30-day All-cause Readmission Rate Research Articles

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.

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.

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.

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 11.8%; 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.

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

Single-Center Experience of 500 Cases of Laparoscopic Sleeve Gastrectomy: Surgical Techniques and Perioperative Management Strategies.

Introduction: Reported results and techniques of laparoscopic sleeve gastrectomy (LSG) are variable. Our objective was to assess results of weight loss, complications, and reflux in a large consecutive series of LSG, describing technical detail which contributed to outcomes. Methods: Retrospective review of prospectively collected data of 500 consecutive patients undergoing LSG. Patient demographics, weight loss, complications, and functional outcomes were analyzed and operative technique described. Results: Five hundred patients underwent LSG over 3 years (2 revisional). Mean (range) preoperative body mass index was 40 kg/m2 (32-75 kg/m2). Mean follow-up and length of hospital stay were 12 months (1-36) and 7.2 days (5-12), respectively. All-cause 30-day readmission rate was 0.3%. Mean excess weight loss was 22.3% (1 month), 42.2% (3 month), 57.2% (6 month), and 73.1% (1 year). There was no mortality and intraoperative complications occurred in our 500 cases. Early surgical complications in 2 (0.2%) patients (postoperative bleeds). Gastro-oesophageal reflux symptoms decreased about 10%. Conclusion: With attention to detail, LSG can lead to good excess weight loss with minimal complications. Tenants to success include repair of hiatal laxity, generous width at angula incisura, and complete resection of posterior fundus.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Abstract 13747: Undernutrition Severity Correlates With Worse Outcomes in Patients Admitted With Peripheral Artery Disease

Introduction: Malnutrition has been associated with inferior outcomes in general. However, there is a lack of data to assess if the degree of malnutrition correlates with worse outcomes in patients with peripheral artery disease (PAD). Methods: We used Nationwide Readmission Database (NRD) for 2016-2019 in our study. First, we extracted all cases older than 18 years that include a primary diagnosis of PAD. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results: We identified 599,717 discharges with PAD. Malnutrition was present in 8% of the study cohort (or 49,853 cases). Half of the patients with malnutrition (or 26,090) had moderate to severe malnutrition. Malnourished patients had similar age distribution compared to those without malnutrition (mean age 71 years vs. 72 years) and slightly more women (42% vs. 37%, p&lt;0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, malignancy, and chronic (liver, renal, and lung) diseases (p&lt;0.001), but similar frequency of hypertension and diabetes. They also had significantly higher inpatient mortality (6% vs. 1.4%, p&lt;0.001), length of stay (mean of 15 days vs. 11 days, p&lt;0.001), and all-cause 30-day readmission rates (27% vs. 22%, p&lt;0.001). Inpatient mortality on readmission was also higher in those with malnutrition (9% vs. 3.8%, p&lt;0.001). Univariate analysis showed that the severity of malnutrition also correlated with higher inpatient mortality (OR 3.8[3.4-4.2] for mild malnutrition and 5[4.6-5.5] for advanced malnutrition). Figure 1 shows that malnutrition is associated with higher inpatient mortality even after adjustment for significant comorbidities and vascular interventions. Conclusions: In patients hospitalized with PAD, underlying malnutrition is an adverse prognosticator.

Abstract 13406: Surveillance Bias: Inpatient Outcomes of Heart Failure in Substance Users as an Example

