Independent Predictors Of Hospital Readmission Research Articles

Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission.

Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.

Hospital Readmission in Patients With Diabetic Foot Ulcers: Prevalence, Causes, and Outcomes.

The aim of the current study was to evaluate the rate of readmission in patients affected by diabetes and foot ulcers (DFUs), and causes and outcomes of patients requiring a new hospitalization. The current study is a retrospective observational study including patients who have required hospitalization since January 2019 to September 2022 due to a DFU. Once patients were discharged, they were regularly followed as outpatients. Within 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided into 2 groups, readmitted and not readmitted patients, respectively. Hence, all patients were followed for 6 months more and outcomes of the 2 groups were analyzed and compared. Overall, 310 patients were included. The mean age was 68 ± 12 years, the majority of patients reported type 2 diabetes (>90%), and the mean diabetes duration was approximately 20 years. Sixty-eight (21.9%) patients were readmitted. The main reason for hospital readmission was the presence of critical limb ischemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%), and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5% vs 89.2%, P < .0001) and higher rate of major amputation (10.3% vs 4.5%, P = .2) in comparison to not readmitted patients. Critical limb ischemia resulted in the only independent predictor of hospital readmission. Hospital readmission is a frequent issue among patients with DFUs, and readmitted patients showed a lower chance of wound healing. Critical limb ischemia resulted in the main cause of new hospitalization.

S1131 Identifying Independent Predictors of Hospital Readmission in Patients With Inflammatory Bowel Disease

S1131 Identifying Independent Predictors of Hospital Readmission in Patients With Inflammatory Bowel Disease

Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes

BackgroundThe aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking.MethodsA retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, with p < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals.ResultsPolypharmacy ≥ 4 medications (aOR 2.38 (1.10–5.15), p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62–8.19), p < .002) and chronic kidney disease (aOR 2.56 (1.11–5.96), p < .027) were independent predictors of 30-day mortality.ConclusionsPolypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.

Effect of Drain Duration and Output on Perioperative Outcomes and Readmissions after Lumbar Spine Surgery.

Single-center retrospective cohort. To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration. The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial. Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (<40 mL cutoff), or drain duration (2 days cutoff). Total output of all drains, total output of the primary drain, drain duration in days, drain output per day, last 8-hour output, penultimate 8-hour output, and last 8-hour delta (last 8-hour output subtracted by penultimate 8-hour output) were collected. Continuous and categorical data were compared between groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to determine whether drain variables can predict hospital readmission, postoperative blood transfusions, and postoperative anemia. Alpha was 0.05. Our cohort consisted of 1,166 patients with 111 (9.5%) hospital readmissions. Results of regression analysis did not identify any of the drain variables as independent predictors of hospital readmission, postoperative blood transfusion, or postoperative anemia. ROC analysis demonstrated the drain variables to be poor predictors of hospital readmission, with the highest area under curve of 0.524 (drain duration), corresponding to a sensitivity of 61.3% and specificity of 49.9%. Drain output or duration did not affect readmission rates following lumbar spine surgery.

Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program.

To determine whether a structured OPAT program supervised by an infectious disease physician and led by an OPAT nurse decreased hospital readmission rates and OPAT-related complications and whether it affected clinical cure. We also evaluated predictors of readmission while receiving OPAT. A convenience sample of 428 patients admitted to a tertiary-care hospital in Chicago, Illinois, with infections requiring intravenous antibiotic therapy after hospital discharge. In this retrospective, quasi-experimental study, we compared patients discharged on intravenous antimicrobials from an OPAT program before and after implementation of a structured ID physician and nurse-led OPAT program. The preintervention group consisted of patients discharged on OPAT managed by individual physicians without central program oversight or nurse care coordination. All-cause and OPAT-related readmissions were compared using the χ2 test. Factors associated with readmission for OPAT-related problems at a significance level of P < .10 in univariate analysis were eligible for testing in a forward, stepwise, multinomial, logistic regression to identify independent predictors of readmission. In total, 428 patients were included in the study. Unplanned OPAT-related hospital readmissions decreased significantly after implementation of the structured OPAT program (17.8% vs 7%; P = .003). OPAT-related readmission reasons included infection recurrence or progression (53%), adverse drug reaction (26%), or line-associated issues (21%). Independent predictors of hospital readmission due to OPAT-related events included vancomycin administration and longer length of outpatient therapy. Clinical cure increased from 69.8% before the intervention to 94.9% after the intervention (P < .001). A structured ID physician and nurse-led OPAT program was associated with a decrease in OPAT-related readmissions and improved clinical cure.

