Readmission In Patients Research Articles

Closing the loop: Utilizing advanced practice providers for a 7-day post hospital discharge follow-up of GI oncology patients at an academic cancer center.

304 Background: Acute care visits for oncology patients may be preventable, especially for high-risk patients with a recent hospitalization. During our 2023 Fiscal Year, we observed an approximate 22% rate for 30 day readmissions for oncology patients, with our gastrointestinal (GI) oncology patients having the most readmissions, at Stanford Cancer Center. Readmission review through clinician surveys suggested that about 28% of unplanned admissions may have been preventable, with root cause analysis identifying timely access to ambulatory symptom management as a major driver. Methods: We established a cancer transitional care (CTC) clinic to provide consistent and timely post-discharge follow-up for oncology patients. We initiated a pilot program for GI oncology patients (chosen due to high acuity and readmission rate) who had an unplanned admission to Stanford Hospital. We aimed to schedule a visit with an advanced practice provider (APPs) within 7 days of discharge. The A3 problem solving process was implemented weekly by a multidisciplinary team. We created a referral in our electronic medical record. Inpatient oncology teams were instructed to place this referral within 3 days before discharge, allowing for adequate patient and family education regarding the goals of CTC visits and ample time for the post-discharge CTC visit to be scheduled prior to patient discharge. Prior to CTC visits, pharmacists performed outreach to reconcile medications to reduce medication errors. Eight oncology APPs were trained regarding the focused nature of a CTC visit, including symptom management, medication reconciliation, and goals of care discussions. Results: At baseline, from June 1 and November 30th, 2023, 61% of patients had follow-up within 7 days of discharge and 12% of patients with none. Between December 13, 2023 and April 19, 2024, CTC implementation resulted in a total of 220 referrals for GI oncology discharges, yielding 144 CTC clinic visits. Resulting in 66.1% of patients having follow up within 7 days of discharge and 9% of patients had no follow up scheduled. 79% of visits were within 7 days of discharge, representing a 29% increase in our goal scheduling timeline. The average time between discharge date and CTC visit was 6.2 days. Sixty six patients also received detailed pharmacy reviews with medication reconciliation and addressing medication access issues. Conclusions: Through our CTC clinic, we standardized post-discharge follow-up access for GI oncology patients, reducing variability in follow up. We plan to disseminate this model across medical oncology subspecialty clinics. Barriers included standardization of follow up with clinical team and expectations for the visit for both patients and clinicians. Future directions include integrating same day symptom management and urgent care access.

S1170 Factors Associated With 30-Day Hospital Readmission in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Retrospective Cohort Study

S1170 Factors Associated With 30-Day Hospital Readmission in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Retrospective Cohort Study

S1533 National Landscape of Unplanned 30-Day Readmissions in Liver Transplant Patients Undergoing ERCP: Insights from National Readmission Database

S1533 National Landscape of Unplanned 30-Day Readmissions in Liver Transplant Patients Undergoing ERCP: Insights from National Readmission Database

Factors Associated with 30-Day Readmissions after Transsphenoidal Pituitary Surgery

PurposeDetermine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery. MethodsPatients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N=83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N=174). ResultsIn a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR=2.335, 95% CI 1.050, 5.562, p=0.045). The presence of AVP deficiency increased the odds of readmission by more than 2-fold (OR=2.784, 95% CI 1.118, 7.124, p=0.029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR=0.334, 95% CI 0.134, 0.813, p=0.016), with the Southeast site being comparable to the Southwest. ConclusionOur study identifies postoperative AVP deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.

TCT-881 Factors Associated With Readmission for Patients Undergoing Transcatheter Aortic Valve Replacement With Concurrent Congestive Heart Failure: An Analysis of the National Readmissions Database

TCT-881 Factors Associated With Readmission for Patients Undergoing Transcatheter Aortic Valve Replacement With Concurrent Congestive Heart Failure: An Analysis of the National Readmissions Database

S1015 Healthcare Utilization, Risk Factors, and 30-Day Readmission of Patients With Non-Variceal Upper Gastrointestinal Bleeding in Prosthetic Cardiac Valves on Anticoagulation

S1015 Healthcare Utilization, Risk Factors, and 30-Day Readmission of Patients With Non-Variceal Upper Gastrointestinal Bleeding in Prosthetic Cardiac Valves on Anticoagulation

Community paramedicine program and outcomes of referred coronary artery bypass grafting patients.

Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure. A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care. There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar. Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals. This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

Established machine learning models to predict readmission for elderly patients with ischemic heart disease.

Established machine learning models to predict readmission for elderly patients with ischemic heart disease.

Experiences After Stroke-Who Needs An Interdisciplinary Clinic Anyway?

Abstract Background Unmet needs, including access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services (McKevitt et al.,2011). All stroke patients should be offered a structured health and social care review six-months post-diagnosis (UK Guidelines on Stroke 2016). We aim to describe patients profile including their unmet needs who attended an Interdisciplinary Stroke Clinic situated within a Dublin teaching hospital. Methods Data was collected for all patients attending an Interdisciplinary Stroke Clinic from March 2023-April 2024, including demographic information, self-reported unmet needs and residual deficits identified using modified Greater Manchester Stroke Assessment Tool (GMSAT). Access to post-acute rehabilitation was recorded. Analysis was conducted using Microsoft Excel. Results Clinic attendance: 251 patients, 13-month period (150males, 101females; mean age 68.7yrs; range 17.27-95.5yrs). Majority of patients attended their appointment alone (n=144). Ischaemic stroke was most prevalent stroke-type of attendees (n=160). Post-acute stroke rehabilitation was accessed in 27% of cases (68/251). Group mean Clinical Frailty Scale score was 3.5 (scale 0-8) equating to ‘managing well/vulnerable’. Regarding patient-reported unmet needs, the following themes were identified, mobility (18%), fatigue (13.5 %), pain (8.5%), memory (5.5%), speech (5%) and mood (3.6%). On GMSAT assessment, fatigue (64%), mobility (49%), falls (44%), dysphagia (30%) was the most frequently identified chronic issues. As a clinical-specialist lead clinic, most issues were dealt at clinic-level with physiotherapy intervention targeting mobility/gait/spasticity (45.4%) and speech and language therapy for swallow/language management (20%) initiated. Conclusion Data from this novel Interdisciplinary Stroke Clinic supports previous research indicating many stroke survivors continue to experience chronic issues, frequently mobility, swallowing and fatigue; some of which can be addressed by stroke-specific therapists. The importance of establishing clinical-specialist led post-acute stroke review clinics/pathways in the Irish setting is highlighted. Analysis of data pertaining to stroke patient readmission is underway.

Building capacity and capability for quality improvement: insights from a nascent regional health system

ObjectivesQuality improvement (QI) is critical in facilitating advancements in patient outcomes, system efficiency and professional growth. This paper aimed to elucidate the underlying rationale and framework guiding JurongHealth Campus (JHC),...

Predicting hospital readmissions in diabetes patients: A comparative study of machine learning models

Predicting hospital readmissions in diabetes patients: A comparative study of machine learning models

Outpatient Follow-Up Visits to Reduce 30-Day All-Cause Readmissions for Heart Failure, COPD, Myocardial Infarction, and Stroke: A Systematic Review and Meta-Analysis.

