopoietic stem cell transplantation (HSCT). In this study, we retrospectively examined in-hospital and short-term outcomes in patients with PSRFs who underwent HSCT. We used the National Readmission Database (NRD) to identify patients who underwent HSCT between 2011 and 2020. Patients were stratified based on the presence of either 0 or ≥ 1 PSRFs, which included factors such as mental illness, substance abuse, cognitive problems, a low income level, and an uninsured status. Patients were also classified into allogeneic-HSCT (allo-HSCT) and autologous-HSCT (auto-HSCT) groups. Our primary endpoints were in-hospital and short-term outcomes. In this nationally representative cohort, 90,747 patients underwent auto-HSCT, while 26,600 patients underwent allo-HSCT. In the auto-HSCT group, individuals with PSRFs exhibited notably higher in-hospital mortality (2.4% vs. 2.8%; p<0.001) and 30-day all-cause readmission rates (14.4% vs. 17.8%; p<0.001) compared to those without PSRFs. Similarly, within the allo-HSCT group, patients with PSRFs had significantly higher in-hospital mortality (5.4% vs. 6.4%; p<0.001) and 30-day all-cause readmission rates (27.3% vs. 31.2%; p<0.001) compared to those without PSRFs. After adjusting for risk factors, the presence of PSRFs emerged as a substantial predictor for heightened 30-day readmission in allo-HSCT and auto-HSCT. The presence of PSRFs is correlated with poorer in-hospital and short-term outcomes after both allo-HSCT and auto-HSCT, with a more pronounced effect observed in allo-HSCT. This research underscores the significance of pinpointing high-risk patients and implies support for merging PSRFs after HSCT is beneficial.

Effect of sacubitril/valsartan on hospital readmissions in heart failure with reduced ejection fraction in Saudi Arabia: A multicenter retrospective cohort study.

Sacubitril/valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) that has been shown in multiple clinical trials to have clinical benefits and is recommended by major clinical management guidelines as a first-line treatment for heart failure with reduced ejection fraction (HFrEF). The most significant benefit that was observed in clinical trials is its effect in reducing hospital readmissions. However, little evidence supports its effectiveness in practice, especially in Saudi Arabia. A multicenter retrospective cohort study was conducted using the patient medical records at 2 tertiary hospitals in Saudi Arabia. Eligible patients were adults (≥18 years old) with a confirmed diagnosis of HFrEF who were discharged on either sacubitril/valsartan or angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) in addition to the other recommended therapy for HFrEF. The primary endpoint was the all-cause 30-day readmission rate. The secondary endpoints included all-cause readmissions at 60-day, 90-day, and 12 months. Additionally, 30-day, 60-day, and 90-day readmissions due to HF were evaluated. A total of 398 patients were included in our analysis; 199 (50.0%) received sacubitril/valsartan (group 1), and 199 (50.0%) received ACEI/ARB (group 2). Our results showed that all-cause 30-day readmissions in group 1 were significantly lower than in group 2 (7% vs 25.0%, RR 0.28, 95% Cl 0.16-0.49; P < .001). Additionally, the secondary outcomes showed significantly fewer 60-day, 90-day, and 12-month all-cause readmissions were identified in group 1 compared to group 2 (11% vs 30.7%, RR 0.36, 95% CI 0.23-0.56; P < .001), (11.6%. vs 32.6%, RR 0.35, 95% CI 0.23-0.55; P < .001) and (23.6% vs 51.2%, RR 0.46, 95% CI 0.35-0.62; P < .001), respectively. Furthermore, HF readmissions at 30-day, 60-day, and 90-day in group 1 were significantly lower than in group 2 (P < .05). Sacubitril/valsartan for the treatment of HFrEF is associated with a significantly lower rate of all-cause readmission as well as HF readmissions compared to ACEI/ARB. These benefits extend up to 12 months post-discharge.

Socioeconomic and Demographic Determinants of Readmission Rates in Congestive Heart Failure Patients: Insights From the Nationwide Readmissions Database.

