Hospital Readmission Rates Research Articles

Linking American Spine Registry (ASR) and Medicare Data:an analysis of 8,755 Lumbar Fusion Cases.

Retrospective observational study. To evaluate whether the combined American Spine Registry and Medicare (ASR/CMS) data yields substantially different findings versus ASR data alone with regard to key parameters such as risk stratification, complication rates and readmission rates in lumbar surgery investigated through an analysis of 8,755 spondylolisthesis cases. Medicare data correlation has been effective for determining revision rates for other procedures such as total hip replacement. Our aim is to determine whether these findings are translatable in the realm of lumbar spinal surgery investigated through an analysis of 8,755 spondylolisthesis cases. The American Spine Registry (ASR) was queried for Medicare-eligible patients who underwent lumbar spinal fusion for lumbar spondylolisthesis. This cohort was analyzed based upon ASR data alone in comparison to the same patients in the combined ASR/Medicare (ASR/CMS) dataset. The primary outcome of interest was readmission at 30 and 90 days postoperatively. There were 8,755 Medicare-eligible cases with a diagnosis of spondylolisthesis within the ASR. The mean age was 72.7 years, 60.8% were female. Medical comorbidities were more frequently detected in the combined ASR/CMS dataset, reflected by a higher mean Charlson Comorbidity Index score (3.49 vs. 3.27, P<0.001). Hospital readmission rates were significantly higher in the combined ASR/CMS dataset at both 30 days (4.89% vs. 1.83%, P<0.001) and 90 days (7.68% vs. 2.66%, P<0.001), with notable increases in readmissions for infections and medical complications. Discharge disposition remained comparable across datasets, with most patients discharged to home or home health care. This study demonstrates that integrating patient-identified Medicare data with the ASR provides a more comprehensive assessment of outcomes for lumbar spinal fusion surgery as demonstrated through an analysis of 8,755 spondylolisthesis cases. These findings, establish the importance of multi-source data linkage to overcome the limitations of single-source registries, thereby enhancing data quality for clinical decision-making and quality improvement in spinal surgery.

Robotic Systems in Spinal Surgery: A Review of Accuracy, Radiation Exposure, Hospital Readmission Rate, Cost, and Adverse Events.

Recent advances within the last decade have allowed robotics to become commonplace in the operating room. In the field of neurosurgery, robotics assist surgeons in pedicle screw placement and vertebral fusion procedures. The purpose of this review is to look at currently used spinal robots available on the market and compare their overall accuracy, cost, radiation exposure, general adverse events, and hospital readmission rates. The authors searched databases including PubMed and Google Scholar for studies on robotic spine surgery using robotic systems: Mazor X/Mazor Renaissance, Cirq, ExcelsiusGPS, and ROSA ONE Spine. The literature was examined for robot accuracy, hospital readmission rates, adverse events, radiation exposure, and cost of the robots. In general, many studies recognize that robot assisted spinal surgery is of equal or greater accuracy compared to freehand surgical techniques. Limited and conflicting data exists regarding radiation exposure and overall adverse events. The upfront cost of robotic spine-based surgery tends to be more than freehand, but minimal data evaluates the cost-effectiveness among robotic systems. This review summarizes the findings comparing the individual robotic systems and their comparison to freehand surgery. As robotics become more popular in clinical practice, additional research is needed to assist hospitals and surgeons in making an informed decision about implementing robotics in spinal surgery.

Advancing Healthcare Management and Patient Outcomes through Business Analytics: A Strategic Approach

Business analytics has started to find its way into the healthcare industry. It has proven to transform the sector by effectively using data in decision-making, enhancing patient experience, and increasing efficiency. This paper explores the use of analytics tools in clinical and administrative areas of focus, including hospital readmission rates, emergency department wait times, and cost savings. A qualitative survey of healthcare professionals complemented a quantitative approach to performance measurement to evaluate the impact of predictive, descriptive, and prescriptive analytics. The results show that readmission rates are down by 38.9%, and the average wait time in emergency departments is down by 25.6%. Logistics, workforce, and inventory showed a cost reduction, proving that adopting analytics was cost-effective. However, some concerns included workforce resistance, data integration issues, and data privacy and fairness issues. In order to overcome the challenges highlighted in the study, the following solutions are suggested: workforce training, improvement of IT facilities, and data governance policies. These measures will help to avoid complications in the adoption and achieve fair utilization of analytics tools. The paper establishes that analytics promises to revolutionize healthcare management, especially when deployed in convergence with other disruptive technologies such as Artificial Intelligence. Subsequent studies must examine the ramifications of analytics on healthcare systems in the international sphere and their role in meeting emerging concerns such as population aging and health emergencies. Consequently, this research highlights business analytics as the key tool that furthers patient care objectives and business sustainability in the hospital.