Posttraumatic stress disorder symptoms after respiratory and cardiovascular emergencies predict risk of hospital readmission: A prospective cohort study.

Twenty-five percent of patients presenting to the emergency department (ED) for a respiratory or cardiovascular medical emergency develop clinically significant posttraumatic stress disorder (PTSD) symptoms. It is possible that development of PTSD symptoms in this cohort is associated with subsequent adverse physical health events. Our objective was to test whether clinically significant PTSD symptoms 30days postdischarge are associated with increased risk for hospital readmission within 24months after discharge among patients presenting to the ED for a respiratory or cardiovascular emergency. This was a prospective cohort study conducted between January 1, 2018, and December 31, 2020, at a U.S. academic medical center, including adult patients presenting with acute respiratory failure or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. PTSD symptoms 30days postdischarge were measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5. The primary outcome was all-cause hospital readmission over the subsequent 24months after hospital discharge from the index ED visit. Of the 99 patients included, 73% (95% confidence interval [CI]= 63% to 81%) had a hospital readmission within 24months. In a multivariable Cox proportional hazards model adjusting for potential confounders (e.g., age, severity of illness during index ED visit, preexisting comorbid conditions) presence of clinically significant PTSD symptoms at 30days was independently associated with increased risk for all-cause hospital readmission at 24months (hazards ratio=2.19, 95% CI= 1.30 to 3.69). These results remained statistically significant across multiple sensitivity analyses. Hospital readmission is common among survivors of acute respiratory failure and cardiovascular instability, and PTSD symptoms 30days postdischarge are an independent predictor of hospital readmission. Survivors of medical emergencies may warrant follow-up evaluation for PTSD symptoms, and future research is warranted to better understand the relationship between psychological trauma and hospital readmission.

600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

BackgroundAlthough it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program.MethodsThis retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission.ResultsDemographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2.Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients ConclusionAn OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future.Disclosures All Authors: No reported disclosures

Abstract 15095: CSHA Frailty Scale as a Predictor of Hospital Readmission After PCI

Introduction: The Canadian Study on Health and Aging (CSHA) Frailty Scale was included in the National Cardiovascular Data Registry’s (NCDR) CathPCI registry beginning April 2018. The value of this frailty assessment as an independent predictor of hospital readmission is unknown. Methods: A retrospective analysis was performed of patients who underwent PCI within the University of North Carolina Medical System between 04/2018 and 12/2018. Outcome data was obtained from our electronic medical record data repository and procedural data from the institutional CathPCI registry. The primary outcome was repeat hospital admission within 1 year of PCI. Significant covariates (p&lt;0.05) in the univariate analyses were considered for inclusion in the multivariate model. Multivariate logistic regression was then performed to determine if CSHA Frailty Scale was an independent predictor of hospital readmission. Results: 1,592 subjects were identified with 367 readmission events. Patients in the readmission cohort were older, had a higher frailty score, and had more comorbidities. Table 1 summarizes the comorbidities included in the logistic regression. CSHA Frailty Scale did not meet significance requirements (P&lt;.05) to be independently associated with readmission. Covariates that were significant independent predictors of readmission included age (OR 1.024, 95% CI 1.012-1.036); cerebrovascular disease (OR 1.688, 95% CI 1.234-2.308); dialysis (OR 2.983, 95% CI, 1.583-5.622); and CHF (OR 2.465, 95% CI, 1.851-3.282). Conclusions: The CSHA Frailty Scale was not independently associated with readmission in the setting of PCI in our health system. This particular assessment of frailty may not provide added value over traditional comorbidities in this patient population.

Increased risk of 30-day hospital readmission among patients discharged against medical advice: a nationwide analysis

PurposeAnnually, 1%–2% of hospitalized patients are discharged against medical advice (AMA), positioning them at an increased risk of readmission, morbidity, and mortality. Our study aim was to examine 30-day all-cause readmission rates and estimate readmission odds among AMA discharges in the United States, across clinically distinct diagnostic subgroups. MethodsWe conducted a retrospective, serial cross-sectional analysis of data from the 2010–2017 Nationwide Readmissions Database. Descriptive statistics and 30-day all-cause readmission rates for hospitalizations among adults aged 18 years or older were estimated by major diagnostic subgroup, discharge disposition, and patient and hospital characteristics. Odds ratios and 95% confidence intervals were calculated using multipredictor logistic regression. ResultsWe found the AMA discharge to be an independent predictor of hospital readmission within 30 days, with a 25.6% readmission rate and an overall adjusted likelihood of readmission that was almost double to quadruple that of routine discharges. Furthermore, although hospitalizations experienced decreased odds of readmission after the Hospital Readmission Reduction Program implementation (October 1, 2012), our results demonstrate that the Hospital Readmission Reduction Program did not modify the impact of an AMA discharge on readmission. ConclusionThese findings have implications for practice, policies, and interventions aimed at improving care quality, preventing AMA discharge, and reducing hospital readmissions in inpatient settings.