Background Congestive heart failure (CHF) is a leading cause of hospitalizations and readmissions, placing a significant burden on the healthcare system. Identifying factors associated with readmission risk is crucial for developing targeted interventions and improving patient outcomes. This study aimed to investigate the impact of socioeconomic and demographic factors on 30-day and 90-day readmission rates in patients primarily admitted for CHF. Methods The study was carried out using a cross-sectional study design, and the data were obtained from the Nationwide Readmissions Database (NRD) from 2016 to 2020. Adult patients with a primary diagnosis of CHF were included. The primary outcomes were 30-day and 90-day all-cause readmission rates. Multivariable logistic regression was used to identify factors independently associated with readmissions, including race, ethnicity, insurance status, income level, and living arrangements. Results A total of 219,904 patients with a primary diagnosis of CHF were used in the study. The overall 30-day and 90-day readmission rates were 17.3% and 23.1%, respectively. In multivariable analysis, factors independently associated with higher 30-day readmission risk included Hispanic ethnicity (OR 1.18, 95% CI 1.03-1.35), African American race (OR 1.15, 95% CI 1.04-1.28), Medicare insurance (OR 1.24, 95% CI 1.12-1.38), and urban residence (OR 1.11, 95% CI 1.02-1.21). Higher income was associated with lower readmission risk (OR 0.87, 95% CI 0.79-0.96 for highest vs. lowest quartile). Similar patterns were observed for 90-day readmissions. Conclusion Socioeconomic and demographic factors, including race, ethnicity, insurance status, income level, and living arrangements, significantly impact 30-day and 90-day readmission rates in patients with CHF. These findings highlight the need for targeted interventions and policies that address social determinants of health and promote health equity in the management of CHF. Future research should focus on developing and evaluating culturally sensitive, community-based strategies to reduce readmissions and improve outcomes for high-risk CHF patients.

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

BackgroundSince 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity.Materials and methodsWe conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients.ResultsAfter the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform.ConclusionThe DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.

Improving patient education in hospitalized patients with chronic obstructive pulmonary disease: A quality improvement initiative using LEAN methodology.

Chronic obstructive pulmonary disease (COPD) is a costly chronic disease affecting more than 15 million Americans. The prevalence among US veterans is 3 times higher than the general population. The Veteran Health Administration developed a standardized, evidence-based COPD educational tool called Green Light to Go (GLTG) designed to educate patients on managing their COPD symptoms at home. Despite the availability of this resource, inpatient education on COPD self-management practices is highly variable across different medical teams. This quality improvement (QI) initiative sought to standardize inpatient COPD patient education using the GLTG tool. This initiative also assessed whether patients receiving standardized patient education during their index hospitalization had lower COPD 30-day readmission rates. The QI initiative followed the LEAN methodology and the A3 framework. The team performed rapid tests of change (plan-do-study-act cycles) to increase the percentage of veterans receiving COPD education. The interventions implemented for this QI initiative focused on clinical, patient, and system improvements. This initiative standardized COPD patient education and increased the percentage of veterans receiving (a) daily COPD education from 0% to 66%, (b) verbal COPD education on discharge from a baseline of 20% to 100%, (c) receipt of written educational material on discharge from 20% to 100%, and (d) the cohort all-cause 30-day readmission rate declined from 19.3% to 14.3%. Given the substantial economic burden of COPD readmissions on the health care system and patients, evidence-based educational interventions may potentially improve outcomes and reduce hospital readmissions in this veteran population.

Impact of Pharmacist Transitions of Care on 30-Day Readmissions Within a Primary Care-Based Accountable Care Organization.

Previous studies in the ambulatory care setting have shown inconsistent results in regard to, or with respect to pharmacist telephonic transitions of care (TOC) encounters and reduction in 30-day readmission rates. No studies that have been completed within an accountable care organization (ACO) evaluating the impact of telephonic TOC encounters performed by a pharmacist have been identified. The objective of this study was to analyze the impact of clinical pharmacy telephonic TOC encounters on readmission rates within a primary care-based ACO. In this retrospective chart review, data for those who had a pharmacist telephonic TOC encounter and those who had an attempt were collected. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 30-day readmission rate for targeted disease states, time to readmission, and readmission reason the same as previous discharge reason. For subjects who received a telephonic TOC encounter, pharmacist intervention type and provider acceptance of intervention(s) were described. For the final analysis, 154 encounters were included, 83 encounters in the telephonic TOC encounter group, and 71 did not receive a telephonic TOC encounter. The 30-day readmission rates were similar among those who received a telephonic TOC encounter and those who did not: the difference was not significant (15.7% vs. 28.2%; P = 0.059). There was also no statistical difference in the secondary outcomes. Even so, the results of this study suggest that performing a pharmacist telephonic TOC encounter in a primary care-based ACO setting has the potential to reduce 30-day readmission rates and further research appears to be warranted in this important area of practice.