Implementation of a Faith Community Nursing Transition of Care Program in the USA: A Propensity Score Matching Analysis.

Faith community nursing (FCN) is a specialty nursing practice that integrates spiritual and religious practices into patient care. This study aimed to quantitatively assess the impact of the standardized FCN transition of care (TOC) program on the rate of hospital readmission and length of stay (LOS) through propensity score matching and difference-in-differences methods. Compared with those in the non-FCN group (n = 409), patients in the FCN group (n = 66) had a reduced likelihood of hospital readmission at 30, 90, and 180days after discharge (by 8.8%, 9.0%, and 9.5%, respectively). Additionally, the FCN group exhibited a shorter LOS by 0.31, 0.53, and 0.87days at 30, 90, and 180days, respectively. The present study thus demonstrated the successful implementation of the FCN TOC program in a hospital setting, which reduced both the hospital readmission rate and LOS after discharge.

Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

BackgroundThe current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode.MethodsWe conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome.ResultsBetween January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP.ConclusionOur analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.

Survivorship and Outcomes of Hip Arthroplasty for Elective Care Versus Fracture in Patients Who Have Solid Organ Transplant: Lung Transplant Patients Do Worse.

With continued improvement in patient outcomes following solid organ transplant (SOT), more SOT recipients may benefit from hip arthroplasty. This study sought to compare the perioperative complications and survivorship of SOT recipients undergoing hip arthroplasty for elective care versus for fracture. A single-institution retrospective review yielded 95 hip arthroplasty procedures (80 patients) performed between August 2016 and May 2023 with a mean follow-up of 35 months. The most common SOT was liver (47%), followed by kidney (31%) and lung (23%). Cases with an elective indication (69 hips) were compared to those with traumatic indications (26 hips). Perioperative complications and patient survivorship were compared between groups and by transplant type. Patient mortality at one year was 19.2% for the fracture group compared to 1.4% for the elective group (P = 0.006). For elective care, lung transplant recipients had a higher incidence of postoperative mortality at final follow-up (27%) when compared to the liver (7%) and renal (0%) (P = 0.044). Hospital length of stay was less in the elective group (2.7 ± 3.1 versus 16.3 ± 21.2 days, P = 0.002), and more elective patients were discharged to home (85 versus 42%, P < 0.001), but there was no difference in the rate of 90-day hospital readmission (P = 0.91) or orthopaedic complication (13 versus 12%, P = 1.0). For fracture care, a preoperative surgical delay greater than 48 hours was more frequently observed for lung compared to liver transplant recipients (83 versus 13%, P = 0.010). Recipients of SOT undergoing hip arthroplasty for fracture experience longer hospitalizations and increased 1-year mortality compared to elective cases with a similar rate of orthopaedic complications and hospital readmissions. When evaluating by SOT type, lung transplant patients may have increased surgical delays for fracture care and postoperative mortality for elective care.

Enhancing Healthcare Efficiency at Almasara Hospital: Distributed Data Analysis and Patient Risk Management

This study presents a distributed system using RAY, K-means clustering, and Weka software to analyze clinical data from Almasara Hospital Group in Tripoli, Libya. The goal is to reduce patient risk and healthcare costs by providing daily feedback to hospital staff. The system utilizes a dataset containing information on 560 patients, including details like patient ID, gender, doctor ID, test IDs, medication, and a binary target variable. By implementing K-means clustering in Weka, the system categorizes patients and identifies patterns to reduce risks and costs for healthcare analytics. The study first reviews existing patient care and feedback practices and then details the implementation of the daily feedback system, which involves advanced data analysis for managing patient feedback and medical data continuously. The use of K-means clustering helps segment patient data, pinpointing specific risk factors and areas for improvement. Weka software aids in the in-depth analysis of these segments, leading to actionable insights. Results show significant improvements in patient outcomes, reduced hospital-acquired infections, and medication errors, and enhanced patient satisfaction scores. Moreover, the study notes a substantial decrease in overall healthcare costs due to more efficient resource allocation and lower hospital readmission rates. This integration of daily feedback with advanced data analysis tools like K-means and Weka emerges as an effective strategy for improving patient safety and operational efficiency in healthcare settings, demonstrating the value of data-driven decision-making and providing a scalable model for other hospitals aiming to enhance patient care and cost management.

