Cause Of Hospital Readmissions Research Articles

Study of changes in serum sodium and potassium levels in term and preterm neonates following phototherapy

Background: Neonatal hyperbilirubinemia is a common physical finding in the first week of life. It is a common cause of hospital readmission during neonatal period. Phototherapy is an important treatment modality. However, it has some complications; amongst them serum electrolyte changes are a common complication. Objective of this study is to determine the changes in serum sodium and potassium in neonates before and after phototherapy and compare the occurrence of these changes in relation to gestational age and birth weight.Methods: In a prospective hospital based comparative study both term and preterm neonates admitted in neonatal intensive care unit receiving phototherapy at Cheluvamba hospital Mysore from July 2021 to April 2022 (10 months) were studied. A predesigned proforma aided the enrolment of new-borns into the study. Serum bilirubin and electrolytes and a comparative study was made between before and after phototherapy groups to determine the incidence of electrolyte imbalance.Results: The study group included 100 neonates. Incidence of low-birth-weight babies was 28% and preterm 22%. Mean birth weight and gestational age was 2.91±0.65 kg and 38.43±1.96 week respectively. The incidence of hyponatremia post phototherapy was found to be 9% which was more in low birth weight and preterm neonates (p<0.001) and was statistically significant. The incidence of potassium changes was found to be non-significant.Conclusions: The study shows that neonates under phototherapy are at higher risk of hyponatremia. This risk is greater in premature and low birth weight babies and hence this group of babies should be closely monitored for electrolyte changes and managed accordingly.

Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care.

One of the most costly and frequent causes of hospital readmissions in the United States is hepatic encephalopathy in patients with underlying liver cirrhosis. In this narrative review, we cover current practices in inpatient management, transitions of care, and strategies to prevent hospital readmissions. Bundled approaches using a model such as the "Ideal Transitions of Care" appear to be more likely to prevent readmissions and assist patients as they transition to outpatient care. Numerous strategies have been evaluated to prevent readmissions in patients with hepatic encephalopathy, including technologic interventions, involvement of nonphysician team members, early follow-up strategies, and involvement of palliative care when appropriate.

Decreasing 30-Day Readmission Rates in Patients With Heart Failure.

Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes. For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%. A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge. The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions. Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes. The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.

A 3-Year Single Center Experience With Left Atrial Pressure Remote Monitoring: The Long and Winding Road.

BackgroundDespite continuous advancement in the field, heart failure (HF) remains the leading cause of hospitalization among the elderly and the overall first cause of hospital readmission in developed countries. Implantable hemodynamic monitoring is being tested to anticipate the clinical exacerbation onset, potentially preventing an emergent acute decompensation. To date, only pulmonary artery pressure (PAP) sensor received the approval to be implanted in symptomatic heart failure patients with reduced ejection fraction. However, PAP's indirect estimation of left ventricular filling pressure can be inaccurate in some contexts.MethodsThe VECTOR-HF study (NCT03775161) is examining the safety, usability and performance of the V-LAP system, a latest-generation device capable of continuously monitoring left atrial pressure (LAP). In our center, five advanced HF patients have been enrolled. After confirmation of the transmitted data reliability, LAP trends and waveforms have guided therapy optimization. The aim of this work is to share clinical insights from our center preliminary experience with V-LAP application.ResultsOver a median follow-up time of 18 months, LAP–based therapy optimization managed to reduce intracardiac pressure over time and no hospital readmission occurred. This result was paralleled by an improvement in both functional capacity (6MWT distance 352.5 ± 86.2 meters at baseline to 441.2 ± 125.2 meters at last follow-up) and quality of life indicators (KCCQ overall score 63.82 ± 16.36 vs. 81.92 ± 9.63; clinical score 68.47 ± 19.48 vs. 83.70 ± 15.58).ConclusionPreliminary evidence from V-LAP application at our institution support a promising efficacy. However, further study is needed to confirm the technical reliability of the device and to exploit the clinical benefit of left-sided hemodynamic remote monitoring.

