Cause Of Hospital Readmissions Research Articles

Impact of intensifying primary antibiotic prophylaxis in at-home autologous stem cell transplantation program for lymphoma patients

Despite the use of fluoroquinolone (FQ) prophylaxis, neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). We analyzed the impact of intensifying primary prophylaxis with the addition of piperacillin/tazobactam (PT) to FQ. Between January 2002 and August 2018, 154 lymphoma patients conditioned with BEAM were included (40% received ceftriaxone (Ct) plus FQ and 60% PT plus FQ). NF and hospital readmission were required in 84 vs. 41% (p < .0001) and 12 vs. 1% (p = .007) of patients within the Ct and PT groups, respectively. The multivariate analysis showed that PT plus FQ retained its independent protective factor for NF (odds ratio (OR): 0.13; p < .001) and for hospital readmission (OR: 0.07; p = .01). The use of PT and FQ prophylaxis may effectively prevent episodes of NF and hospitalizations in lymphoma patients managed in our at-home ASCT care model.

Association Between Patient-Tailored Case Management Initiative and Outcomes in Subacute Rehabilitation Facilities to Decrease 30-day Hospital Readmissions for Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) will become the 3rd leading cause of death worldwide in 2020 and is currently the 3rd leading cause of hospital readmissions in the US. In October 2014, the Centers for Medicare and Medicaid Services (CMS) introduced penalties followed by bundle payments for care improvement initiates in patients hospitalized with an acute exacerbation of COPD (AECOPD). Fragmented care across settings cause readmissions for COPD. A patient-tailored case management initiative mitigated 30-day hospital readmissions at Sub-Acute Rehabilitation (SAR) centers. Care management and coordination activities represent important strategies for decreasing 30-day hospital readmissions from SARS.

National Landscape of Hospitalizations in Patients with Left Ventricular Assist Device. Insights from the National Readmission Database 2010-2015.

The number of patients with left ventricular assist devices (LVAD) has increased over the years and it is important to identify the etiologies for hospital admission, as well as the costs, length of stay and in-hospital complications in this patient group. Using the National Readmission Database from 2010 to 2015, we identified patients with a history of LVAD placement using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V43.21. We aimed to identify the etiologies for hospital admission, patient characteristics, and in-hospital outcomes. We identified a total of 15,996 patients with an LVAD, the mean age was 58 years and 76% were males. The most common cause of hospital readmission after LVAD was heart failure (HF, 13%), followed by gastrointestinal (GI) bleed (11.8%), device complication (11.5%), and ventricular tachycardia/fibrillation (4.2%). The median length of stay was 6 days (3-11 days) and the median hospital costs was $12,723 USD. The in-hospital mortality was 3.9%, blood transfusion was required in 26.8% of patients, 20.5% had acute kidney injury, 2.8% required hemodialysis, and 6.2% of patients underwent heart transplantation. Interestingly, the most common cause of readmission was the same as the diagnosis for the preceding admission. One in every four LVAD patients experiences a readmission within 30 days of a prior admission, most commonly due to HF and GI bleeding. Interventions to reduce HF readmissions, such as speed optimization, may be one means of improving LVAD outcomes and resource utilization.

Characteristics of diabetes diagnosis and control in toddlers and preschoolers from families with limited resources: A single center experience