A 5-Year Review of Characteristics and Outcomes of Trauma Surgery Patients Leaving Against Medical Advice.

The objective of this study was to characterize the demographic, social, economic, and clinical factors of trauma surgery patients leaving against medical advice (AMA). Data were retroactively obtained from a level-one trauma center in a medium-sized metropolitan area from January 2017 to December 2021. The sample population consisted of patients admitted or treated by the trauma surgical service. In the 5-year study period, 130 surgical patients left AMA and met the inclusion criteria for this study. The average patient was 38.8 years old. The majority were male (77.7%) and White (47.7%). It was found that 74.6% of patients had insurance, 23.6% were experiencing homelessness, and 6.2% required an interpreter. A large percentage of patients had a past medical history significant for depression (31.5%), anxiety disorders (25.4%), and substance use disorder (68.5%). Analysis of the hospital time course of this patient population indicated that patients were most often admitted to trauma surgery (70.0%) and most often required consults by neurosurgery (28.5%). Procedures were performed for 81.5% of patients and social services were consulted for 60.8% of patients. Only 50.8% of patients who left AMA were noted to receive discharge instructions. Nearly half (44.6%) of the patients returned to a hospital to receive additional care within 1 month of their initial AMA discharge date. A concerning number of trauma surgery patients left without discharge instructions, possibly leading to a high rate of 30-day hospital readmission. Future studies are needed to examine and further characterize the relationship between discharge protocol and outcomes of patients leaving AMA.

Identifying specific subgroups of older patients at risk of repeated hospital readmissions and death after discharge in a prospective multicentre cohort in France

ObjectiveTo identify specific subgroups of older patients at risk of repeated hospital readmissions and death.DesignProspective, multicentre, DAMAGE (Patient Outcomes After Hospitalization in Acute Geriatric Unit) cohort of adults aged 75...

Home intravenous diuretic administration for heart failure management: A scoping review.

Heart failure (HF) significantly impacts healthcare systems due to high rates of hospital bed utilization and readmission rates. Chronic HF often leads to frequent hospitalizations due to recurrent exacerbations and a decline in patient health status. Intravenous (IV) diuretic administration is essential for treating worsening HF. Emerging strategies include home-based IV diuretic therapy administration; however, limited practical implementation guidance is available. This scoping review aims to summarize the literature on home IV diuretic administration for HF patients, focusing on the interventions' characteristics, and facilitators and barriers to its implementation. This review followed the scoping review framework proposed by Arksey and O'Malley and PRIMSA-ScR. A comprehensive search was conducted across six databases (CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsychINFO and Scopus) and grey literature to identify English studies from inception to April 13, 2024. Two independent reviewers screened articles and resources for inclusion and data was extracted using a form created by the authors in Covidence. The search yielded 2,049 results, with nine studies meeting the inclusion criteria. Studies varied in design, including feasibility, pilot, observational, and pre/post-intervention evaluations. The majority were conducted in European countries, with sample sizes ranging from 12 to 96 patients receiving home IV diuretics for HF. Key implementation challenges include appropriate patient selection, IV cannulation competency of healthcare providers, and multi-disciplinary and multi-agency collaboration. Evidence on home IV diuretic administration practices for HF management remains limited. However, this scoping review suggests that commonalities across studies could form the basis for developing standard protocols in outpatient settings. Despite the lack of formal evidence-based guidelines, the findings also suggest that tailored, community-specific approaches and safe infusion guidance documents could enhance the efficacy and scalability of home IV diuretic therapy. Future research should focus on refining these strategies and exploring diuretic escalation methods beyond traditional acute care administration to optimize patient outcomes.

Health and economic evaluation of herbal medicines for heart failure: A population-based cohort study.