Open approach, extended pelvic lymph node dissection, and seminal vesicle invasion are independent predictors of hospital readmission after prostate cancer surgery: a large retrospective study.

The aim of this study is to evaluate factors (clinical, pathological and perioperative) associated with the risk of hospital readmission after radical prostatectomy (RP) over the long term in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. From January 2013 to December 2018 patients older than 18 years, who provided signed consent and underwent open or robot assisted radical prostatectomy were enrolled and retrospectively evaluated. Patients who underwent any previous prostate cancer (PCA) treatments were excluded. Specifically, skilled and experienced surgeons performed the two surgical approaches. Patients were followed for complications and hospital readmission (RAD) for a period of six months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. A total of 1062 patients underwent RP. RARP was performed in 891 cases and ORP in 171 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 651 patients. Hospital readmission occurred in 53 cases (5%). Based on the final multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (HR=2.093; 95% CI: 1.177-3.722), ORP (HR=4.393; 95% CI: 2.516-7.672) and ePLND (HR=4.418; 95% CI: 1.544-12.639). ORP, ePLND and seminal vesicle invasion are independent predictors of the risk of hospital readmission over the long term at a large single tertiary referral center. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of hospital readmission and related risk factors. Assessing seminal vesicle invasion by preoperative clinical staging identifies locally advanced disease, which is associated with an increased risk of hospital readmission.

P6360Prognostic value of polypharmacy in patients with heart failure

Abstract Background Polypharmacy creates an increased patient's burden by drug-drug interactions and poor adherence. However, there are very few studies available evaluating the association of polypharmacy with hospital readmission in patients with heart failure (HF). Purpose The aim of this study was to investigate the impact of polypharmacy on hospital readmission for HF. Methods We enrolled 1253 patients who were hospitalized with acute heart failure (AHF) or acute exacerbation of chronic heart failure in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to July 2018 (age 78.1±11.5 years, male 51.4%). Our Registry is a prospective multicenter community-based cohort study of HF patients in Japan. The inclusion criteria for the registry was a diagnosis of HF during hospitalization according to the Framingham criteria, and there were no exclusion criteria. From data at discharge, we collected data on clinical characteristics, medication schedule, and social backgrounds. We defined polypharmacy as the use of seven or more medications. The primary end point was HF rehospitalization within 1 year after discharge. Cox proportional hazards regression analysis was used to describe the association between polypharmacy and 1-year HF rehospitalization, controlling for potential confounding factors. Results In this study, the prevalence of polypharmacy was 59.7% of all patients. Patients with polypharmacy were more likely to have comorbidities such as hypertension, dyslipidemia, diabetes, chronic kidney disease, coronary artery disease and dementia. They also had lower EF (50.9±0.64 vs 53.6±0.80, p&lt;0.01), compared to patients without polypharmacy. There was no significant difference in age, gender and BMI, compared to patients without polypharmacy. During the follow-up period, a total of 278 patients (24.9%) were readmitted for HF. In Kaplan-Meier analyses, hospital readmission for HF during 1-year follow-up was significantly higher in patients with polypharmacy (p&lt;0.01) (figure). After adjusting for gender, age, EF, and the other co-morbidities, polypharmacy was independently associated with higher risk of rehospitalization for HF (hazard ratio 1.28, 95% confidence interval, 1.07–1.52, p&lt;0.01). Conclusion Polypharmacy is an independent predictor of hospital readmission for HF. Our study suggests the need for developing an effective strategy to choose the appropriate drugs in patients with HF. Acknowledgement/Funding Nakajima Steel Pipe

Readmission After Lobectomy for Lung Cancer: Not All Complications Contribute Equally.

