Likelihood Of Rehospitalization Research Articles

Rehospitalization rate and predictors of rehospitalization in heart failure patients in North Central Nigeria

Abstract 
 Heart failure (HF) is a major cause of morbidity and mortality worldwide. Despite the advancement in its treatment the rate of rehospitalization of patients after treatment for HF is still high around the world. Studies assessing rehospitalization rates of HF patients are few in Nigeria. The objective of the study was to determine the 180-day rehospitalization rate and predictors of rehospitalization in acute HF patients managed in our Centre. The study was a retrospective cohort study of 148 patients with acute HF.
 The 180-day rehospitalization rate in our patients was 16.2%. The median time to rehospitalization was 61days. Serum urea (p=0.016), serum creatinine (p=0.033), admission eGFR < 60mls/min/1.73m2 (p=0.007), LVEF (p=0.045) were associated with rehospitalization. eGFR < 60mls/min/1.73m2 was an independent predictor of 180-day rehospitalization OR 5.4, (CI 1.701-7.690), p=0.014 suggesting 5 times greater likelihood of rehospitalization than patients with higher eGFR. The Kaplan-Meier survival curve for 180-day rehospitalization was plotted.
 In conclusion, the 180-day rehospitalization rate among our patients varies from other reported rates in our environment. Acute HF patients with renal dysfunction have a high likelihood of medium term rehospitalization and hence constitute an at-risk group for targeted intervention during admission.

Physical Therapists

Background: The physical therapist's (PT's) role on the interprofessional team is specialized to address a patient's functional needs. Statement of the Problem: Functional status is a key determinant for rehospitalization and is associated with the greatest risk of readmission, yet typical discharge planning teams do not include the PT as an integral member of the team. When PTs are involved, the likelihood of rehospitalization is much lower. The PT has an essential role in the discharge process to align the patient's capacity with the community resources that will best achieve a safe transition plan, facilitate restoration of functioning, and achieve an optimal outcome. Impact Statement: PTs are essential members of the care transitions team and improve patient outcomes across the health care system. This perspective highlights a critical nontraditional role for PTs to fill that will help improve health care decision-making and reduce the risk for rehospitalization and adverse health outcomes.

Factors associated with 30-days and 180-days psychiatric readmissions: A snapshot of a metropolitan area

Psychiatric re-hospitalization rate is a widely used quality indicator within mental health care. This study aims to investigate which variables are implied in determining readmissions over two intervals after the index event, 30 days and 6 months. The study sample included 798 inpatients, it was divided into two groups: not readmitted patients (NRP) and readmitted patients (RP), which has been further split into: Readmitted within 30 days (RP30dd) and Readmitted during the 150-day period (between 31 and 180 days) after the index discharge (RP150). A multivariate logistic regression with backward selection method was performed in order to find variables independently associated with readmission. The overall incidence of readmissions was 16.04%. Discharge to a Psychiatric Nursing Home was found to be a protective factor for all the groups. In adds, for the overall readmission, compulsory index admission and higher education (this lasts as in RP30dd group) were protective factors; whereas higher length of stay (as for readmission within 31–180 days) and a diagnosis of Personality Disorder were risk factors. The patient-specific factors significantly associated with likelihood of rehospitalization in the final model do identify some high-risk groups toward to whom possibly address prevention strategies.

Is a Skilled Nursing Facility's Rehospitalization Rate a Valid Quality Measure?