Heart failure (HF) represents an advanced stage of various cardiovascular disorders, with its elevated admission rates and resultant health economic burden posing an ongoing global concern. To evaluate the health and economic benefits of herbal medicine (HM) for patients with HF. Population-based cohort study. A five-year retrospective cohort study was carried out at a nationally recognized hospital in China. The study utilized propensity score matching (PSM) to match patients with HF. Chi-square tests were used to analyze dichotomous variables, and t-tests were employed for continuous variables. Logistic regression was used to examine hospital readmission rates, while multiple linear regression was utilized to evaluate direct medical costs. Statistical significance was set at p < 0.05. After implementing PSM, 1924 HF patients were included in the analysis. The study identified two significant risk factors affecting the readmission rates: age over 65 years (adjusted odds ratio (OR) = 1.25, 95 % confidence interval (CI) [1.02, 1.53]) and smoking (adjusted OR = 1.31, 95 % CI [1.01, 1.70]). Additionally, patients who received adjunctive HM treatment exhibited a significantly lower readmission rate compared to those without HM treatment (adjusted OR = 0.76, 95 % CI [0.64, 0.92]). Furthermore, the use of HM during patient hospitalization did not significantly impact direct medical expenses but instead provided positive health economic benefits (incremental cost-effectiveness ratio (ICER) = 98.52). Factors influencing direct routine medical costs included over 65 years of age (Coef = 60.78, 95 % CI [36.25, 85.31]), and cardiac function classification (New York Heart Association (NYHA) III: Coef = 1979.92, 95 % CI [1401.82, 2558.03]; NYHA IV: Coef = 6052.48, 95 % CI [5166.59, 6938.38]). The integration of HM in patients with HF reduced readmission rates without a notable increase in direct medical costs, and the expense of HM remains an economically range indicating positive health economic outcomes.

Predictive value of geriatric nutritional risk indexes for hospital readmission and mortality in older patients

The Geriatric Nutritional Risk Index (GNRI) plays a crucial role in assessing nutritional status and predicting clinical outcomes in older patients. This study explores the GNRI as a prognostic tool for clinical outcomes in older inpatients. Spanning from August 2013 to December 2020, the research involved 573 older patients at Tianjin Third Central Hospital, China. The study assessed the association of GNRI with 6-month hospital readmission and 3-year all-cause mortality rates. Our findings reveal that higher GNRI scores significantly correlate with reduced hospital readmissions and mortality, underscoring the utility of GNRI in predicting clinical outcomes and guiding interventions in geriatric care. The study highlights the potential of integrating GNRI assessments into routine clinical evaluations to enhance patient care and optimize resource utilization in healthcare settings.

TECHNOLOGY TRANSFER IN HEALTHCARE: LEVERAGING PREDICTIVE MODELS TO OPTIMIZE MEDICAL OUTCOMES

Objective: This study aims to apply a predictive model using a decision tree algorithm on real patient data to identify patterns related to hospital readmission rates, contributing to improved clinical decision-making and advancing technology transfer in healthcare. Theoretical Framework: Grounded in predictive analytics and healthcare management, the study leverages the decision tree algorithm's ability to provide interpretable outputs, enabling healthcare professionals to make informed decisions based on data-driven insights. Method: Real patient data was used to construct a decision tree model. The algorithm was trained to identify factors associated with clinical resubmission rates. Performance measures, such as accuracy, precision, and recall, were applied to validate the model's robustness and predictive capabilities. Results and Discussion: The decision tree successfully identified critical predictors of hospital readmissions, including patient characteristics and clinical factors. The model demonstrated high predictive accuracy, providing actionable insights for stratifying at-risk patients. These findings underline the model’s practical utility in supporting evidence-based interventions. Research Implications: For clinical practice, the model facilitates targeted care and resource allocation, reducing readmission rates. For healthcare management, it demonstrates the potential of technology transfer to integrate predictive models into routine workflows, enhancing efficiency and outcomes. Originality/Value: This study contributes to the growing body of research on predictive analytics in healthcare by showcasing the application of a decision tree model in real-world scenarios. Its emphasis on technology transfer highlights its practical significance, bridging the gap between research and implementation in clinical settings.