Transcatheter aortic valve implantation with and without mitral stenosis — A National Readmission Database study

IntroductionMitral valve stenosis (MS) can be concomitantly present in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Some studies have reported up to one-fifth of patients who underwent TAVI also have MS. The relationship between mitral stenosis and TAVI has led to concerns regarding increased adverse cardiac outcomes during and after the procedure. MethodsThe Nationwide Readmission Database (NRD 2016–2019) was utilized to identify TAVI patients with MS with ICD-10-CM codes. The primary outcome was a 30-day readmission rate. Secondary outcomes included predictors of all-cause readmissions, length of stay, and total hospitalization cost. We assessed readmission frequency with a national sample weighed at 30 days following the index TAVI procedure. Unadjusted and adjusted odds ratios were analyzed for in-hospital outcomes using univariate and multivariate logistic regression for study cohorts. ResultsA total of 217,147 patients underwent TAVI procedures during the queried time period of the study. Of these patients, 2140 (0.98 %) had MS. The overall 30-day all-cause readmission rate for the study cohort was 12.4 %. TAVI patients with MS had higher rates of 30-day readmissions (15.8 % vs 12.3 %, aOR 1.22, CI: 1.03–1.45, P < 0.01). Additionally, TAVI patients with MS had longer lengths of hospital stay during index admissions (5.7 vs. 4.3 days), along with higher total hospitalization costs ($55,157 vs. $50,239). In contrast, in-hospital mortality during index TAVI admission did not differ significantly between the two groups, although there was a trend toward higher mortality in the MS group (2.1 % vs. 1.5 %). Among the TAVI MS cohort, patients admitted on weekends (aOR: 1.11, 95 % CI: 1.02–1.22, P = 0.01), admitted to non-metropolitan hospitals (aOR: 1.29, 95 % CI: 1.11–1.66, P = 0.04) and presence of co-morbidities such as atrial fibrillation (AF)/flutter (aOR: 1.24, 95 % CI: 1.16–1.32, P < 0.01), chronic obstructive pulmonary disease (COPD) (aOR: 1.16, 95 % CI: 1.11–1.22, P < 0.01), prior stroke (aOR: 1.09, 95 % CI: 1.03–1.14, P < 0.01), chronic kidney disease (CKD) ≥3 (aOR: 1.16, 95 % CI: 1.11–1.22, P < 0.01), end-stage renal disease (ESRD) (aOR: 1.75, 95 % CI: 1.61–1.90, P < 0.01), and anemia (aOR: 1.23, 95 % CI: 1.18–1.28, P < 0.01) were associated with increased odds of readmission. ConclusionConcomitant MS in patients undergoing TAVI is associated with higher readmission rates and total hospital costs. This can contribute significantly to healthcare-related burdens. Further studies are required to evaluate in-hospital outcomes and predictors of readmission in patients undergoing TAVI with the presence of concomitant MS.

The health-care utilization and economic burden in patients with genetic skeletal disorders

BackgroundMost genetic skeletal disorders (GSD) were complex, disabling and life-threatening without effective diagnostic and treatment methods. However, its impacts on health system have not been well studied. The study aimed to systematically evaluate the health-care utilization and economic burden in GSD patients.MethodsThe patients were derived from 2018 Nationwide Inpatient Sample and Nationwide Readmissions Database. GSD patients were extracted based on International Classification of Diseases-10th revision codes.ResultsA total of 25,945 (0.12%) records regarding GSD were extracted from all 21,400,282 records in NIS database. GSD patients were likely to have significantly longer length of stay (6.50 ± 0.08 vs. 4.63 ± 0.002, P < 0.001), higher total charges ($85,180.97 ± 1,239.47 vs. $49,884.26 ± 20.99, P < 0.001), suffering more procedure, diagnosis and transferring records in comparison to patients with common conditions. GSD patients had a significantly higher 30-day all-cause readmission rate based on Nationwide Readmissions Database.ConclusionsThe heavy health-care utilization and economic burden emphasized the urgency for policy leaders, scientific and pharmaceutical researchers, health care providers and employers to identify innovative ways and take effective measurements immediately, and eventually to help improve the care, management, and treatment of these devastating diseases.

