Prevention Of Rehospitalization Research Articles

Abstract 10932: Prediction of 30-Day Hospital Readmission in High-Risk Atherosclerotic Cardiovascular Disease Patients Using Machine Learning Methods on Electronic Health Record Data from Medical Information Mart for Intensive Care-3 Database

Introduction: Despite significant therapeutic advancements, Atherosclerotic Cardiovascular Disease (ASCVD) patients require frequent hospitalization. Machine learning (ML) algorithms present an opportunity to develop improved and more generalizable prediction models for 30-day hospital readmission due to ASCVD. Objectives: The current study aims to leverage electronic health record (EHR) data to predict 30-day hospital readmission in high-risk ASCVD patients. Methods: This study utilized the MIMIC III database (a publicly available large, single-centre critical care database of 46,520 patients) comprising of deidentified ~60,000 ICU admissions. Adult patients with the first admission due to ASCVD event and whose length of stay (LOS) in the ICU was >48 hours were included. To develop a prediction model, features representing groups of diagnosis data along with demographics and length of stay in the hospital were used. The performance of ML models was evaluated using the area under the receiver operating characteristic curves (AUCs). Results: Our cohort consisted of 22,666 admissions (mean age 70.1 years) due to an ASCVD event. Out of the 9022 readmissions within 180 days, 60.5% were observed within 30 days of discharge. Among the 17 prospective predictors age, LOS and first hospitalization due to coronary atherosclerosis, heart failure, and haemorrhage issues were the most important factors to predict readmission within 30 days (Fig A). Random Forest was the best performing model with an AUC of 0.66 (Fig B). Conclusions: This model can be helpful in predicting the readmission of high-risk patients after the first ASCVD event which might address the huge unmet need of aiding healthcare resource planning, better patient care, and prevention of rehospitalization and death by intensifying treatment interventions in those patients and taking appropriate decisions to discharge patients based on their age, LOS and ASCVD events resulting in first hopitalization.

Heart failure re-hospitalization differently affects the following mortality in patients with reduced, mid-range and preserved LVEF

Abstract Introduction The recent advances in the treatment for heart failure with reduced ejection fraction (HFrEF) have been remarkable, while no therapy has convincingly improved the prognosis in HF patients with preserved (HFpEF) and mid-range (HFmrEF) ejection fraction. Frequent decompensations of HF lead to progressive deterioration of cardiac and renal function, and quality of life. Hence, prior studies have reported that the mortality of HFrEF patients increases as hospitalization for HF repeats. However, it is still unclear whether this trend applies for HFpEF and HFmrEF patients. Purpose We aimed to compare the prognostic impact of re-hospitalization due to HF on cardiovascular death (CVD) among HFrEF, HFmrEF and HFpEF patients. Methods This observational study included 1,930 consecutive patients who were hospitalized for worsening of HF and discharged alive. Of them, patients who have never or have not been hospitalized for HF at least last 2 years, were finally analyzed. Patients were consisted of the population with HFrEF (EF<40%, n=421), HFmrEF (EF 40–49%, n=202) and HFpEF (EF>50%, n=291). Patients in each EF-classified population were divide into 2 subgroups based on whether patients were re-hospitalized for HF during the observational period, respectively. The primary endpoint of this study was CVD. Results During the observation period, Kaplan-Meier analysis showed that patients who were re-hospitalized for HF had higher event rate of CVD in HFrEF group (Log-rank p=0.008, Figure). Even after adjusting with multivariate covariates including age, sex, EF, brain natriuretic peptide and estimated glomerular filtration rate, re-hospitalization for HF was an independent predictor for CVD in HFrEF group (HR: 1.95, 95% CI: 1.11–2.86, p=0.029). However, in HFmrEF group and HFpEF group, there was no significant difference in the rates of CVD between 2 subgroups divided whether patients were re-hospitalized for HF or not (p=0.91, p=0.34, respectively). Conclusion Re-hospitalization for HF affected the CVD rate in HFrEF group, but not in HFmrEF and HFpEF groups. The prevention of re-hospitalization for HF is important particularly in HFrEF patients in order to improve cardiovascular mortality. Funding Acknowledgement Type of funding sources: None.

Electronic Assisted Living Technology in CCRC, Assisted Living, and In-Home Care

A qualitative study based on structured interviews with 21 healthcare leaders from CCRC’s, In-Home Care Agencies, or Medicare PACE facilities was conducted. Implications of electronic assisted living technologies on caregiver workforce were assessed. The use of assisted living technology was shown to have implications for workforce support and the alleviation of demands on caregivers. Communication and assessment tools were also found to be useful in the reduction of caregiver stress. There is optimism regarding the effectiveness of high-tech platforms in easing caregiver burden but there is skepticism about the return on investment given the initial cost and time needed for onboarding and data organization. The lack of user-friendliness and the required time to train to use tech are also barriers. The use of technology for remote check-ins and to monitor vitals is desirable. Also predicting dementia risk and monitoring for wandering are other opportunities for tech adoption. The enthusiasm for technology is tempered with caution for who will keep tabs on remote monitoring and who bears the responsibility to respond to the information gathered. Labor shortages, time constraints, and disorganized documentation are incentives for tech adoption. High-tech solutions for would ideally be user-friendly and help reduce staff demands. Except for the prevention of re-hospitalization by monitoring vitals the benefits of adopting new tech are not perceived as cost-effective.