To determine whether the observed differences in the risk-adjusted rehospitalization rates across skilled nursing facilities (SNFs) reflect true differences or merely differences in patient severity. Elderly Medicare beneficiaries newly admitted to an SNF following hospitalization. We used 2009-2012 Medicare data to calculate SNFs' risk-adjusted rehospitalization rate. We then estimated the effect of these rehospitalization rates on the rehospitalization of incident patients in 2013, using an instrumental variable (IV) method and controlling for patient's demographic and clinical characteristics and residential zip code fixed effects. We used the number of empty beds in a patient's proximate SNFs during hospital discharge to create the IV. The risk-adjusted rehospitalization rate varies widely; about one-quarter of the SNFs have a rehospitalization rate lower than 17 percent, and for one-quarter, it is higher than 23 percent. All the IV models result in a robust finding that an increase in a SNF's rehospitalization rate of 1 percentage point over the period 2009-2012 leads to an increase in a patient's likelihood of rehospitalization by 0.8 percentage points in 2013. Treatment in SNFs with historically low rehospitalization causally reduces a patient's likelihood of rehospitalization. Observed differences in rehospitalization rates reflect true differences and are not an artifact of selection.

Exercise therapy for heart failure patients in Canada.

Contemporary pharmacologic therapies have greatly improved outcomes in patients with heart failure (HF). Exercise therapy also has become increasingly recognized and utilized over the last decade. Patients with HF undergo significant central and peripheral deconditioning. Aerobic and resistance training in this patient population may improve quality of life, muscular strength, aerobic capacity, and potentially longevity. Those HF patients who are able to remain adherent to exercise training programs may improve their self-monitoring skills with respect to progressive volume overload, as well as their capacity for independent living, thereby reducing the likelihood of rehospitalization.

Comorbidity in heart failure. Results of the Spanish RICA Registry.

We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization. Data were obtained from the 'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge. We included 2051 patients, mean age 78 and 53% females. LVEF was ⩾ 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index ≤ 60). Mean ChI was 2.91 (SD ± 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001). HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.

Association of dementia with early rehospitalization among Medicare beneficiaries

Preventable hospital readmissions have been recognized as indicators of hospital quality, a source of increased healthcare expenditures, and a burden for patients, families, and caregivers. Despite growth of initiatives targeting risk factors associated with potentially avoidable hospital readmissions, the impact of dementia on the likelihood of rehospitalization is poorly characterized. Therefore, the primary objective of this retrospective cohort study was to investigate whether dementia was an independent predictor of 30-day readmissions. Administrative claims data for all admissions to Rhode Island hospitals in 2009 was utilized to identify hospitalizations of Medicare fee-for-service beneficiaries with a diagnosis of Alzheimer's Disease or other dementias. Demographics, measures of comorbid disease burden, and other potential confounders were extracted from the data and the odds of 30-day readmission to any United States hospital was calculated from conditional logistic regression models. From a sample of 25,839 hospitalizations, there were 3908 index admissions of Medicare beneficiaries who fulfilled the study criteria for a dementia diagnosis. Nearly 20% of admissions (n=5133) were followed by a readmission within thirty days. Hospitalizations of beneficiaries with a dementia diagnosis were more likely to be followed by a readmission within thirty days (adjusted odds ratio (AOR) 1.18; 95% CI, 1.08, 1.29), compared to hospitalizations of those of without dementia. Controlling for discharge site of care did not attenuate the association (AOR 1.21; 95% CI, 1.10, 1.33).

Population Level Assessment of Hospital Based Outcomes Following Laparoscopic Versus Open Partial Nephrectomy During the Adoption of Minimally Invasive Surgery