Impact of TheraNow Telehealth Physical Therapy Program on Hospital Readmission Rate Post Major Joint Replacement Surgery

Background: Hip and knee replacement are two of the most commonly performed major joint replacement surgeries in orthopedic surgery. Both procedures successfully eliminate pain, correct the deformity, and improve patient mobility to regain quality of life and perform daily life activities. Rehabilitation and recovery are crucial during the 12 weeks following any major joint replacement surgery. Most people are discharged from the hospital 2–3 days after surgery to continue rehabilitation. Specific exercises aim to improve the joint’s mobility, improve strength and restore patient function.
 The primary cause of hospital readmissions after major joint replacement is infection and can hinder the patient’s functional recovery. Therefore, a comprehensive program is essential to reduce infections and promote recovery. The virtual rehabilitation program is an evolving approach to optimize care and compliance. One such program is the TheraNow telehealth physical therapy program. TheraNow integrates artificial intelligence-powered tools and highly trained physical therapists in a care-navigation platform specially designed for rehabilitation after major joint replacement surgery. The objective of this study was to evaluate the impact of the TheraNow Telehealth Physical Therapy program on patient rehabilitation and hospital readmission rate following major joint replacement surgery.
 Materials and Methods: Forty patients participated in this particular post-joint replacement virtual rehabilitation program on TheraNow application for an online and in-home physical therapy program. The program incorporated three phases of rehabilitation: pre-rehabilitation, post-surgical rehabilitation, and functional rehabilitation. A licensed physical therapist evaluated the patient via a synchronous video conferencing visit, at which time the Physical Therapist developed a customized program for each patient. Every patient booked appointment according to their own choices of time slots, and the same licensed physical therapists administered the entire program from start to finish for each patient. Physical Therapists provided customized therapy to every patient with a duration of 45-60 minutes of the personalized session. In addition, this study tracked and identified all hospital readmissions within 30 days of discharge from the patients’ medical records.
 Results: The overall mean age of the study population was 65.20+8.41. Out of the 40 enrolled patients, 3 (7.50%) are 41-50 years old, while the majority (42.5%) belonged to 61-70 years of age followed by 71-80 years (27.5%) and 51-60 years (22.5%). 23 (57.5%) were female, while 17 (42.5%) were males. Only one re-admission happened due to surgical site infection in the first 30 days after the surgery under the program brought the readmission rate to 2.5%.
 Conclusion: The study reported lower hospital readmission rate after major joint replacement surgeries. The TheraNow Telehealth Physical Therapy program reported a 2.5% readmission rate in the first 30 days of the physical therapy program for major joint replacement surgeries as compared to the previous literature where they have reported hospital readmission rate of 3.3%- 5.6% in 30 days post-surgical follow-up.

Frequency and factors associated with hospital readmission after COVID-19 hospitalization: the importance of post-COVID diarrhea

PurposeThe aim of this study was to describe the incidence and risk factors for hospital readmission and infection during the months after COVID-19 hospital admission. MethodsThis prospective study included adult patients who were hospitalized due to COVID-19 and had been discharged from April 2020 to August 2020. All patients had a medical evaluation with a structured questionnaire 6 to 11 months after hospital admission. The authors included only patients with confirmed COVID-19 by RT-PCR. Patients with pregnant/postpartum women, with a proven COVID-19 reinfection or incapable of answering the questionnaire were excluded. ResultsA total of 822 patients completed the follow-up assessment, and 68% reported at least one recurrent symptom related to COVID-19. The most frequent symptom was myalgia (42%). Thirty-two percent of patients visited an emergency room after COVID-19 hospitalization, and 80 (10%) patients required re-hospitalization. Risk factors for hospital readmission were orotracheal intubation during COVID-19 hospitalization (p = 0.003, OR = 2.14), Charlson score (p = 0.002, OR = 1.21), congestive heart failure (p = 0.005, OR = 2.34), peripheral artery disease (p = 0.06, OR = 2.06) and persistent diarrhea after COVID-19 hospitalization discharge (p = 0.02, OR = 1.91). The main cause of hospital readmission was an infection, 43 (54%). Pneumonia was the most frequent infection (29%). ConclusionsThe presence of symptoms after six months of COVID-19 diagnosis was frequent, and hospital readmission was relatively high.