Nurse-Led Collaborative Management Using Telemonitoring Improves Quality of Life and Prevention of Rehospitalization in Patients with Heart Failure.

The effects of disease management using telemonitoring for patients with heart failure (HF) remain controversial. Hence, we embedded care coordination and enhanced collaborative self-management through interactive communication via a telemonitoring system (collaborative management; CM). This study evaluated whether CM improved psychosocial status and prevented rehospitalization in patients with HF in comparison with self-management education (SM), and usual care (UC).We randomly allocated 59 patients into 3 groups; UC (n = 19), SM (n = 20), and CM (n = 20). The UC group received one patient education session, and the SM and CM groups participated in disease management programs for 12 months. The CM group received telemonitoring concurrently. All groups were followed up for another 12 months. Data were collected at baseline and at 6, 12, 18, and 24 months.The primary endpoint was quality of life (QOL). Secondary endpoints included self-efficacy, self-care, and incidence of rehospitalization. The QOL score improved in CM compared to UC at 18 and 24 months (P < 0.05). There were no significant differences among the 3 groups in self-efficacy and self-care. However, compared within each group, only the CM had significant changes in self-efficacy and in self-care (P < 0.01). Rehospitalization rates were high in the UC (11/19; 57.9%) compared with the SM (5/20; 27.8%) and CM groups (4/20; 20.0%). The readmission-free survival rate differed significantly between the CM and UC groups (P = 0.020).We conclude that CM has the potential to improve psychosocial status in patients with HF and prevent rehospitalization due to HF.

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders

Adjunctive probiotic microorganisms to prevent rehospitalization in patients with acute mania: A randomized controlled trial.

Immunological abnormalities play a role in the pathophysiology of mania and have been associated with relapse. Probiotic organisms such as Lactobacilli and Bifidobacteria modulate inflammation in humans and animal models. The trial examined whether the administration of probiotic organisms prevents psychiatric rehospitalizations in patients recently discharged following hospitalization for mania. Patients hospitalized for mania (N=66) were randomized after discharge to receive 24weeks of adjunctive probiotics (Lactobacillus rhamnosus strain GG and Bifidobacterium animalis subsp. lactis strain Bb12) or adjunctive placebo in a parallel two-group design format. The effect of treatment group on the risk of rehospitalization was calculated using Cox regression models. The modulating effect of systemic inflammation was measured employing an inflammation score based on immunoglobulin levels directed at previously defined antigens. During the 24-week observation period there were a total of 24 rehospitalizations in the 33 individuals who received placebo and eight rehospitalizations in the 33 individuals who received the probiotics (z=2.63, P=.009). Hazard functions indicated that the administration of the probiotics was associated with a significant advantage in time to all psychiatric rehospitalizations (hazard ratio [HR] =0.26, 95% confidence interval [CI] 0.10, .69; P=.007). Probiotic treatment also resulted in fewer days rehospitalized (mean 8.3 vs 2.8days for placebo and probiotic treatment, respectively; χ2 =5.17, P=.017). The effect of the probiotic treatment on the prevention of rehospitalization was increased in individuals with elevated levels of systemic inflammation at baseline. Probiotic supplementation is associated with a lower rate of rehospitalization in patients who have been recently discharged following hospitalization for mania.

Prevention of Rehospitalization in Non-Compliant Patients Utilizing Transitional Care Program (TCM): A Bundle Payment Care Initiative (BPCI Model 3) Case Study

Prevention of Rehospitalization in Non-Compliant Patients Utilizing Transitional Care Program (TCM): A Bundle Payment Care Initiative (BPCI Model 3) Case Study

Prevention of re-hospitalization by home-based intervention and adaptive servo-ventilation therapy in a patient who experienced repeated hospitalization for decompensated heart failure

Re-hospitalization for acute decompensated heart failure (HF) carries a high risk for early mortality and impaired quality of life. In Japanese patients who were hospitalized for acute HF, 1-year all-cause mortality was 17.0%, while all-cause mortality and re-hospitalization for HF at 1 year were 31.9% [ [1] Kajimoto K. Sato N. Takano T. Association of age and baseline systolic blood pressure with outcomes in patients hospitalized for acute heart failure syndromes. Int. J. Cardiol. 2015; 191: 100-106 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ]. Post-discharge outcomes are particularly poor in older HF patients with chronic kidney disease (CKD) [ [2] Komajda M. Hanon O. Hochadel M. et al. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur. Heart J. 2009; 30: 478-486 Crossref PubMed Scopus (235) Google Scholar ]. Despite the well-understood importance of medical therapy in HF, β-blockers and renin–angiotensin system (RAS) blockers cannot be used sometimes in older patients because of poor tolerance.

Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany

The goal of this study was to prevent rehospitalizations and thus to optimize satisfaction with treatment and quality of life in patients suffering by schizophrenia or schizoaffective disorder. A complex intervention with improved cooperation between in- and outpatient services was applied to 46 "high utilizing" patients after discharge from inpatient care during an intervention phase of 6 months. The study was controlled by a matched group of 47 patients receiving treatment as usual. The intervention was based on a computerized decision support module. Eight psychiatrists in private practices were supplied with this software to obtain guideline-based recommendations according to current psychopathology and clinical state. Suggested complex interventions by the software included psychoeducation, social competence group therapy, integrated psychological therapy, computer-based cognitive training, coping skills training, sociotherapy, nursing care, home visits, social-worker care, assistance to family members, and the use of an emergency call-in line. A local hospital project team arranged specifically suggested interventions. We intended to accomplish a reduction of rehospitalization rates by 50% in the intervention group within a 12-month follow-up phase. Satisfaction with treatment, subjective quality of life, and treatment costs in terms of daily inpatient costs were compared between both groups. Moderator variables such as socio-demographical aspects or influences of certain interventions to rehospitalization rate were analyzed. The sample included patients more seriously ill than originally expected. Subjects in the control group (CG) were older (46 years) than those subjects in the intervention group (IG) (40 years). Other sociodemographical aspects (sex, family status, level of education, and number of former hospitalizations) showed no differences between both groups. The rehospitalization rate and the mean length of inpatient treatment were reduced to nearly 50% in the intervention group. The rate of readmissions increased in the control group, leading to a difference of 23% between both groups. The most important factor to favorably influence rehospitalization rates was the participation in coping skills training. There was an increase in patient satisfaction with treatment, while the subjective quality of life remained constant. Since these improvements were accomplished with lower costs (in terms of inpatient care), cost effectiveness was higher in the IG than in the CG. The most important single factor to favorably influence rehospitalization rates was the participation in coping skills training. Only the guideline consistent complex therapies as common intervention caused the significant overall result. Thereby, satisfaction with treatment increased considerably during the 6 months of intervention and remained constant during 12 months of follow up. The model project described is an important step to gain evidence and experience with integrated care for patients with schizophrenia.

Medical cost analysis of family psychoeducation for schizophrenia

Family psychoeducation has been shown to prevent the relapse of schizophrenia. However, whether medical costs are reduced by this approach remains uncertain. The subjects were patients with schizophrenia who lived with high-expressed emotion (EE) families and were at high risk of relapse. A total of 30 patients whose families underwent psychoeducation and intensive family sessions or psychoeducation and subsequent support were regarded as the psychoeducation group. A high-EE group without family psychoeducation made up of 24 patients was used as a control group. The mean outpatient medical cost, duration of hospitalization, inpatient medical cost, and total medical cost during the follow-up period were compared between the psychoeducation group and the control group. The mean inpatient medical cost was 270,000 yen in the psychoeducation group and 470,000 yen in the control group. The mean total medical costs were 500,000 yen in the psychoeducation group and 710,000 yen in the control group. The cost in the psychoeducation group was significantly lower than the control group by Mann-Whitney U-test. The proportion of patients with a total medical cost greater than the median value was 23% in the psychoeducation group and 54% in the control group with a significant difference. The medical cost can be reduced in the psychoeducation group compared with the control group due to the prevention of re-hospitalization by family psychoeducation.

Risk factors for repeated hospitalizations among home healthcare recipients.

One indicator of quality home healthcare is the prevention of rehospitalization. This study explored factors that place patients at risk for repeat hospitalizations after home healthcare admission. One year of outcomes assessment information data from a large home health agency was used to identify 7,393 patients who had at least one episode of rehospitalization. Results revealed that after the data had been adjusted for age and gender, a number of demographic, clinical, and functional factors predicted repeat hospitalizations. Home health agencies that focus on these risk factors may improve the effectiveness and efficiency of their efforts to prevent rehospitalization.

Effectiveness of case management with severely and persistently mentally ill people.

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly on estimated effectiveness. Important questions concerning the differential effectiveness of case management by specific program, worker, client, and client-worker relationship characteristics remain to be answered.

Intensive short-term treatment in a day care facility for the prevention of rehospitalization of patients in the community showing recurrence of psychotic symptoms.

Intensive short-term treatment in a day care facility for the prevention of rehospitalization of patients in the community showing recurrence of psychotic symptoms.