The comparative outcomes of laparoscopic and open partial nephrectomy remain incompletely defined. Therefore, we used population based data to examine resource use and short-term outcomes among patients with kidney cancer treated with laparoscopic vs open partial nephrectomy. Using linked SEER (Surveillance, Epidemiology, and End Results)-Medicare data we identified patients with kidney cancer treated with laparoscopic or open partial nephrectomy from 2000 through 2007. We then used Medicare claims to identify several postoperative outcomes including intensive care unit care, length of stay, rehospitalizations, operative mortality and postoperative complications. We fit multivariate logistic regression models to estimate the association between each outcome and surgical approach (ie laparoscopic partial nephrectomy vs open partial nephrectomy), adjusting for patient and tumor characteristics. We identified 651 (28%) and 1,670 (72%) patients treated with laparoscopic partial nephrectomy and open partial nephrectomy, respectively. Compared to those who underwent open partial nephrectomy, patients treated with laparoscopic partial nephrectomy had a 34% lower probability of requiring intensive care unit time (20.0% vs 30.2%, p <0.001) and shorter median length of stay (3 vs 5 days, p <0.001), with no differences observed in the likelihood of rehospitalization or operative mortality. While the frequency of postoperative complications was similar (35.5% vs 36.1%, p = 0.829), patients treated with laparoscopic partial nephrectomy had a nearly twofold greater probability of genitourinary complications and postoperative hemorrhage (p <0.001). At a population level the patients with kidney cancer treated with laparoscopic partial nephrectomy experienced a shorter and less intense hospitalization, supporting the benefits of laparoscopy. However, the greater likelihood of procedure related complications highlights the need for continued efforts aimed at ensuring the safe adoption and application of this advanced surgical technique.

Leaving before Discharge from a Homeless Medical Respite Program: Predisposing Factors and Impact on Selected Outcomes

Medical Respite addresses care needs of homeless patients post-hospital discharge and is linked to reduced rehospitalization compared with standard discharge. However, outcomes may differ for Respite patients who exit before completing post-acute treatment and discharge plans. Using administrative data from a San Francisco Medical Respite center (2007-2010), this retrospective study compares patient characteristics, post-Respite connections to community services, and likelihood of rehospitalization within 90 days of Respite exit between patients who choose to leave before discharge and all other Respite patients (logistic regression, odds ratio). Of 860 encounters, 31% ended when patient chose to leave before discharge. Female gender (OR 1.65), living on the street immediately prior to Respite (OR 1.36) and substance use (OR 1.55) were associated with increased risk of leaving early. Patients who left early were more likely than others to decline referrals to services and more likely to be re-admitted within 90 days.

Abstract P201: Impact of Special Populations on Thromboprophylaxis and Clinical Outcomes of Patients Undergoing Knee Replacement Surgery in the US

Background: New anticoagulants are evaluated in clinical trials which often initially focus on prevention of venous thromboembolism (VTE) after major orthopedic surgery. Unlike clinical trials, real-world surgical patients include special populations of patients with comorbidities or concomitant drug use. Objective and purpose: To evaluate the proportion of special patient groups in a real-world population undergoing knee arthroplasty, and to assess their thromboprophylaxis status and clinical outcomes. Methods: Data were extracted from the IMS' PharMetrics® Patient-Centric database for patients aged ≥ 18 years and undergoing knee arthroplasty during 2007. The primary efficacy end point was the overall rate of hospital acquired VTE as one of the secondary hospital discharge reasons. The overall rate of adverse bleeding events was one of the secondary hospital discharge reasons as the primary safety end point. Results: Of the 19,390 knee arthroplasty patients included in the analysis, 3,279 (17%) were aged ≥ 75 years, 4,368 (23%) used a CYP3A4 inhibitor, and 1,882 (10%) used warfarin chronically. Smaller proportions had atrial fibrillation (AF; 1,334; 7%), renal insufficiency (766; 4%), used antiplatelet drugs (621; 3%), had hepatic impairment (320; 2%), or had a history of acute coronary syndromes (ACS; 288; 2%). Pharmacologic thromboprophylaxis was prescribed to 47% (9,063 of 19,390) of patients. In a logistic regression model, the likelihood of VTE events was increased significantly (all P &lt; 0.05) with AF (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.06-1.88), chronic warfarin use (OR 1.33; 95% CI 1.03-1.72), and each increasing year of age (OR 1.01; 95% CI 1.00-1.02). ACS increased the odds of bleeding events (OR 1.50; 95% CI 1.14-1.97; P &lt; 0.05). The likelihood of rehospitalization for ACS was increased in patients with a history of ACS (OR 5.47; 95% CI 1.93-15.54). Conclusion: Special populations are prevalent in everyday knee surgery patients and certain comorbidities or drug use can be associated with increased odds of VTE events or bleeding. Additional studies on the effects of different patient characteristics on clinical outcomes are warranted, particularly for new anticoagulants where little real-world data exist.