Addressing COVID-19 Barriers to Clinical Trial Enrollment and Implementation in the PHARM-DC Study

Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge interventions on 30-day hospital readmissions among older adults taking ≥10 medications or ≥3 high-risk medications. The PHARM-DC intervention includes pharmacist-led patient counseling, medication reconciliation at discharge, and a follow-up phone call post-discharge. We will highlight study protocol adaptations undertaken during the COVID-19 pandemic to address challenges to enrollment and to minimize risk of COVID-19 exposure for study participants and research personnel. Additionally, we will share insights from focus groups and semi-structured interviews with pharmacist interventionists and pharmacy leaders on barriers and facilitators to implementation due to the pandemic and strategies for future clinical trials to overcome barriers.

The Impact of Hepatic Cirrhosis on Chronic Obstructive Pulmonary Disease in the United States: A Nationwide Analysis.

We aimed to study the impact of Hepatic Cirrhosis (HC) on chronic obstructive pulmonary disease (COPD).Our study is a retrospective cohort study using the 2016-2017 National Readmission Database (NRD). NRD is part of the Healthcare Cost and Utilization Project (HCUP), organized and supported by means of the Agency for Healthcare Research and Quality (AHRQ). Patients were included if they were 18 years or older and had a principal diagnosis of COPD based on International Classification of Diseases, Tenth Revision (ICD-10- CM) codes and had a secondary diagnosis of HC.A total of 505,004 patients were included in the study with a diagnosis of COPD, 6196 (1.23%) of whom had HC. HC was found to be more common amongst male patients between the ages of 50 and 65 years. Medicare beneficiaries with high comorbidity burden, lower socioeconomic status, and those who received treatment in a large urban teaching hospital also had higher rates of HC. Patients with HC and COPD correlated to an increase of in-hospital mortality (adjusted odds ratio (aOR: 2.21, p<0.001) and 30-day hospital readmission rate (aOR: 1.23, p<0.001) compared with patients without HC. The in-hospital mortality rate was higher during readmission compared with index admissions (5.01% versus 2.16%; p<0.001). In addition, HC was associated with higher morbidity including prolonged mechanical ventilation (aOR: 1.39, p<0.001), resource utilization with prolong length of stay (LOS) (adjusted mean difference (aMD: 0.51, p<0.001), higher total hospitalization charges (aMD: 4967, p<0.001), and costs (aMD: 1200, p<0.001). Both patient groups had similar odds of being intubated (aOR: 1.18, p-0.13), tracheostomy (aOR: 0.81, p-069) and bronchoscopy rates (aOR: 1.27, p-0.36). The most common causes of hospital readmission were found to be COPD with acute exacerbation (19.7%), sepsis, unspecified organism (6.0%, acute and chronic respiratory failure with hypoxia (4.2%), acute on chronic systolic heart failure (3.9%), and hepatic failure, unspecified coma (3.1%). Various autonomous prognosticators of readmission were sex (particularly female), alcohol dependence, LOS greater than 7 days, lower comorbidity burden, and discharge to short term hospital or against medical advice. On the other hand, males, patients without a history of alcohol dependence, greater comorbidity burden, and LOS fewer than 3 days, were less likely to be readmitted. We found that HC is related to higher in-hospital mortality, LOS, increased mechanical ventilation, resource utilization with prolonged LOS, hospital costs, odds of intubation, and tracheostomy and bronchoscopy rates. Our study aims to shed light on the impact of HC on COPD in hopes to improve future management.

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3–15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01–1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06–1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26–2.69), asthma (OR: 1.52; 95% CI: 1.04–2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86–0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76–0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00–1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

English

BACKGROUND Hyperbilirubinemia is the most common cause of hospital readmission in neonates affecting about 60 % of term and 85 % of preterm neonates. Often, it is a benign condition but may result in neurological sequelae like bilirubin induced encephalopathy and kernicterus spectrum of disorders. We wanted to evaluate the foetal and maternal risk factors of hyperbilirubinemia and also identify the modifiable risk factors of it in neonates. METHODS An observational case - control study was carried out from July 2018 to July 2020. Neonates with hyperbilirubinemia levels in the range of phototherapy as described by the age and gestation by the American Academy of Paediatrics were taken as cases and neonates without hyperbilirubinemia were taken as controls. Detailed demographic-, prenatal-, perinatal-, family-history and physical-examination was undertaken for all the neonates included in the study and various risk factors were assessed such as the presence of maternal illness, intrauterine growth retardation (IUGR), premature rupture of membranes (PROM), prematurity, ABO and Rh incompatibility, previous history of phototherapy in siblings, breast feeding problems and birth asphyxia. RESULTS Multivariate logistic regression studies of data collected has shown a significant association between IUGR (P value 0.01), prematurity (P value 0.002), ABO incompatibility (P value 0.009), breast feeding problems (P value 0.001), birth asphyxia (P value 0.05) and presence of PROM (P value 0.05) with neonatal hyperbilirubinemia. CONCLUSIONS Early identification of neonatal hyperbilirubinemia and prompt intervention reduces the morbidity and mortality associated with this common condition. KEY WORDS Jaundice of Neonate, Neonatal Jaundice, Icterus Neonatorum