AimTo describe the characteristics of diabetes diagnosis, insulin therapy regarding type, dose and frequency also the degree of glycemic control achieved in toddlers and preschoolers coming from families with limited resources. MethodsOver one year, 69 toddlers and preschoolers clinically diagnosed as type 1 diabetes were included. Data related to presentation at diagnosis, insulin therapy and glycemic control was reviewed from patients' care givers and medical records. ResultsDiabetic ketoacidosis (DKA) was recorded in 71% of the children at initial diagnosis. The mean time since diabetes diagnosis was 2 ± 1 years. Most of children (65/69, 94%) were on basal-bolus regimen while four (6%) were on basal insulin only. NPH and long acting analogues were used as basal insulin in (74%) and (26%). Regular insulin and rapid acting analogues were used as bolus insulin (27%) and (73%).The mean frequency of daily self monitoring of blood glucose was (2.9 ± 1). The arithmetic mean of HbA1c done over past 6 months to one year before inclusion in the study was 8.2 ± 1.5% (66 ± 12 mmol/mol) with 65% having HbA1c ≥ 7.5% (≥58 mmol/mol). ConclusionToddlers and preschoolers with diabetes coming from families with limited resources frequently present with DKA at diagnosis and have suboptimal self-monitoring of blood glucose and glycemic control. NPH is more commonly used in this age group, combined with postprandial rapid analogues and less commonly preprandial regular insulin and that yields more favorable HbA1c but with a greater risk of hypoglycemia. The most common cause of hospital readmission was ketoacidosis and uncontrolled hyperglycemia.

Assessment of Pharmacist Intervention Among Post Hospital Discharge Patients with Moderate and Severe Acute Heart Failure

Background: Acute heart failure is the most common cause for hospitalization and the third highest cause of hospital readmission with nearly quarter of patients being re hospitalized within 30 days after discharge. Implementation of Clinical pharmacists in coordinated&#x0D; inpatient care, discharge planning and outpatient care result in significant improvements in adverse drug events reduction, medication adherence, quality of life and patient knowledge.&#x0D; Objective: Evaluating pharmacist- based program for patients with moderate and sever acute heart failure via improving summary discharge in reduction hospital readmission, enhancing medications adherence and improve quality of life.&#x0D; Patients and Methods: This prospective study was carried out under interventional pharmacist- based program carried out on 50 patients whom completed this study, they were randomly allocated to two groups, program group who are receiving program for assessment and review starting from 30 minutes pre hospital discharge till 12 weeks. The control group on usual care which include physician-based discharge summary, routine laboratory test without pharmacist intervention (25 patients for each group).&#x0D; Result: After 12 weeks of follow up among program patients in comparison with control group, study findings revealed significant improvement in self-care heart failure index domains (maintenance, management, confidence and total SCHFI score (P=0.001) in both moderate heart failure (NYHAIII) and severe heart failure (NYHAIV) groups, also increase in domains of belief medication questionnaire whether specific necessity and specific concern domains (P=0.001) or decreased in general harm and general overuse (P=0.001) in both moderate and severe heart failure. Moreover, increase in all domains of WHO quality of life questionnaire (WHOQOL) (P=0.001) in both moderate and sever heart failure with predominant improvement in moderate heart failure. Both serum brain natriuretic peptide (P=0.001) and cardiac troponin I (P&lt;0.01) level were decreased in patients with moderate and severe HF and ejection fraction was improved (P=0.03) only among patients with severe HF of program group.&#x0D; Conclusion: Implementing pharmacist- based management program for patients with moderate and severe acute heart failure via summary discharge markedly improve disease awareness, medication adherence, reduced hospital readmission and total mortality at the end-line of study among intervention patients compared to the usual care.

Hospital readmission following transjugular intrahepatic portosystemic shunt: a 14-year single-center experience.

BackgroundPlacement of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively common procedure used to treat complications of portal hypertension. However, only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital readmission. We therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of readmission.MethodsWe reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients. A series of univariable logistic-regression models were fit to assess potential predictors of 30-day readmission.ResultsA total of 566 patients were included in the analysis. The 30-day readmission rate after TIPS placement was 36%. The most common causes for readmission were confusion (48%), infection (15%), bleeding (11%), and fluid overload (7%). A higher Model for End-Stage Liver Disease (MELD) score corresponded with a higher rate of readmission (odds ratio associated with each 1-unit increase in MELD score: 1.06; 95% confidence interval: 1.02–1.09; P = 0.001). Other potential predictors, including indication for TIPS placement, were not significantly associated with a higher readmission rate.ConclusionsThe 30-day readmission rate after TIPS placement with covered stents is high, with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS placement. Novel interventions to help reduce the TIPS readmission rate should be prioritized in future research.