INFLUENCE OF WEARABLE HEALTH TECHNOLOGY ON PREVENTIVE HEALTHCARE IN HOSPITALIZED PATIENTS

Background: Wearable health technology has revolutionized modern healthcare by enabling real-time monitoring and proactive interventions. These devices are increasingly used in various healthcare settings to improve outcomes such as activity levels, sleep quality, and hospital readmission rates. However, there is limited evidence regarding their effectiveness in hospitalized patients, a population with unique and intensive healthcare needs. This study aimed to evaluate the impact of wearable technology in enhancing preventive healthcare outcomes among hospitalized individuals. Objective; To assess the effectiveness of wearable health technology in improving activity levels, sleep quality, and reducing hospital readmissions among hospitalized patients across three distinct groups: chronic illness, post-surgical, and rehabilitation. Methods: This six-month study (December 2023 to May 2024) was conducted in four tertiary care hospitals in Punjab, Pakistan, using a mixed-methods approach. A total of 300 participants were purposively recruited and divided into chronic illness (n=120), post-surgical (n=100), and rehabilitation (n=80) groups. Wearable devices monitored key health indicators, including activity levels, sleep quality, and readmission rates. Quantitative data were collected through wearable device metrics and hospital records, while qualitative data were gathered via interviews with patients and healthcare providers. Statistical analysis was performed using descriptive and inferential methods, with thematic analysis employed for qualitative data. Results: Among the chronic illness group, 78% reported improved activity levels, 72% better sleep quality, and 69.6% fewer hospital readmissions. The post-surgical group showed similar improvements, with 70% reporting enhanced activity levels, 68% better sleep quality, and 62% reduced readmissions. The rehabilitation group demonstrated slightly lower outcomes, with 60% improving activity levels, 57.6% reporting better sleep, and 52.8% fewer readmissions. Across all groups, females (68%-70%) and patients aged 31-50 years (43%-49%) showed higher engagement and improved outcomes compared to males and older age groups. Conclusion: Wearable health technology demonstrated significant potential in enhancing preventive healthcare outcomes among hospitalized patients. Improvements in activity levels, sleep quality, and reduced readmissions were most pronounced in the chronic illness group. However, adherence challenges and data privacy concerns highlight the need for patient-centered designs and robust privacy frameworks. These findings emphasize the utility of wearable devices in optimizing hospital care, supporting the broader integration of technology into healthcare systems.

At-Home Care Program for Acute Myeloid Leukemia Induction Phase in Patients Treated with Venetoclax-Based Low-Intensity Regimens.

Background: Even though venetoclax in combination with azacitidine (VenAza) is considered a low-intensity regimen, its patients present a high incidence of cytopenia and infections during the first courses, making the initial management a challenging phase. Methods: This difficulty in our center led to the establishment of an At-Home (AH) program for ramp-up and follow-up patients during the VenAza combination induction phase focused on therapy administration, patient and caregiver education, and management of adverse events (AEs). A total of 70 patients with newly diagnosed acute myeloid leukemia (ND-AML) or relapsed/refractory AML (R/R AML) were treated with VenAza from March 2019 to May 2022. We compared outcomes between patients managed with a hospital-based (inpatient) approach and those managed through the AH program. Results: Despite most patients experiencing grade 3-4 cytopenias (96.9%), the incidence of serious infections and other AEs was comparable between both groups, with no significant difference in febrile neutropenia (42.3% vs. 27.8%, p = 0.38). Overall, the AH cohort demonstrated a significantly lower hospital readmission rate after ramp-up (29.5% vs. 84.6%, p = 0.001). Moreover, the inpatient cohort's admission days were longer than in the AH cohort (13 vs. 8, p = 0.28). Conclusions: AH management was feasible and safe, leading to better resource use, enhanced patient comfort, and improved treatment compliance. The potential of AH programs for managing low-intensity chemotherapy regimens can reduce hospital admissions and subsequently improve patient and caregiver well-being.

Safety and Efficacy of Initiating Parenteral Nutrition at Home, Home Start PN, in Advanced Peritoneal Metastasis.

Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis. Health records of advanced cancer patients receiving TPN during 2009-2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher's exact and Kruskal-Wallis tests were used to analyze the data. Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13; p = 0.95), baseline body weight (p = 0.13), baseline albumin (p = 0.26) or pre-albumin (p = 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%, p = 0.1), stable/increased pre-albumin (68% vs. 65%, p = 1), and stable/increased albumin levels (48% vs. 59%, p = 0.58). There was no difference in observed readmission between the groups (p = 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet. This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital.

Exercise in primary care after robot-assisted radical cystectomy for urinary bladder cancer - effects on postoperative complications: a secondary analysis of a randomised controlled trial.