Introduction: Substance use (SU), including opioid, methamphetamine, and cocaine use, is not infrequent among those with heart failure (HF). We aimed to characterize substance use among patients with heart failure and its association with inpatient outcomes. Methods: We used the Nationwide Readmission Database (NRD) for 2019 for our retrospective study. First, we extracted all cases older than 18 years that included a primary diagnosis of HF. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results: We identified 1,318,006 discharges with a primary diagnosis of HF. SU was present in 5% of the study cohort (n= 57,395 cases). Patients with SU were younger than those without SU (mean age 55 years vs. 72 years, p&lt;0.001) and fewer women (29% vs. 49%, p&lt;0.001). Patients with SU had a higher prevalence of underlying hypertension, acquired immunodeficiency syndrome, and chronic lung and liver disease, but a lower prevalence of malignancy, dementia, end-stage renal disease, diabetes, and cerebrovascular disease (p&lt;0.001). Substance users had significantly lower inpatient mortality (1.4% vs. 2.9%, p&lt;0.001), but higher leaving against medical advice (AMA) (8% vs. 1%, p&lt;0.001), length of stay (mean 9 days vs. 8 days, p&lt;0.001), and all-cause 30-day readmission rates (58% vs. 46%, p&lt;0.001). Even after adjusting for age, gender, and comorbidities, the presence of SU continued to be associated with lower inpatient mortality compared to those without SU (OR 0.81 [0.73-0.90]). In this case, mortality rates are calculated based on discharge-level records rather than patient-level records. This leads to a dilution of the inpatient mortality rate because drug users who have multiple readmissions contribute more to the denominator. After excluding patients who left AMA or had readmission in the same year, SU was not associated with any favorable outcome (OR 1 [0.90-1.12]). Conclusions: While administrative data offers opportunities to study clinical outcomes, understanding how data is created and analyzed is key. Because the NRD database is built based on discharge-level rather than patient-level records, this is an example of how these calculations can introduce bias.

How do hospitals respond to input regulation? Evidence from the California nurse staffing mandate

Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 min increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients “quicker and sicker”, rather, AMI patients recovered more quickly due to an improvement in care quality per day.

Reducing refeeding syndrome incidence among patients with head and neck cancer: A quality improvement initiative.

459 Background: Refeeding syndrome (RFS) constitutes a wide spectrum of electrolyte abnormalities and clinical symptoms following re-introduction of nutrition, specifically carbohydrate, in malnourished patients (pts). Refeeding phenomena (RFP) is the isolated decline in electrolyte levels (phosphate, potassium, or magnesium) following refeeding. Average incidence of RFS in head and neck cancer (HNC) pts is 20%. Early identification of high-risk pts and increasing awareness about RFP is crucial to avoid rapid nutritional replenishment and therefore reduce health care costs, morbidity, and mortality from RFS. We conducted a quality improvement (QI) project at a single academic university hospital with objective of reducing RFS incidence, length of hospital stay (LOS) and 30 day all-cause readmission and ED visit rates in HNC pts started on enteral nutrition (EN). Methods: We conducted a prospective observational study between Aug 2021 and Nov 2022 among pts with HNC admitted for feeding tube insertion. Pts determined to be high-risk for RFS according to ASPEN criteria were included. Serum electrolyte levels were obtained and monitored twice daily for 3 days following initiating continuous feeds with a standard, fiber free, 1.5 kcal/mL formula @ 20mL/h (’Safe start’). If low, electrolytes were promptly supplemented. Enteral thiamine supplements (100 mg daily for 5-7 days) were started. A registered dietitian conducted a nutrition assessment within 24 h of EN initiation to provide EN regimen and formula advancement recommendations, as well as EN needs for home. Case management was consulted within 24 h of EN initiation to facilitate timely discharge and delivery of home supplies. Data including LOS and 30-day all-cause readmission and ED visits were collected. ASPEN criteria were used to define mild, moderate, severe RFP. For comparison, similar data was retrospectively collected by reviewing medical records of 57 HNC pts (control group) admitted for feeding tube insertion between Dec 2017 and April 2021. Results: Of the 56 pts in the study group, 8 (14.3%) experienced RFS, 12 (21.4%) mild RFP, 7 (12.5%) moderate RFP, and 12 (21.4%) severe RFP. The average LOS in study group was 10 days compared to 13 in control group. 30-day all-cause readmission and ED visit rates were 21.4% and 12.5% in study group compared to 45.6% and 19.3% respectively in control group (Table 1). Conclusions: RFP/RFS is often underdiagnosed and undertreated in HNC pts. Through QI measures we were able to decrease RFS incidence rate to less than the reported average. Close collaboration between physicians, nurses, dietitians, and case managers facilitates timely intervention to prevent RFS, reduce LOS and readmissions.[Table: see text]