Analysis of 30-day hospital readmissions and related risk factors for COVID-19 patients with myocarditis hospitalized in the United States during 2020

Background Despite extensive research on COVID-19 and its association with myocarditis, limited data are available on readmission rates for this subset of patients. Thirty-day hospital readmission rate is an established quality metric that is associated with increased mortality and cost. Methods This retrospective analysis utilized the Nationwide Readmission Database for the year 2020 to evaluate 30-day hospital readmission rates, risk factors, and clinical outcomes among COVID-19 patients who presented with myocarditis at their index hospitalization. Results Our analysis revealed that 1) the 30-day all-cause hospital readmission rate for patients initially hospitalized with COVID-19 and myocarditis was 11.7%; 2) after multivariate adjustment, the primary predictor of readmission for COVID-19 patients with myocarditis was discharge against medical advice; 3) COVID-19 patients with myocarditis who required readmission had a higher proportion of older patients and Medicare beneficiaries; 4) the most common diagnoses at readmission were COVID-19, sepsis, congestive heart failure, acute myocardial infarction, and pneumonia; and 5) readmitted patients were more likely to require renal replacement therapy during their index hospitalization. Conclusion This study underscores the importance of optimizing discharge plans, preventing irregular discharges through shared decision-making, and ensuring robust post-hospital follow-up for patients with COVID-19 and myocarditis at index admission.

Abstract TMP42: Reducing 30-day Stroke Readmissions Using a Multi-Step Quality Improvement Approach

Background: Thirty-day all-cause readmissions occur in about 12% of acute ischemic stroke (AIS) patients, are associated with a 4-fold increase in mortality, and are associated with increased cost utilization. Therefore, reducing 30-day readmissions in AIS patients is of paramount importance. In this study, we aimed to test the effect of a multi-step quality improvement (QI) initiative on readmission rates in hospitalized AIS patients. Methods: We included all patients discharged from a Comprehensive Stroke Center with a diagnosis of AIS or TIA over a 3-year period. The pre-intervention period was 1/1/2020 - 9/30/2021. The approach was instituted on 10/1/2021. After a 3-month washout, the post-intervention period was 1/1/2022 - 6/30/2023. Intervention measures are below.1. An inpatient checklist was instituted to help providers identify and address common problems before AIS/TIA patients were discharged.2. Complex patients discharged home would receive a call shortly after discharge to ensure good understanding of their care and next steps. Such patients were also scheduled to follow up in a rapid access clinic within 2 weeks of discharge.3. Complex patients discharged to a facility required a handoff call to the facility’s accepting provider.4. All readmissions were reviewed in our monthly QI meeting, with efforts to identify preventable causes.We used t-tests to compare mean observed to expected (O:E) length of stay and mortality metrics between the pre- and post-intervention periods. We used Chi Square tests to compare overall readmission rates. Results: Over the study period, 2532 patients were discharged with a principal diagnosis of AIS or TIA, and the all-cause 30-day readmission rate was 8.8% (223/2532). Compared to pre-intervention, the post-intervention period had a lower 30-day readmission rate (7.6% vs. 10.2%, p = 0.023), a non-significantly lower mean O:E mortality rate (0.71 vs. 0.82, p = 0.252), and a non-significantly lower mean O:E hospital length of stay (0.92 vs. 0.88, p = 0.13). Conclusion: At a Comprehensive Stroke Center, a multi-step approach for transitions of care was associated with reduced all-cause readmission rates without increasing hospital length of stay or mortality. Our findings require external validation.

Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure

The Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare. To compare changes in the quality and outcomes of care for patients hospitalized with heart failure according to hospital participation in the BPCI program. This cross-sectional study used a difference-in-difference approach to evaluate the BPCI program in 18 BPCI hospitals vs 211 same-state non-BPCI hospitals for various process-of-care measures and outcomes using American Heart Association Get With The Guidelines-Heart Failure registry and CMS Medicare claims data from November 1, 2008, to August 31, 2018. Data were analyzed from May 2022 to May 2023. Hospital participation in CMS BPCI Model 2 Heart Failure, which paid hospitals in a fee-for-service process and then shared savings or required reimbursement depending on how the total cost of an episode of care compared with a target price. Primary end points included 7 quality-of-care measures. Secondary end points included 9 outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30-day and 90-day all-cause readmission rate and mortality rate. During the study period, 8721 patients were hospitalized in the 23 BPCI hospitals and 94 530 patients were hospitalized in the 224 same-state non-BPCI hospitals. Less than a third of patients (30 723 patients, 29.8%) were 75 years or younger; 54 629 (52.9%) were female, and 48 622 (47.1%) were male. Hospital participation in BPCI Model 2 was not associated with significant differential changes in the odds of various process-of-care measures, except for a decreased odds of evidence-based β-blocker at discharge (adjusted odds ratio [aOR], 0.63; 95% CI, 0.41-0.98; P = .04). Participation in the BPCI was not associated with a significant differential change in the odds of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)-defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or having a follow-up visit within 7 days or less. Participation in the BPCI was associated with a significant decrease in odds of in-hospital mortality (aOR, 0.67; 95% CI, 0.51-0.86; P = .002). Participation was not associated with a significant differential change in hospital-level risk-adjusted 30-day or 90-day all-cause readmission rate and 30-day or 90-day all-cause mortality rate. In this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.