MEDICAL COMPLICATIONS AND INJURY LEADING TO EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS

Medical injury consistently ranks among the most expensive hospital stay diagnoses and represents a frequent cause of hospital readmission. Although older adults are at greater risk of medical injury, in part, because of greater incidence of comorbidity and increased medical complexity, little is known about the burden of medical injury leading to ED use or the costs and outcomes associated with these events among older adults. In response, this study used nationally representative data from the 2014 Nationwide Emergency Department Survey to examine the epidemiology of older adult ED-visits for medical injury. Principal diagnosis codes were grouped using AHRQ’s Clinical Classification Software to identify medical injury-related visits. Results indicated that in 2014, 506,466 ED-visits for medical injuries occurred, comprising 2% of all older adult ED-visits. Leading causes of medical injury included malfunction of device, implant and grafts (24%); infection and inflammation of internal prosthetic device, implant, and graft (16%), and other complications of surgical and medical procedures (15%). Risk factors for medical injury included being male, Medicaid as primary payor, and number of chronic conditions. Multinominal logistic regression and multivariate regression results indicate that Medical injury-related ED visits were associated with higher hospitalization risk (RRR=2.08, p<0.000), 27% longer hospital stays, and 24% higher total charges relative to non-medical injury related visits. However, medical injury was not associated with risk of death after adjustment. Study findings suggest that ED-visits for medical injury occur frequently among older adults and are associated with significant burden and cost.

Assessment of Pharmacist Intervention Among Post Hospital Discharge Patients with Moderate and Severe Acute Heart Failure

Background: Acute heart failure is the most common cause for hospitalization and the third highest cause of hospital readmission with nearly quarter of patients being re hospitalized within 30 days after discharge. Implementation of Clinical pharmacists in coordinated inpatient care, discharge planning and outpatient care result in significant improvements in adverse drug events reduction, medication adherence, quality of life and patient knowledge. Objective: Evaluating pharmacist- based program for patients with moderate and sever acute heart failure via improving summary discharge in reduction hospital readmission, enhancing medications adherence and improve quality of life. Patients and Methods: This prospective study was carried out under interventional pharmacist- based program carried out on 50 patients whom completed this study, they were randomly allocated to two groups, program group who are receiving program for assessment and review starting from 30 minutes pre hospital discharge till 12 weeks. The control group on usual care which include physician-based discharge summary, routine laboratory test without pharmacist intervention (25 patients for each group). Result: After 12 weeks of follow up among program patients in comparison with control group, study findings revealed significant improvement in self-care heart failure index domains (maintenance, management, confidence and total SCHFI score (P=0.001) in both moderate heart failure (NYHAIII) and severe heart failure (NYHAIV) groups, also increase in domains of belief medication questionnaire whether specific necessity and specific concern domains (P=0.001) or decreased in general harm and general overuse (P=0.001) in both moderate and severe heart failure. Moreover, increase in all domains of WHO quality of life questionnaire (WHOQOL) (P=0.001) in both moderate and sever heart failure with predominant improvement in moderate heart failure. Both serum brain natriuretic peptide (P=0.001) and cardiac troponin I (P&lt;0.01) level were decreased in patients with moderate and severe HF and ejection fraction was improved (P=0.03) only among patients with severe HF of program group. Conclusion: Implementing pharmacist- based management program for patients with moderate and severe acute heart failure via summary discharge markedly improve disease awareness, medication adherence, reduced hospital readmission and total mortality at the end-line of study among intervention patients compared to the usual care.

Role of Post-Acute Care in Readmissions for Preexisting Healthcare-Associated Infections.