Relationship of health-related social needs and hospital readmissions in patients following a hospitalization for atrial fibrillation

Atrial fibrillation (AF) has a high economic burden on the healthcare system with rehospitalizations as the most significant contributing factor necessitating an understanding of aspects related to hospitalizations to minimize economic costs and improve patient outcomes. Our study aims to assess whether all-cause 30-day hospital readmission following AF-specific hospitalization is associated with health-related social needs (HRSN) using the Nationwide Readmissions Database (NRD). All hospitalization data were abstracted from the 2015–2019 NRD, including hospitalizations for patients at least 18 years of age with a primary discharge diagnosis of AF. For each hospitalization, we identified secondary diagnoses for five HRSN domains including employment, family, housing, psychosocial, and socioeconomic status. Primary outcomes included all-cause 30-day readmission rates. Secondary outcomes included all-cause 90-day readmissions and diagnosis on readmissions. An estimated 1,807,460 index hospitalizations in the United States included a primary discharge diagnosis of AF. Of these, 97.3 % included a diagnosis in only one HRSN domain with the most frequently diagnosed HRSN domain being housing (54.5 %) followed by socioeconomic (29.4 %), family (10.0 %), employment (6.1 %), and psychosocial (2.8 %). Index hospitalizations that included any HRSN diagnosis had 2.2-times greater unadjusted odds of all-cause 30-day readmission (95 % CI: 2.1 to 2.3-times greater, p < .001). Index hospitalizations that included an HRSN diagnosis were associated with higher rates of 90-day readmission due to conduction disorder and COPD. In conclusion, there is a significant association between HRSN and hospital readmissions in patients with AF. Further research is required to explain the true nature of this relationship with a specific emphasis on housing insecurity.

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

Association of vena cava filters and catheter-directed thrombolysis for deep vein thrombosis with hospital readmissions

BackgroundAcute deep vein thrombosis (DVT) affects >350,000 patients each year in the United States. Contemporary rehospitalization rates and predictors of acute DVT have not been well-characterized. We aimed to evaluate the all-cause 30-day readmission rate and its association with catheter-directed thrombolysis and vena cava filters in patients with proximal and caval DVT. MethodsPatients with an index hospitalization for acute proximal lower extremity DVT were evaluated for unplanned readmission rates at 30 days using the Nationwide Readmission Database from 2016 to 2017. We used Cox proportional hazard model to determine the predictors of 30-day readmissions and their association with inferior vena cava (IVC) filter and CDT use. ResultsWe identified 58,306 adult patients with an index hospitalization for acute proximal DVT. The unplanned 30-day rehospitalization rate was 14.7% (95% confidence interval [CI], 14.5-15.0%). There were 4995 patients (10.0%) who underwent CDT and 6085 (12.2%) who underwent IVC filter placement. In multivariable analysis, only CDT was associated with a lower hazard for rehospitalization (hazard ratio [HR], 0.77; 95% CI, 0.71-0.84; P < .001), whereas IVC filter placement (HR, 1.26; 95% CI, 1.19-1.34; P < .001), Charlson Comorbidity Index of >3 (HR, 1.47; 95% CI, 1.38-1.56; P < .001), malignancy (HR, 1.45; 95% CI, 1.34-1.57; P < .001), and length of stay >5 days (HR, 1.39; 95% CI, 1.33-1.46; P < .001), and acute kidney injury (HR, 1.18; 95% CI, 1.11-1.25; P < .001) were associated with higher readmission rates. ConclusionsThe 30-day unplanned rehospitalization rate continues to be high in patients with acute proximal DVT. CDT was associated with lower rehospitalization rates, whereas IVC filter placement was associated with increased rehospitalization rates.