Local Healthcare Economy Research Articles

Burden of 30-Day Readmissions After Percutaneous Coronary Intervention in 833,344 Patients in the United States: Predictors, Causes, and Cost: Insights From the Nationwide Readmission Database

ObjectivesThis study aimed to examine the 30-day unplanned readmissions rate, predictors of readmission, causes of readmissions, and clinical impact of readmissions after percutaneous coronary intervention (PCI). BackgroundUnplanned rehospitalizations following PCI carry significant burden to both patients and the local health care economy and are increasingly considered as an indicator of quality of care. MethodsPatients undergoing PCI between 2013 and 2014 in the U.S. Nationwide Readmission Database were included. Incidence, predictors, causes, and cost of 30-day unplanned readmissions were determined. ResultsA total of 833,344 patients with PCI were included, of whom 77,982 (9.3%) had an unplanned readmission within 30 days. Length of stay for the index PCI was greater (4.7 vs. 3.9 days) and mean total hospital cost ($23,211 vs. $37,524) was higher for patients who were readmitted compared with those not readmitted. The factors strongly independently associated with readmissions were index hospitalization discharge against medical advice (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.65 to 2.22), transfer to short-term hospital for inpatient care (OR: 1.62; 95% CI: 1.38 to 1.90), discharge to care home (OR: 1.57; 95% CI: 1.51 to 1.64), and chronic kidney disease (OR: 1.50; 95% CI: 1.44 to 1.55). Charlson Comorbidity Index score (OR: 1.28; 95% CI: 1.27 to 1.29) and number of comorbidities (OR: 1.18; 95% CI: 1.17 to 1.18) were independently associated with unplanned readmission. The majority of readmissions were due to noncardiac causes (56.1%). ConclusionsThirty-day readmissions after PCI are relatively common and relate to baseline comorbidities and place of discharge. More than one-half of the readmissions were due to noncardiac causes.

Dressings optimisation strategy: Meeting the needs of the patient and the population

A managed procurement-based system for the delivery of wound care dressings provides clinical, financial and systemic benefits to the local healthcare economy while meeting the needs of individual patients and supporting informed clinical autonomy. The need for a system and budget that are responsive to local population and service changes, and the potential burden on community nurses to transport dressings can create a challenge. The authors argue that despite these limitations, the benefits are such that questioning current processes by delivering a managed procurement solution is an asset to patients, clinicians and the local health-care economy.

Is breast best in the west of England? Use of linked routinely collected data sources to quantify the protective effect of breastfeeding against infectious gastrointestinal and respiratory illness during the first year of life

BackgroundThe potential health benefits of breastfeeding, including the protective effect against common childhood infectious diseases, are well known. This project sought to quantify the reduced risk of admission to hospital during the first year of life due to these illnesses, in Bristol, UK, to help to build the business case for local breastfeeding promotion, and to generate information specific to the population of the city. MethodsTwo routine data sources were linked: child health records and hospital episode records for 17 260 Bristol resident children born during 2009–11. Children missing any of the required variables were excluded, as were low birthweight and preterm infants, and babies admitted to hospital in the first 48 h of life, to reduce the effect of reverse causality on any association observed. The primary exposure variable was feeding status at the 6–8 weeks check, and the primary outcome was hospital admissions for gastrointestinal and respiratory infectious illness during the first year of life, based on diagnoses codes used in similar studies. Relative risks of admission were estimated with a multiple regression model, adjusting for a range of known confounders: maternal age and smoking status at delivery, ethnicity, deprivation, birthweight, gestation at delivery, and parity. Ethics approval was obtained from South Central NHS Research Ethics Committee and the University of the West of England Faculty Research Ethics Committee. FindingsThe cohort consisted of 12 918 children (75% of all births in the population). Significant (p<0·05) risk reductions associated with a reduced risk of admission for infectious gastrointestinal illness were found for any, exclusive, and partial breastfeeding, compared with no breastfeeding (odds ratio 0·371, p<0·001; 0·361, p<0·001; 0·359, p=0·003). They were also found for partial and any breastfeeding and risk of admission for infectious respiratory illness (0·766, p<0·001; 0·633, p=0·005). InterpretationBreastfeeding was associated with a significantly reduced risk of admission for infectious illness during the first year of life. The findings suggest that an increase in breastfeeding prevalence could bring considerable savings to the local health-care economy. The data linkage method using pre-existing routinely recorded data provided useful and robust findings in line with research typically requiring costly and lengthy primary data collection, and offers potential for more research of this type to be conducted closer to local service provision in future. FundingThis research was conducted as part of a postgraduate study funded by Bristol Primary Care Trust. Their successor organisation (Bristol Clinical Commissioning Group) acted as host with their agreement obtained through the Avon Primary Care Research Collaborative. None of these organisations had any influence on the design or conduct of the research. I had the final decision to submit the abstract for publication. I had and still retain access to all data used for the analyses that contributed to this research.

P14 The impact of audit on CNS team development

In 2011 the Hospice Clinical Nurse Specialist (CNS) team were facing a significant increase in patient referrals numbers (approximately 70 per month). The demand for community based care, rather than...

Reducing unplanned care: a new paradigm

Each local healthcare economy faces a challenge. The rising numbers of accident and emergency (A&amp;E) attendances and emergency hospital admissions (unplanned care) are neither affordable, nor desirable. The current financial climate has only increased this challenge. Local healthcare economies now not only need to reduce the total number of each from one financial year to the next, but to do this in an absence of ideas and approaches that work. Data analysis from NHS Wakefield District has been used to inform a new paradigm on how the total levels of unplanned care are viewed and understood. The analysis shows that local healthcare economies should embrace at least two main findings, if they are to reduce the totals. The first is to work from the basis that the totals for unplanned care in any financial year are driven by the number who experience them, rather than by the number who have more than one unplanned event in a year. The second specifically concerns emergency admissions. Individuals who experience an admission in a financial year are unlikely to have experienced one in those before it.

White Paper Report of the 2010 RAD-AID Conference on International Radiology for Developing Countries: Identifying Sustainable Strategies for Imaging Services in the Developing World

The 2010 RAD-AID Conference on International Radiology for Developing Countries was a multidisciplinary meeting to discuss data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services reduce health care quality. The theme of this year's conference was sustainability, with a focus on establishing and maintaining imaging services in resource-limited regions. Conference presenters and participants identified 4 important components of sustainability: (1) sustainable financing models for radiology development, (2) integration of radiology and public health, (3) sustainable clinical models and technology solutions for resource-limited regions, and (4) education and training of both developing and developed world health care personnel.

Collaboration across primary and secondary care dermatology services

Purpose: The paper demonstrates the complexities of leadership in a local health-care community across primary and secondary care interface, using the example of a general practitioner (GP) with a special interest role (GPwSI) in dermatology. It focuses on how the service will develop and how it could be achieved. Design: Various models and theories about change management were consulted focusing particularly on the goals of the local health-care economy, resources available and environment/contextual surroundings. Practical implications: Primary care trusts (PCTs), acute trusts and clinicians need to work collaboratively to achieve an integrated, flexible care pathway, so that patients and the PCTs can be assured of an efficient and good quality service. Conflicts between primary and secondary care dermatology services are not sustainable for a long period. Originality: The Government's agenda is a shift of care closer to people's homes, so PCTs do need to be aware of what they wish to commission, and consider moving traditional hospital-based facilities into community settings, such as walk-in centres, polyclinics and large health centres, associated with improved GP and patient education on skin problems.