Although preventable, healthcare-associated infections (HAIs) are commonly observed in post-acute care settings for at-risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post-acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. We used 2013-2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections). A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older. Our outcome was a 30-day preexisting, or "linked," HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care ("home"). Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = -1.29 to -1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity. SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370-378, 2020.

CHF Order Set Improves Time to Hospital Readmission

Introduction Congestive heart failure (CHF) is the leading cause of hospital readmission, with rates approaching 20% within 30-days and 50% within 6-months. Readmissions account for 43% of Medicare spending at 17 billion dollars yearly. A study by Krive et al in 2014 proved admission order sets were effective, efficient, and decreased inpatient CHF mortality (1.8% vs. 3.2% p=0.034). However, qualitative evidence of the effectiveness of order sets in readmission reduction is lacking. Hypothesis We hypothesized that the consistent use of a protocolized admission CHF Order Sets versus manual order entry will serve to increase time to 30-day readmission for Medicare patients admitted having a primary diagnosis of CHF. Methods A retrospective analysis of CHF patients was performed at WVU from 1/1/16-1/1/18. Readmissions were compared between CHF Order Set and manual order entry groups using Pearson chi-squared and Fishers exact tests. Mann Whitney U Tests were applied to the data due to unbalanced (non-normal distribution) among cohorts. Results The Cardiology service had the highest compliance in use of the order set at 26% with other services averaging less than 7%. The admission CHF Order Set increased the mean number of days to 30-day readmission compared to the manual entry group (12.22 vs. 15.76 days p=0.027). Cardiology providers utilized the order set more frequently for patients with a higher 2017 American Medical College Mortality Risk Score. Conclusions Protocolized admission CHF order sets improves time to hospital readmission. Based on AMC Mortality Risk Score, the CHF order set was proven to be most useful with sicker patients. Limitations faced in this study were limited compliance of order set use and sample size of 1657 between cohorts. Moving forward, there is a need for a mandatory push for order set use and additional analysis to further critique its components based on admission rates and clinician feedback. With decreased Medicare expenditures, millions in admission costs may be saved each year in addition to decreases in hospital-acquired infections and complications.

Effectiveness of Short Term Home-Based Care for Long Term Prevention of Heart Failure Hospitalizations of High Risk Patients

Introduction Heart failure is the number one cause of hospital readmissions among Veteran Affairs (VA) patients. We implemented a home-based RN/LPN team to high risk patients who provided short-term, intensive CHF case management in collaboration with a cardiologist. Hypothesis Decline in the number of ER visits, inpatient days and 30-day readmission rates with patients who follow in the home-based HF program when compared six months pre-program, and during and after enrollment. Methods This retrospective study done at the Indianapolis VA Medical Center had 108 CHF patients enrolled in the home-based CHF program from May 2016-September 2017. Data was retrieved from national VA databases as well as the electronic medical record. We compared patients’ acute care utilization six months prior to the program, during the program, six, and twelve months post-program discharge using chi squared test. Results The 30-day readmission rate of the 108 patients closely followed by the care team (average 57 days) was only 7%. This contributed to a significant decrease in readmission overall (7%) compared to prior to initiation of the program (500 HF patients admitted in 2016 with 21% readmission rate, p Conclusions Short-term, intensive home-based teams for high-risk veterans with CHF can reduce ER visits, admissions, 30-day readmissions, and the number of inpatient days and be highly cost-effective. This home-based care model showed significant effect persisting after the formal program/intervention ended, as there was a continued sizable reduction in total inpatient days at six and twelve months post-program discharge.