Impact of Pharmacist Inhaler Prescribing at Discharge for Chronic Obstructive Pulmonary Disease on Readmission Rates.

Acute exacerbation of COPD (AECOPD) is one of the six conditions in the Hospital Readmissions Reduction Program for which institutions are penalized for high 30-day readmission rates. This institution's Transitions of Care (TOC) pharmacists have prescribing authority to optimize guideline-directed medical therapy (GDMT), defined as discharging on rescue plus triple therapy inhalers under an approved protocol. While several studies evaluate the impact of pharmacist-led interventions on COPD readmission rates, there is a lack of literature with respect to pharmacists prescribing inhalers under an approved protocol. This study aims to evaluate all-cause 30-day COPD readmission rates. This was an IRB-approved, single-center, retrospective evaluation conducted between May 2021 and August 2023. Patients were included if they met criteria under the CMS HRRP COPD model. Patients in the pre-implementation group received usual care, with post-discharge nurse follow-up while patients in the post-implementation group received TOC pharmacy services. The primary outcome was all-cause 30-day readmission rates. Secondary outcomes included readmission reason and proportion of patients discharged on GDMT. A total of 279 patients were included, with 187 patients in the pre-implementation group and 92 patients in the post-implementation group. All-cause 30-day readmission rates in the pre- and post-implementation groups were 26% and 14%, respectively (p=0.02). The proportion of patients discharged on GDMT was 26% in the pre-implementation group and 100% in the post-implementation group (p<0.001). Utilizing a TOC pharmacy service may be associated with a reduction in all-cause 30-day readmission rates for patients with COPD.

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.

Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR. We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software. A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group. Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.

Risk of 30-Day All-Cause Readmission in Interstitial Lung Disease Patients after COVID-19: National-Level Data.

Rationale: Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset. Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital. Methods: This study is a nested cohort study that used the PearlDiver patient records database. Adult patients (age ⩾18 yr) who were admitted to hospitals in 28 states in the United States with COVID-19 or ILD diagnoses were included. We defined and analyzed two separate cohorts in this study. The first cohort consisted of patients with COVID-19 and was later divided into two groups with or without a history of ILD. The second cohort consisted of patients with ILD and was later divided into groups with COVID-19 or with a non-COVID-19 pneumonia diagnosis at admission. We also studied two other subcohorts of patients with and without idiopathic pulmonary fibrosis within the second cohort. Propensity score matching was employed to match confounders between groups. The Kaplan-Meier log rank test was applied to compare the probabilities of outcomes. Results: We assessed the data of 2,286,775 patients with COVID-19 and 118,892 patients with ILD. We found that patients with COVID-19 with preexisting ILD had an odds ratio of 1.6 for 30-day all-cause readmission. Similarly, an odds ratio of 2.42 in readmission rates was observed among hospitalized individuals with ILD who contracted COVID-19 compared with those who were hospitalized for non-COVID-19 pneumonia. Our study also found a significantly higher probability of intensive care admission among patients in both cohorts. Conclusions: Patients with ILD face heightened rates of hospital readmissions, particularly when ILD is combined with COVID-19, resulting in adverse outcomes such as decreased quality of life and increased healthcare expenses. It is imperative to prioritize preventive measures against COVID-19 and establish effective postdischarge care strategies for patients with ILD.