Incidence and Causes of Late Hospital Readmissions After Living Donor Renal Transplant: A Retrospective Study.

Our primary aim was to find the incidence, causes, and factors responsible for late hospital readmissions. There were 185 patients included in the study. The patients were divided into 2 groups: those with late readmission after discharge and those with no late readmission. Inpatient records and charts were assessed for the medical status of the patients, cause of chronic kidney disease, comorbidities, vintage and modality of dialysis, and hospital admissions 3 months before transplant. Collected patient data included recipient age, sex, height, weight, body mass index, hepatitis C status, donor age, methods of immunosuppression and induction, duration of hospital stay, postoperative complications and secondary procedures, number, duration, and causes of hospital readmission after transplant, and methods of evaluation and management during readmission. There were 80 patients who received 127 late hospital readmissions. The most common cause of late hospital readmission was infection, which led to 45 admissions (35.43%). Of 45 admissions for infections, 18 were caused by urinary tract infections. Other reasons for admission were pneumonia (10 admissions), cytomegalovirus infection (11 admissions), and tuberculosis (6 admissions). The second most common cause of readmission was infectious or noninfectious diarrhea, which led to 29 admissions (22.88%). There were 28 late hospital readmissions (22.4%) for the evaluation or management of graft dysfunction. Newonset diabetes after transplant and febrile illness were causes of late hospital readmission in 8 cases each (6.9%), with 9 late hospital readmissions (7.08%) the result of other causes. Incidence of late hospital readmission is high (43.2%), and the most common cause is infection, particularly urinary tract infections. Age of the recipient and early hospital readmission are predictive factors for late hospital readmission.

Causes and Risk Factors for Hospital Readmission in Patients with Ureteral Stones Treated With Transurethral Lithotripsy

Introduction: Urinary tract stones are recognized as the third most prevalent disease in urology. Transurethral lithotripsy (TUL) is the most prevalent surgical modality for ureteral stones. Some patients experience hospital readmission and possibly another surgical intervention after TUL. The present study aimed to assess the causes and risk factors of readmission in patients with ureteral stones treated with TUL. Materials and Methods: This cross-sectional study was conducted on all the patients who underwent TUL in Imam Reza Hospital in Mashhad, northeast of Iran, from March 2018 to September 2019. The case group consisted of 67 patients who were hospitalized due to primary urinary stone-related complications. The patients who were admitted for the removal of double J (DJ) catheter (n=118) were regarded as the control group. Results: The most common causes of hospital readmission were re-TUL for the removal of the remnant urinary stones when patients came back for DJ catheter removal (29.9%). The second and third causes of readmission were fever after DJ catheter removal (20.9%) and fever after TUL (14.9%). The main risk factors for hospital readmission were stone size, age, and male gender. Conclusion: As evidenced by the results of the present study, stone size, age, and male gender were the major risk factors for hospital readmission after TUL. The most common causes of readmission were re-TUL at the time of DJ catheter removal, fever after DJ catheter removal, and fever after TUL.