Health Related Quality of Life a Predictor of 30 Day Hospital Readmission among Heart Failure Patients

Background Heart failure (HF) is the leading cause of hospital readmission among patients, age 65 years and older with the prevalence increasing 46% from 2012 to 2030, resulting in more than 8 million Americans affected. As defined by Healthy People 2020, health related quality of life measures, the way in which HF diagnosis could affect the physical, emotional, mental and social dimensions of the patient's life. Quality of life refers to patients subjective perceptions of the effect of HF on their activity of daily living. Overall quality of life is subjective and individualized. Research is limited regarding the prediction of 30 day hospital readmissions and the use of self-reporting tools among Heart failure (HF). It is important to understand the variables associated with health- related quality of life (HRQOL). Purpose The purpose of this project was to examine the relationship between self-reported Health related quality of life (HRQOL) to 30 day hospital re-admission rates among patients with HF as measured by the Minnesota Living with heart failure questionnaire (MLHQ). The independent variables in this study is quality of life; the dependent variable is 30-day hospital readmission rate. Research Question What is the relationship between health related quality of life to 30 day hospital readmission rates among patients with diagnosis of heart failure? Hypothesis There will be a positive correlation between increase in health related quality of life challenges as measured by the Minnesota Living with heart failure questionnaire (MLHQ) and 30 day hospital readmissions. Methods A quantitative, descriptive co-relational research design (n=66) was used to examine the correlation between the predictor variable, Health related quality of life, to 30-day hospital readmission rates among patients with HF. The Minnesota Living with Heart failure questionnaire (MLHFQ) was utilized as a self- reporting tool to assess quality of life scores. IRB was obtained from the institution of study, participants who volunteered to participate in the study and met the eligibility criteria were consented and requested to complete the MLHFQ as a self - reported tool. Results A total of seventy participants were recruited to the study, of which four participants were excluded due to mortality, lack of contactable phone number or having opted for palliative care. An independent sample t-test done to test for relationship between health quality of life and readmission was significant (p Conclusions The results of this study provide Health care providers information about predictors of readmissions among participants diagnosed with HF.

Interventions to address medication-related causes of hospital readmissions: A scoping review

Unplanned readmissions pose a tremendous burden on patients, providers, and payers. A significant proportion of readmissions are medication-related. Despite the availability of literature regarding hospital-level strategies to reduce readmissions, little has been written about strategies aimed at medication-related readmissions. We sought to identify successful readmission reduction strategies by performing a scoping literature review of research published between 2000 and 2017. We identified 21 studies that met our inclusion criteria. From these studies, we identified 7 components frequently employed as a part of interventions to reduce medication-related readmissions: discharge planning, discharge education, post-discharge telephone calls, the use of a professional coordinator with clinical training to administer the intervention, patient education efforts, provider training efforts, and medication reconciliation. Thirty-eight percent of all the interventions identified were associated with a statistically significant reduction in readmissions. Of the 7 common intervention components we identified, none were consistently associated with intervention success in the full sample. However, interventions implemented by inpatient hospitals, in particular academic medical centers, had a higher success rate than interventions implemented by other providers. We examined a subsample of larger studies and found that discharge planning and medication reconciliation components were included in most of the successful interventions. Future research should look beyond simply identifying components included in an intervention and should instead seek to identify contextual factors that enable or inhibit the success of these components. Research examining discharge planning and medication reconciliation efforts will be particularly important.

Digoxin Use and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction

BackgroundHeart failure is a leading cause for hospital readmission. Digoxin use may lower this risk in patients with heart failure with reduced ejection fraction (HFrEF), but data on contemporary patients receiving other evidence-based therapies are lacking. MethodsOf the 11,900 patients with HFrEF (ejection fraction ≤45%) in Medicare-linked OPTIMIZE-HF, 8401 were not on digoxin, of whom 1571 received discharge prescriptions for digoxin. We matched 1531 of these patients with 1531 not receiving digoxin by propensity scores for digoxin use. The matched cohort (n = 3062; mean age, 76 years; 44% women; 14% African American) was balanced on 52 baseline characteristics. We assembled a second matched cohort of 2850 patients after excluding those with estimated glomerular filtration rate <15 mL/min/1.73 m2 and heart rate <60 beats/min. Hazard ratios (HRs) and 95% confidence intervals (CIs) for digoxin-associated outcomes were estimated in the matched cohorts. ResultsAmong the 3062 matched patients, digoxin use was associated with a significantly lower risk of heart failure readmission at 30 days (HR, 0.74; 95% CI, 0.59-0.93), 1 year (HR, 0.81; 95% CI, 0.72-0.92), and 6 years (HR, 0.90; 95% CI 0.81-0.99). The association with all-cause readmission was significant at 1 and 6 years but not 30 days. There was no association with mortality. Similar associations were observed among the 2850 matched patients without bradycardia or renal insufficiency. ConclusionsAmong hospitalized older patients with HFrEF receiving contemporary treatments for heart failure, digoxin use is associated with a lower risk of hospital readmission but not all-cause mortality.

Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates.

Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min·m2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of hospital readmissions in the United States. The quality of care delivered to patients with COPD is known to be lacking across the care continuum, and may contribute to high rates of readmission. As part of the response to these issues, the Centers for Medicare and Medicaid instituted a penalty for 30-day readmissions as part of their Hospital Readmission Reduction Program in October 2014. At the time the penalty was instated, there was little published evidence on effective hospital-based programs to reduce readmissions after acute exacerbations of COPD. Even now, several years later, few published programs exist, and we continue to lack consistent approaches that lead to improved readmission rates. In addition, there was concern that the penalty would widen health disparities. Despite the dearth of published evidence to reduce readmissions beyond available COPD guidelines, many hospitals across the United States began to develop and implement programs, based on little evidence, due to the financial penalty. We, therefore, assembled a diverse group of clinicians, researchers, payers, and program leaders from across the country to present and discuss approaches that had the greatest potential for success. We drew on expertise from ongoing readmission reduction programs, implementation methodologies, and stakeholder perspectives to develop this Workshop Report on current best practices and models for addressing COPD hospital readmissions.

Primary Prophylaxis with Piperacillin/Tazobactam in Lymphoma Patients Managed at Home after Autologous Stem Cell Transplantation

Background: Neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). Methods: Analyze the impact of intensifying primary antibiotic prophylaxis with piperacillin/tazobactam (PT) in the incidence of NF and in the need for hospital readmission in a home care ASCT model. Between January 2002 and June 2017, 143 consecutive lymphoma patients, conditioned with BEAM, were managed at home since +1day of ASCT. Sixty-one patients (42*7%) received prophylactic ceftriaxone (Ct) and 82 (57*3%) PT. Due to the presence of differences in the baseline characteristics, we performed a propensity score matching. The final study population was 86 patients (43 in each group). Findings: NF occurred in 39*5% of patients in the prophylactic PT group compared with 86% in Ct group (P<0*0001). Blood culture positive was documented in 11*8% and 18*9% febrile episodes in the PT and Ct group, respectively; being coagulase-negative Staphylococcus the most frequently isolated bacteria in Ct group. In the multivariate analysis, PT retained its independent protective factor for NF (OR 0*11; P<0*001). Hospital readmission was required in 6 (14%) patients in the Ct group and 1 (2*3%) patient in the PT group (P=0*1). In the multivariate analysis, only PT retained its independent protective factor for hospital readmission (OR 0*11; P=0*05). Interpretation: This study suggests that in at home ASCT, the use of PT prophylaxis significantly reduces the incidence of NF in lymphoma patients. Funding: The authors do not have any funding sources. Declaration of Interest: The authors declare no disclosures. Ethical Approval: The Ethics Committee of the Hospital Clinic of Barcelona approved the study and was in accordance with the Declaration of Helsinki. All patients signed a written informed consent.

The metabolic model of heart failure: the role of sodium glucose co-transporter-2 (SGLT-2) inhibition.