Epidemiology, Outcomes, and 30-Day Readmissions in Acquired Hemophilia

Background: Acquired Hemophilia is a rare bleeding disorder characterized by the presence of autoantibodies (inhibitors) against coagulation factors, mainly targeting factor VIII. It predominantly affects older individuals with underlying autoimmune disorders or malignancies. Achieving hemostasis and inhibiting autoantibody production through immunosuppression are the mainstays of treatment. However, overcorrection of bleeding poses a risk of thrombosis, while immunosuppression increases the risk of infectious complications in older patients with co-existing comorbidities. This study sheds light on the epidemiology of acquired hemophilia, including readmission rates and causes of readmission. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2019 to identify hospitalizations with acquired hemophilia, using the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code D68.311. Descriptive analysis was performed to report patient demographics, hospital characteristics, various comorbid conditions, and complications. The all-cause 30-day readmission rate was calculated, excluding index admissions from December and deaths during index admissions. Additionally, primary diagnoses at readmission were identified. The analysis produced national estimates after applying weights, utilizing the methodology provided by the Healthcare Cost and Utilization Project. Results: Out of 1,450 admissions for acquired hemophilia between 2016 and 2019 in the United States, 803 (55.4%) were males, and 857 (59.1%) belonged to the age group of 61-80 years, with a median age at admission of 73 years. Furthermore, the majority were admitted to a teaching hospital (83.5%), with the highest quintile of acquired hemophilia-specific hospital volumes (43.8%) in a large metropolitan area with at least 1 million residents (59.8%). Although 20.9% had an underlying solid malignancy, only 28.5% had an otherwise high comorbidity burden with the Charlson comorbidity index of &amp;gt;3. Underlying hematologic malignancy was reported in 3.9% of admissions, and 13.5% had a diagnosis of an autoimmune disease. Regarding complications, acute myocardial infarction occurred in 9.5%, disseminated intravascular coagulation was noted in 1.2%, intracranial hemorrhage in 1.5%, ischemic stroke in 2.5%, and venous thromboembolism in 4.4%, with 30.2% of admissions experiencing some form of bleeding. The median length of stay was 7 days, and 101 deaths occurred during the index admission, resulting in a 7% inpatient mortality rate. Out of 1,349 patients who were discharged alive, 371 were readmitted within 30 days, with a 30-day readmission rate of 27% (table 1). The median time to readmission was 10 days (interquartile range 5-18), and the median length of stay during readmission was 7 days (interquartile range 3-14), with 10.8% mortality during readmission. The median hospitalization charges were $11,3008 for both index admissions and readmissions. After omitting readmissions coded as hemophilia, infection (30.8%), followed by bleeding (28.2%), was the most common cause for readmission (figure 1). Conclusion: The study highlights a high rate of bleeding and thrombotic complications in acquired hemophilia, necessitating a careful approach to factor replacement for achieving hemostasis. Moreover, bleeding and infection are the primary reasons for the elevated 30-day readmission rate of 27%, and there is an additional 11% mortality during readmission, indicating a significant incidence of treatment-related toxicity and disease relapse.

1180. Empiric treatment of uncomplicated intraabdominal infection with cefazolin with or without metronidazole

Abstract Background Treatment guidelines for management of intra-abdominal infection (IAI) differ on whether cefazolin should be used first line to treat uncomplicated infection. In an effort to reduce unnecessary fluoroquinolone and piperacillin/tazobactam use, protocols were implemented with which recommendations were made to narrow to cefazolin ± metronidazole for uncomplicated IAI. The purpose of this study was to determine if there is a difference in outcomes with cefazolin +/- metronidazole versus broader-spectrum antibiotics for treatment of uncomplicated IAI. Methods This was a retrospective cohort study that reviewed inpatients at three acute-care community teaching hospitals from January 1, 2017, through December 31, 2021. Treatment groups were patients treated with cefazolin +/- metronidazole (study group) compared to those treated with piperacillin/tazobactam or ceftriaxone, ciprofloxacin, or cefepime each +/- metronidazole (control group). Inclusion criteria were age ≥ 18 years old; admission diagnosis of uncomplicated cholecystitis, diverticulitis, or appendicitis; and received as empiric inpatient treatment either cefazolin ± metronidazole, piperacillin/tazobactam, or ceftriaxone, ciprofloxacin, or cefepime ± metronidazole for at least 24 hours. Exclusion criteria were presence of perforation or abscess for cholecystitis or diverticulitis, cholangitis or pregnancy. The primary outcome measure was all-cause 30-day readmission rate. Results A total of 779 patients were included in the cefazolin group and 2269 patients were included in the broader-spectrum group. All-cause 30-day readmission rate was 5.8% in the cefazolin +/- metronidazole compared to 12.1% in the broader-spectrum group (OR 0.38, 95% CI 0.27-0.53, p &amp;lt; 0.001). Average length of stay was 3.6 days for the cefazolin group vs. 4.4 days for the broader-spectrum group (cefazolin group range 1 to 35 days, broader-spectrum group range 1 to 59 days, p &amp;lt; 0.0001). Conclusion Empiric treatment of uncomplicated intra-abdominal infection with cefazolin +/- metronidazole did not result in an increase in 30-day readmissions compared to broader-spectrum empiric antibiotics. Disclosures All Authors: No reported disclosures