Pharmacist Collaborative Care in Heart Failure Management in Kirkuk City- Iraq

Background: In spite of advances toward the treatment of heart failure (HF), the number of hospital readmissions, and their associated health care costs are very high, and anticipated to rise exceptionally over the next decade that put an expanded load on the healthcare system. Drug-related problems (DRPs) is among the leading cause of hospital readmission. DRPs occur frequently upon discharge due to changes in medication regimen or suboptimal discharge instructions given to patients. Which can cause harm to patients. A need was therefore identified to update systems of care for HF. Recent policy is an increasing focus on delivering of intensive pharmaceutical care for these patients with the aim of reducing hospital admissions. Objective: To clarify the role of clinical pharmacist (CP) in the care of patients with HF in reducing rehospitalization, discrepancies, improving adherence and health related quality of life (QOL). Methods: A prospective, randomized, controlled intervention study was conducted on 100 patients with chronic HF were recruited from the Cardiac Clinic and Internal Medical Ward, at Azadi Teaching Hospital in Kirkuk City from March to August 2019. Patients have been randomized to two groups (50 patients per each) standard care (control) or standard care plus a follow-up program (intervention) that includes medication review and interview. Intervention participants are scheduled for a 30-min appointment with the clinical pharmacist, following their standard follow-up appointments at the Cardiac Clinic, patients in the intervention group were seen individually two times (baseline and follow-up) or as required over six weeks, at the Cardiac Clinic. An intervention agenda was set to check and manage any problems with prescribing and adherence. Additional information supplied on the discharge medication related to dose adjustments and discontinued medication. The data were analyzed using Statistical Package for the Social Sciences (SPSS) V.22, chi-square (X2) test, and t-test, and the significance level was < 0.05. Results: Ninety- three out of 100 patients were completed the study distributed between intervention and control group (47, 46) patients respectively. Both groups were nearly similar in term of age, gender, education level and smoking. After 6 weeks, there were statistically significant reductions in the following parameters of the intervention group; the total number of hospitalization (49 vs 23; P < 0.003), length of stay (LOS) (131 days’ vs 53 days; P < 0.002). Number of medication discrepancies, with a significant improvement in Patients' adherence (P value ≤ 0.01) and QOL. Regarding control group, no significant difference in the number of rehospitalization but the LOS there was a significant difference, a significant difference in one type of discrepancies, no improvement in adherence and QOL. Conclusions: The results of the current study revealed that pharmacists' contribution to providing medication care for patients with HF has a great impact on reducing the number of rehospitalization, LOS, medication discrepancies, and improving patient’s adherence and QOL, as well.

Application of the replicating effective programs framework to design a COPD training program

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and a common cause of hospital readmissions in the United States. While best practices exist in COPD management, incorporation of such approaches into routine clinical care remains a challenge. ObjectivesThis evaluation applied principles from the field of dissemination and implementation (D&I) science to design a training package integrating best practice for COPD management. The D&I field promotes evidence-based implementation strategies, frameworks, and assessment approaches that can be considered by clinicians to promote adoption of best practices. MethodsThis prospective mixed-methods evaluation applied a D&I science model to develop, implement, and evaluate an interprofessional training program for COPD management originally piloted in 2016. The authors provide a contextual example of how a guiding D&I framework, replicating effective programs, was applied to design and implement a Web-based training program for clinicians preparing to implement the COPD service. A questionnaire and profession-specific focus group sessions were conducted to evaluate trainee confidence and enactment of critical service components. ResultsA total of 41 of the 50 interprofessional trainees responded to the pre- and postquestionnaire including primary care clinical pharmacists (n = 15), primary care registered nurses (n = 9), triage registered nurses (n = 12), and respiratory therapists (n = 5). Statistically significant improvements in trainee confidence and enactment were observed in 31 of the 40 total survey items (77%). Pooled focus group data provided attestation that the training enhanced practitioners’ confidence in their role within the service. Opportunities for further improvement were also identified, such as incorporating a video modeling clinic example and accompanying written materials. ConclusionThis evaluation provides a case-study example of how D&I science can be used to design, implement, and evaluate a training package for trainees to spread a promising best practice. Clinicians can consider similar applications of D&I science to enhance training and spread novel services across health systems.