The aim of this study was to identify independent predictors of hospital readmission for patients undergoing lobectomy for lung cancer. Hospital readmission after lobectomy is associated with increased mortality. Greater than 80% of the variability associated with readmission after surgery is at the patient level. This underscores the importance of using a data source that includes detailed clinical information. Using the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD), we conducted a retrospective cohort study of patients undergoing elective lobectomy for lung cancer. Three separate multivariable logistic regression models were generated: the first included preoperative variables, the second added intraoperative variables, and the third added postoperative variables. The c statistic was calculated for each model. There were 39,734 patients from 277 centers. The 30-day readmission rate was 8.2% (n = 3237). In the final model, postoperative complications had the greatest effect on readmission. Pulmonary embolus {odds ratio [OR] 12.34 [95% confidence interval (CI),7.94-19.18]} and empyema, [OR 11.66 (95% CI, 7.31-18.63)] were associated with the greatest odds of readmission, followed by pleural effusion [OR 7.52 (95% CI, 6.01-9.41)], pneumothorax [OR 5.08 (95% CI, 4.16-6.20)], central neurologic event [OR 3.67 (95% CI, 2.23-6.04)], pneumonia [OR 3.13 (95% CI, 2.43-4.05)], and myocardial infarction [OR 3.16 (95% CI, 1.71-5.82)]. The c statistic for the final model was 0.736. Complications are the main driver of readmission after lobectomy for lung cancer. The highest risk was related to postoperative events requiring a procedure or medical therapy necessitating inpatient care.

Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction.

The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications. Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay. In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%, p = 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%, p = 0.03), hospital readmission (1.0% vs 0.3%, p = 0.001), and overnight hospital stay (16.2% vs 6.0%, p < 0.001). Obesity was a risk factor for both hospital readmission and overnight hospital stay, while hypertension, diabetes, chronic obstructive pulmonary disease, and a smoking history were associated with increased rates of overnight hospital stay. The most common reasons for hospital readmission were deep vein thrombosis or pulmonary embolism (25.0% of all readmitted patients), surgical site infection (25.0%), and post-operative pain (14.1%). In this propensity-matched analysis adjusting for baseline patient characteristics and operative factors, procedure length of greater than or equal to 90min in ACLR was independently associated with an increased risk of hospital readmission and overnight hospital stay. As a surrogate measure of surgical complexity, operative time may be a useful perioperative variable for post-operative risk stratification and patient counseling. III.

Sa1189 – Gastroesophageal Reflux Disease is an Independent Predictor of Hospital Readmission in Patients with Atrial Fibrillation: Analysis of the Nationwide Readmission Database

Sa1189 – Gastroesophageal Reflux Disease is an Independent Predictor of Hospital Readmission in Patients with Atrial Fibrillation: Analysis of the Nationwide Readmission Database

The Frequency of and Reasons for Hospital Readmission Post Percutaneous Coronary Intervention

ObjectivesThe objective of this study was to determine the frequency of and reasons for six months unplanned readmission to hospital post Percutaneous Coronary Intervention (PCI).BackgroundPCI has become an important and effective way of treating heart disease; however the occurrence of hospital readmission post PCI is not well documented.MethodsThe frequency of hospital readmissions were tracked for six months following PCI using the APPROACH registry database. The incidence of and reasons for hospital readmission were determined using the Capital Health Region Administrative Database and the ICD-10 coding for hospital readmission.ResultsOf 2641 subjects, it was observed that 4.5% of patients were readmitted to hospital within six months of PCI and 18.6% of patients visited the ED for reasons directly related to PCI. The top reasons for readmission were chest pain (31.2%), atherosclerotic heart disease (24.3%), bleeding/complications with anticoagulation (10.9%), myocardial infarction (7.5%) and procedural complications (3.7%). Factors shown to be independent predictors of hospital readmission were congestive heart failure (p = 0.009), pulmonary disease (p = 0.008), malignancy (p = 0.002), liver disease (p = 0.012) and female gender (p = 0.015).ConclusionsThe data indicates that while in-patient six months unplanned hospital readmission post PCI is relatively low, ED visits are substantial. The creation of a post PCI clinic and/or a post PCI hotline may prove to be useful in decreasing hospital visits post PCI. If patients are routinely followed up in the early post PCI period, access to health care may be improved, allowing complications to be observed sooner and care to be given quicker.

Pharmacogenetics: Ethics and Public Policy

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Validation of a risk stratification tool for a Hospital Outreach Medication Review (HOMR) program.

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources. To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review. A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively. 235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25). Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Intervention for diabetes patients in Indonesia: A mixed methods study

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Electronic prescription anomalies – A study of frequencies, types, and effects in Finnish community pharmacies

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.