The Effect of an Inpatient Transition Intervention on Attendance at the First Appointment Postdischarge From a Psychiatric Hospitalization

Only 42% of initial appointments following psychiatric hospitalization are kept nationally. Missed appointments increase the likelihood of rehospitalization and increase costs of outpatient care. This study explored the feasibility, outcomes, and cost of a transition intervention on attendance at the first postdischarge appointment. A pilot study using a one-group prospective design interviewed 15 patients hospitalized with psychosis to address potential barriers to attendance at the first postdischarge appointment. Patients also identified an agenda for this appointment and received a reminder letter. Twelve (92%) of 13 patients attended the postdischarge appointment compared with the previous rate of 44%. Two additional patients were unable to attend because they had been rehospitalized before the scheduled time of the first appointment. Contact with a clinician who can bridge the gap between discharge and the first postdischarge appointment is feasible and may be helpful in increasing attendance rates.

Exploring the Link between Ambulatory Care and Avoidable Hospitalizations at the Veteran Health Administration

This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

Assessing Patient's Neighborhood Can Aid Treatment Planning

Assessing Patient's Neighborhood Can Aid Treatment Planning

Relevance of short-term variation of B-type natriuretic peptide in patients with clinically stable heart failure

In patients with clinically stable chronic heart failure, circulating B-type natriuretic peptide (BNP) levels may exhibit considerable variation over a period of a few days. The aim of this study was to evaluate the clinical impact of this phenomenon. In 23 patients with clinically stable mild-to-moderate systolic heart failure [median (interquartile range) 72 (64-77) years, left ventricular ejection fraction 30 (27-40)%] and a history of previous hospitalization for heart failure, BNP was measured at two time points [T1 and T2, interval 5 (3-7) days] for calculation of the absolute change in BNP concentrations between T1 and T2 (DeltaBNP; irrespective of whether there was a decrease or increase). Follow-up for rehospitalization was 436 (407-458) days. In the group overall, DeltaBNP was 26 (9-116) pg/ml [19 (10-28)% of the value at T1]. During follow-up, 8/23 (35%) patients were rehospitalized. BNP concentrations at T1 [340 (187-533) vs. 210 (108-606) pg/ml; P = 0.33] and T2 [328 (125-491) vs. 259 (89-536) pg/ml; P = 0.51] were similar in patients who were rehospitalized and those who were not; however, DeltaBNP was higher in patients requiring rehospitalization [98 (36-186) vs. 19 (6-93) pg/ml; P = 0.04]. Patients with DeltaBNP <26 pg/ml had a longer rehospitalization-free survival than those with DeltaBNP > or = 26 pg/ml (log rank P = 0.02). Sensitivity and specificity of DeltaBNP > or = 26 pg/ml for the prediction of rehospitalization were 88% and 67% respectively. In this small study among patients with clinically stable heart failure, higher DeltaBNP over a period of a few days was associated with a higher likelihood of rehospitalization during follow-up.

The Effects of Nonprofessional Caregivers on the Rehospitalization of Elderly Recipients in Home Healthcare

The purpose of this study is to evaluate the effects of the presence and types of nonprofessional caregivers on the rehospitalization of elderly recipients in home healthcare (HHC). Outcome and Assessment Information Set records of 9832 elderly recipients discharged from hospitals were selected for multivariate analyses. The likelihood of rehospitalization among elderly recipients of HHC did not vary on the basis of the presence and types of nonprofessional caregivers. The findings suggest that when elderly patients are receiving formal HHC services, their risk for rehospitalization is not affected by the presence or the specific types of nonprofessional caregivers.