Remote Dielectric Sensing (reds) Use In The Prevention of Heart Failure Rehospitalizations- A Meta-analysis

Introduction Acute decompensated heart failure (ADHF) is a major cause of hospital readmissions despite technological advances and multiple guidelines. Remote dielectric sensing (ReDS) is a non-invasive electromagnetic-based tool that measures absolute lung fluid content. This technology identifies changes in pulmonary pressures before the development of symptoms, hence assists physicians to adjust the medical therapy before clinical worsening. The objective of this meta-analysis is to see the use of Remote Dielectric Sensing (ReDS) in the prevention of heart failure rehospitalizations. Methods Using PubMed, Ovid (MEDLINE), and Cochrane database we searched using the MeSH terms including,” Radar Sensing,” “Remote Dielectric Sensing (ReDS)” Heart failure exacerbations,” Heart failure rehospitalizations,”. The primary outcome was to assess the rate of heart failure rehospitalization with the use of the device. Unadjusted odds ratios were calculated using a random-effect model using RevMan V 5.3. Results Our analysis included a total of 568 patients in the ReDS group and 1167 patients without ReDS. The mean age of the sample was 65.2±12.8 with 66% males and 34% females. We found that patients with ReDS monitoring had lower odds of heart failure rehospitalizations (Odds ratio=0.41; 95% CI=0.31-0.54; p-value Conclusion ReDS monitoring can be beneficial in lowering heart failure rehospitalization by remote monitoring. However, large clinical studies are warranted to further assess its efficacy in reducing hospital readmissions and mortality.

Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia

Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. This cohort study included the electronic health records and administrative claims data of 30 746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). Of 30 746 patients, 15 507 (50.4%) were men, 26 198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.

Improving heart failure transitional care after hospital discharge: A quality improvement project

Background and objective: The burden of heart failure is growing, affecting more than 6 million Americans and an estimated of 26 million worldwide. Heart failure is the most common cause of hospital readmission in the United States and is identified as a marker of poor health outcomes. Thirty day readmission contribute to more than $30 billion dollars in health care expenditures, underscoring a need for the development and implementation of programs that reduce readmission and improve outcomes for individuals with heart failure. The purpose of this quality improvement project was to implement a heart failure education program to increase attendance to a transitional care clinic and reduce 30-day readmissions.Methods: We included 22 individuals who received heart failure education, focused on symptom management and transitional care. Descriptive and statistical analyses were performed to examine attendance to the transitional care clinic and 30-day readmission.Results: There was a statistical significance between individuals attending follow-up at the designated transitional care clinic and 30-day hospital readmission (p ≤ .05). Of the (N = 22) participants, 64% were not readmitted into the hospital 30 days after discharge.Conclusions: The findings of this project demonstrate that a nurse-led evidence-based heart failure education program can improve attendance to transitional care programs and reduce 30-day readmissions. A well-designed plan for transitional care remains a critical component of patient care necessary to address complications and optimize continuity of care after discharge.

Invasive Home Mechanical Ventilation: 10-Year Experience of a Pediatric Home Care Service.

Children dependent on invasive home mechanical ventilation (HMV) represent a growing population worldwide. The objective of this study was to assess the experience of 10 years of medical assistance given to pediatric patients on continuous invasive HMV at a Brazilian Home Care Service (HCS), specifically patient characteristics and predictors of outcome (ie, hospital readmission, death, and location of death). Medical records for children on invasive HMV at the HCS between 2007 and 2016 were evaluated to collect the following data: age at admission to HCS, sex, principal diagnosis, length of hospital admission and home care period, number and cause of hospital readmissions, number of procedures, death and location of death. The odds ratio was used to understand the likelihood of death for each diagnosis, hospital readmission, and admission age, using a binary logistic regression model. Twenty-seven children were evaluated. The most prevalent diagnosis was cerebral palsy (37.0%). The mean duration of home care was higher than the mean hospital length of stay (955.0 ± 4.6 d versus 341.0 ± 0.5 d, respectively). First hospital readmission mean was at 392.6 ± 548.9 d, and the main cause was respiratory tract infection (45.9%), especially tracheitis. Of the total number of deaths (13), 76.9% occurred in hospital units. There was no statistically significant result observed for greater odds of death for any of the diagnoses and admission age on HCS. However, children who had a hospital readmission < 6 months after hospital discharge presented 10% greater chance of death (P = .02). The most prevalent diagnosis of children on continuous invasive HMV was cerebral palsy. The main cause of hospital readmission was respiratory tract infection, especially tracheitis. Having the first hospital readmission at < 6 months after discharge was shown to be a risk factor associated with mortality.