An exercise programme in primary care soon after radical cystectomy for urinary bladder cancer was previously evaluated regarding its effects on physical function. A secondary aim, presented herein, was to evaluate the programme in terms of its effect on postoperative complications. Patients who were planned for robot-assisted radical cystectomy for urinary bladder cancer at Karolinska University Hospital between September 2019 and October 2022 were invited to participate. At discharge from hospital, they were randomised to intervention group including aerobic and resistance exercises with physiotherapist in primary care twice a week for 12 weeks and daily walks, or to unsupervised home-based exercise including daily walks. Readmission rates between 30 and 90 days after discharge, and complications according to Clavien Dindo were collected from the medical records and analysed. Ninety patients were randomised, with a mean (SD) age of 72 (9) years. Readmission rates between 30 and 90 days showed no difference between the groups. For readmitted patients, the intervention group had significantly fewer complications reported as Clavien Dindo grade 2 compared to the control group. Conclusion: An exercise programme in primary care soon after robot-assisted radical cystectomy appears to be safe for patients, as measured by hospital readmission rates. Trial registration: Clinical Trials (NCT03998579).

An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia.

Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults. We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions. A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions. Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.

A nurse-led, telehealth transitional care intervention for people with multimorbidity: a feasibility study

Objective: We aimed to develop and test the feasibility of a nurse-led, telehealth transitional care intervention for people with multimorbidity. Design and methods: A feasibility study, using quantitative and qualitative methods was conducted at an 800-bed acute metropolitan hospital from March 2021 to January 2022. Eligible participants were adult inpatients with multimorbidity. The intervention involved three stages: (1) baseline risk of readmission assessment and collaborative development of a Transition Action Plan; (2) transitional care coordination following hospital discharge, and (3) handover to the primary healthcare provider. A Transition Coordinator delivered the intervention with the aim of determining the intervention’s feasibility in a practice environment. Acceptability to patients was assessed using a feedback survey. Acceptability to staff was noted through recorded interactions, collaboration, and feedback. Results: Twenty-one adults with a mean age of 78 years participated in the intervention. Participants had 3-10 comorbid chronic conditions, and the most common were hypertension (71%), other cardiovascular (66%), renal (52%), and diabetes (47%). Most patients (52%) were at medium risk of readmission and 38% were at high risk, however, only 24% of patients were readmitted. The study identified there is no routine risk of re-admission screening for patients with multimorbidity, and the intervention was found to be acceptable and feasible to patients, ward staff, and the multidisciplinary team. Conclusion: The results indicated feasibility of a transitional care intervention for people with multimorbidity, and the need for routine risk of readmission screening for people with multimorbidity. Further research is required to determine if the intervention is cost-effective and associated with reduced rates of hospital readmission. What is already known about the topic? People with multimorbidity often receive fragmented health services, which may increase their risk of hospital readmission. Internationally, Transitional Care Model interventions improve the transition experience from acute hospital care to the community and reduce short-term readmission rates, for people with multimorbidity. Transitional Care Model interventions have shown improved health and economic benefits for older adults. However, these benefits have not been evaluated in Australia. What this paper adds This study provides evidence regarding the feasibility and acceptability of a low-cost, nurse-led, transitional care intervention to support people with multimorbidity transitioning from acute hospital care to home/community, in the Australian context. The study identified high support needs of participants upon transition and provides preliminary evidence in favour of a fundamental shift from discharge planning to stratified transition planning for patients with multimorbidity. Presently, on hospital admission, there is no systematic risk of readmission assessment or transition care planning and implementation for people with multimorbidity. This is a notable service gap requiring redress across South Australian Local Health Networks.

Exploring the pharmacological mechanism of Qishen Yiqi dropping pills in treating chronic heart failure based on network pharmacology and molecular docking

Chronic heart failure (CHF) is a severe condition that affects millions of people worldwide. Despite standardized treatments, patients often face recurrent symptoms such as dyspnea, edema, and fatigue, which impair their quality of life and contribute to high mortality and hospital readmission rates. Traditional Chinese Medicine (TCM) offers alternative therapies, and Qishen Yiqi Dropping Pills (QYDP) has emerged as a potential treatment for CHF. QYDP is composed of Danshen, Huangqi, Jiangxiang, and Sanqi and is known for its ability to promote circulation, enhance Qi, and support cardiac health. Although clinical studies have suggested that QYDP can alleviate CHF symptoms, the underlying molecular mechanisms are not fully understood. In this study, network pharmacology and molecular docking were used to explore the pharmacological targets of QYDP for CHF treatment. Four core genes were identified: AKT1, HIF1A, STAT3, and MYC. Molecular docking confirmed the interactions between these genes and active compounds in QYDP, such as kaempferol, luteolin, quercetin, tanshinone IIa, and cryptotanshinone. These findings suggest that QYDP may treat CHF through a multitarget mechanism, offering new insights into its therapeutic potential and providing a basis for further clinical research.