Congestive heart failure hospitalizations and survival in California: Patterns according to race/ethnicity

Background Congestive heart failure (CHF) disproportionately affects African Americans, but data are limited concerning CHF hospitalization patterns among Hispanic and Asian populations, the 2 fastest growing ethnic groups in the United States, and race/ethnic patterns of rehospitalization and survival among patients with CHF are unknown. We conducted a study to assess rates of CHF hospitalization, readmission, and survival among diverse populations in California. Methods and Results We used 2 study designs. First, we calculated the population-based incidence of CHF hospitalization in California in 1991. Next we conducted a retrospective cohort study that identified patients initially hospitalized for CHF in 1991 or 1992 and followed these patients for 12 months after their index hospitalization to determine their likelihood of rehospitalization or death. Data were analyzed with Cox proportional hazards models. African Americans had the highest rate of CHF hospitalization. Age-adjusted hospitalization rates were comparable among whites, Latinos, and Asian women and all lower than those in African American, whereas Asian men had the lowest rates. On adjusted analyses, African Americans were more likely than whites and Asians to be rehospitalized (relative risk 1.07; 95% confidence interval 1.04 to 1.10). However, they were less likely to die within the 12-month follow-up period (relative risk 0.86; 95% confidence interval 0.82 to 0.90). Whites, conversely, had the highest posthospitalization mortality rates. Conclusions These findings demonstrate important racial-ethnic differences in CHF morbidity and mortality rates. The disparate findings of higher hospitalization and rehospitalization rates and lower mortality rates among African Americans than whites may represent differences in the underlying pathophysiology of CHF in these groups or differences in access to quality care. Further studies are needed to explain these seemingly paradoxical outcomes. (Am Heart J 1999;137:919-27.)

Psychiatric rehospitalization following hospital discharge.

The purpose of this study was twofold: to examine the patient characteristics at discharge from an acute psychiatric unit that were associated with an increased likelihood of rehospitalization within the following six months, and to examine the relationship between rehospitalization and the nature of psychiatric aftercare in a well-integrated hospital and community based psychiatric service. The study reviewed the extent of psychiatric rehospitalization following the closure of large numbers of institutional psychiatric beds. At six months after discharge 38% of the patients had been readmitted to an institution, most commonly a hospital. Despite the provision of an integrated hospital and community health service with excellent welfare support, dissatisfaction with finances independently exerted an influence on the risk of readmission. Implications for future research and treatment planning are discussed focussing on the complex integration of health and welfare services.

Managed mental health care and patterns of inpatient utilization for treatment of affective disorders.

In this analysis we made use of a large data base of individuals insured by large American corporations to estimate the impact of managed care provision on hospital care for depression. Data on 6,348 individuals hospitalized for depression were examined to assess the effect of managed care techniques on the cost per episode and the likelihood of rehospitalization. Preadmission certification programs were found to lead to significant long- and short-run savings for payers.

Clinical Prediction of Medical Rehospitalization: Psychological Assessment with the Battery of Asthma Illness Behavior

Psychomaintenance in chronic illness refers to the perpetuation of chronicity or the defeat of medical management because of psychological, as opposed to strictly physical, reasons. The Battery of Asthma Illness Behavior (BAIB) has been developed to assess psychomaintenace potentials among chronic asthmatics. In this study of 57 adult asthmatic patients, the clinical utility of the BAIB was assessed by having two psychologists predict the likelihood of rehospitalization within six months following intensive medical treatment. Independent, blind predictions using the BAIB, but in the absence of any demographic or medical information, enabled hit rates of 70% and 84% by te psychologists. Moreover, the predictions were independent of the objective severity of the patients' asthma, indicating that the clinical judgments were not merely readings of the patients' asthma severity on the basis of the BAIB scores. The need for rapid, clinical assessment of psychological factors maintaining chronic illness was discussed.