Digital Technologies in Heart Failure Management

Heart failure (HF) is the leading cause of hospital readmission for patients over 65 years old in the United States. HF is a unique clinical condition requiring frequent monitoring of objective patient variables that cannot be accomplished by office visits alone. With the advent of smartphones, Bluetooth, and Wi-Fi technologies, an opportunity arose for the digital management of HF patients. This paper reviews the current digital technologies available in HF management and future directions that have the potential to change clinical practice. Implantable, wireless pulmonary artery hemodynamic monitoring systems, such as CardioMEMS, have shown strong evidence in reducing HF hospitalization. Wearable activity trackers can also be used to track functional status and rhythm abnormalities in HF; however, evidence that these devices improve clinical outcomes in HF is lacking. There is currently promise in non-invasive measurements of pulmonary congestion and cardiovascular hemodynamics using Remote Dieletric Sensing Technologies (ReDS), seismocardiography, and ballistocardiography, but these technologies are not routinely used in clinical practice. Future applications of digital technologies will likely incorporate personalized medicine to improve clinical care. Digital management of HF has emerged as a promising avenue for prevention of HF hospitalization. Although some technologies have shown to improve clinical outcomes, further studies are needed on currently existing technologies to assess their viability as tools in preventing rehospitalization. It is important for the clinician to understand the limitations of digital technologies, as well as their potential to worsen healthcare disparities.

Incidence, Predictors, Causes, and Cost of 30-Day Hospital Readmission in Chronic Obstructive Pulmonary Disease Patients Undergoing Bronchoscopy.

IntroductionChronic obstructive pulmonary disease (COPD) has a significant disease burden and is among the leading causes of hospital readmissions, adding a significant burden on healthcare resources. The association between 30-day readmission in a COPD patient undergoing bronchoscopy and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed, and comparison has been made with COPD patients not undergoing bronchoscopy.MethodsWe conducted a comprehensive analysis of the 2016 Nationwide Readmission Database (NRD) of 30-day all-cause readmission among COPD patients undergoing bronchoscopy. A Cox’s proportional hazards model was used to obtain independent relative risks of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy. Our primary outcome was the 30-day all-cause readmission rate in both groups. Other secondary outcomes of interest were the 10 most common reasons for readmission, resource utilization, independent predictors of readmission, and relative proportion of comorbidities between the index admission (IA) and the readmission in both groups.ResultsThe overall rate of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy was 17.32% and 15.87%, respectively. The final multivariate model in the bronchoscopy group showed that the variables found to be an independent predictor of readmission were: pulmonary hypertension (hazard ratio [HR] 2.35; 95% confidence interval [CI] 1.26-4.25; P < .01), adrenal insufficiency (HR 4.47; 95% CI 1.44-13.85; P = .01) and discharge to rehab status. Independent predictor variables of admission in Group B were gender (women < men; HR 0.91; 95% CI 0.88-0.93; P < .01), and type of insurance (Medicaid > Medicare > private insurance).For all patients undergoing bronchoscopy, the mean length of stay (LOS) for IA was 11.91 ± 20.21 days, and LOS for readmission was 5.87 ± 5.48 days. The mean total cost of IA for patients undergoing bronchoscopy was much higher than that of readmission ($26,916 vs. $12,374, respectively). The entire LOS for readmission was 1,265 days, with a total cost of $2.66 million.For patients not undergoing bronchoscopy during the IA, mean LOS for IA was 4.26 ± 4.27 days, and mean LOS for readmission was 5.39 ± 5.51 days, which was longer than the IA in Group B but still shorter than LOS for readmission in Group A (patients undergoing bronchoscopy). The mean total cost of readmission was higher than the IA ($8,137 for IA vs. $10,893 for readmission). The total LOS in this group of patients was 313,287 days, with the total cost of readmission at $628 million.ConclusionsPatients undergoing bronchoscopy have a slightly higher rate of 30-day readmissions as compared to patients not undergoing bronchoscopy, and the LOS is also slightly higher in this group during subsequent readmissions as compared to readmission in patients not undergoing bronchoscopy in IA. The readmission rate in COPD patients is impacted by a variety of social, personal, and medical factors. Patients with multiple medical comorbidities have a higher risk of readmission. In our understanding, bronchoscopy in a patient with acute exacerbation of COPD should be reserved for selected patients, and the rationale should be clarified, as it affects the overall LOS and healthcare expenditure.