Heart failure (HF) is one of the leading causes of hospital readmissions and health care expenditures. With a vast degree of advancements in the clinical approach and diagnosis, its management protocol is limited in terms of enhancing quality of life and prognosis. Type 2 diabetes mellitus (T2DM) is considered as one of the commonly associated comorbid conditions in the HF population. The understanding of the molecular and metabolic models of HF has led to the utilization of therapeutic goals of T2DM in improving HF-related complications. In the recent era, SGLT-2 inhibitors have shown success in decreasing cardiovascular mortality in the T2DM population. This article will help the reviewer to comprehend the pathophysiology of HF and the potential role of SGLT-2 inhibitors in the management algorithm of HF and its associated risk factors in T2DM.

Patient's self- reported functional status and health related quality of life: prognostic predictors for 30-day hospital readmission among heart failure patients

Purpose The purpose of this project was to examine the relationship between self-reported functional status as measured by the New York Heart Failure Association (NYHA) functional classification and health related quality of life (HRQOL) to 30-day hospital readmission rates among patients with Heart Failure (HF). Research question What is the relationship between self-reported functional status and health related quality of life to30-day hospital readmission rates among patients with diagnosis of heart failure? Background Heart failure is the leading cause of hospital readmission among patients, age 65 years and older (Mozzafarian, 2016). An estimated increase of 46% from 2012 to 2030 will result in eight million Americans affected with the disease (CDC, 2016). The increasing number of patients affected by HF is alarming. Various quality improvement projects identified by The Joint Commission (TJC) including discharge planning instructions, arranging transition of care at discharge, measuring left ventricular function, seven day follow-up appointment, and evidence based prescription of medications have been implemented (TJC, 2016). Yet the efforts of this nature have not been associated with lower readmission rates (Bonow et al., 2012; Joynt and Jha, 2013a; Glass, Lisk and Stensland, 2012). The efforts to reduce the preventable hospital readmission rates among this population is a prominent target for change since finding strategies to reduce readmissions would reduce cost and improve patient outcomes. Design and methods A quantitative, descriptive correlational research design (n=66) was used to examine the correlation between the predictor variables, functional status and quality of life, to 30-day hospital readmission rates among patients with HF. The data was collected between November 2017 and January 2018. Institutional Board Review (IRB) approval was obtained from participating study site prior to data collection. Findings The computed chi-square p-value to test the relationship between NYHA functional status classification and 30-day readmission was .044, which is under the required 2 with p Implications The results of this study provide health care providers information about predictors of readmissions among participants diagnosed with HF.

Combining pharmacy expertise with asthma educator certification: assessing the impact on inner-city asthma patients

Objective: Asthma is one of the major causes of hospital readmissions in the South Bronx. The goal of this study was to assess the impact of asthma education provided by registered pharmacists with asthma educator certification (AE-C), on medication adherence and hospitalizations/Emergency Department (ED) visits. Methods: This was a retrospective chart review of patients seen in the pulmonary clinic from October 2014 to August 2015 for asthma education by AE-C pharmacists. Medical records were reviewed over an 18-month period – 9 months before and after the initial asthma education session. Data obtained included adherence to asthma controller inhalers based on pharmacy refill claims, asthma control using asthma control test (ACT) scores and asthma-related hospitalizations or ED visits within 30 days of asthma education. Pre-education data served as the pre-intervention group data and post-education data served as the post-intervention group data, allowing each patient to serve as their own control. Results: We found a statistically significant improvement in average medication adherence, i.e. asthma controller inhaler fills at pharmacy (46.3% vs 67.9%, p-value <0.001) and asthma control (15.71% vs 56.38%, p-value <0.001) between the pre-intervention and the post-intervention groups. Additionally, a lower hospitalization/ED utilization rate (31.2% vs 6.38%, p-value <0.001) was observed in the post-intervention group within 30 days of education. Conclusions: Asthma education provided by AE-C pharmacists had a positive impact on asthma care in our inner-city community. Improving medication adherence and asthma control as well as decreasing hospital utilization could potentially decrease health care costs in addition to improving quality of life.