Hospital readmissions is an important public health problem that US hospitals are responsible for reducing. One strategy for preventing readmissions is to schedule an outpatient follow-up visit before discharge. The objective of this study was to determine whether outpatient follow-up visits are an effective method to reduce 30-day all-cause readmissions for patients discharged from US hospitals with heart failure, chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI), or stroke. We conducted a systematic review and meta-analysis to identify relevant articles published from 2013 through 2023. We searched PubMed, CINAHL, and Cochrane. Eligible studies were those that assessed the effect of postdischarge outpatient follow-up visits on 30-day all-cause readmission. We used random effect meta-analyses to generate pooled adjusted effect estimates and 95% CIs. We initially identified 2,256 articles. Of these, 32 articles underwent full-text review and 15 met inclusion criteria. Seven studies addressed heart failure, 3 COPD, 2 AMI, and 3 stroke. Ten articles provided sufficient information for meta-analysis. The pooled adjusted effect measure was 0.79 (95% CI, 0.69-0.91), indicating that outpatient follow-up visits were associated with a 21% lower risk of readmission. However, we found a high degree of between-study heterogeneity (Q = 122.78; P < .001; I2 = 92.7%). Subgroup analyses indicated that study quality, disease condition, and particularly whether a time-dependent analysis method was used, explained much of the heterogeneity. Outpatient follow-up visits are a potentially effective way to reduce 30-day all-cause readmissions for patients discharged with heart failure or stroke, but evidence of benefit was lacking for COPD and we found no studies for assessing AMI. Our results emphasize the importance of study quality.

The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review.

Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring of patients' vital signs in decreasing readmissions with a focus on a specific patient population particularly prone to rehospitalization: patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) through a comparative effectiveness systematic review. Three major electronic databases, including PubMed, Scopus, and ProQuest's ABI/INFORM, were searched for English-language articles published between 2012 and 2023. The studies included in the review employed telemedicine incorporating telemonitoring technologies and quantified the effect on hospital readmissions in the HF and/or COPD populations. Thirty scientific articles referencing twenty-nine clinical studies were identified (total of 4,326 patients) and were assessed for risk of bias using the RoB2 (nine moderate risk, six serious risk) and ROBINS-I tools (two moderate risk, two serious risk), and the Newcastle-Ottawa Scale (three good-quality, four fair-quality, two poor-quality). Regarding the primary outcome of our study which was readmissions: the readmission-related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. Fourteen studies suggested that telemedicine using telemonitoring decreases the readmission-related burden, while most of the remaining studies suggested that it had a neutral effect on hospital readmissions. Examination of prospective studies focusing on all-cause readmission resulted in the observation of a clearer association in the reduction of all-cause readmissions in patients with COPD compared to patients with HF (100% vs. 8%). This systematic review suggests that current telemedicine interventions employing telemonitoring instruments can decrease the readmission rates of patients with COPD, but most likely do not impact the readmission-related burden of the HF population. Implementation of novel telemonitoring technologies and conduct of more high-quality studies as well as studies of populations with ≥2 chronic disease are necessary to draw definitive conclusions. This study is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), identifier (INPLASY202460097).

Transitions of Care Pharmacist Impact Following Hospitalization for Acute Myocardial Infarction.

Background: Patients admitted with acute myocardial infarction (AMI) are at high risk for morbidity and rehospitalizations. Pharmacists can play a vital role in secondary prevention by providing services such as medication reconciliation and patient education upon discharge. Objective: The purpose of this study was to evaluate the impact of a pharmacist-led transitions of care (TOC) service on readmissions in patients hospitalized with AMI. Methods: This single center, pre-post observational cohort study evaluated adults with AMI who received pharmacist TOC services compared with a historical cohort who did not. Patients were excluded if they underwent cardiac surgery during admission. The primary outcome was the difference in 90-day cardiovascular (CV)-related readmissions. Secondary outcomes included 30- and 90-day all-cause readmissions, 30-day CV-related readmissions, and patients discharged on defect-free guideline-directed medical therapy (GDMT) for AMI. Results: There were 252 patients in each cohort included. No difference was found in 90-day CV readmissions, with a rate of 10.7% in the pre-TOC group versus 9.9% in the post-TOC group (OR 0.937, 95% CI [0.493, 1.769]; P = 0.842). Patients discharged on defect-free GDMT significantly increased from 61.5% pre-TOC to 87.7% post-TOC (OR 5.424, 95% CI [3.204, 9.468]; P < 0.001). There were no significant differences found in other key secondary outcomes. Conclusion and relevance: This study did not find a significant difference in hospital readmissions after implementation of a pharmacist-led TOC service. However, the service was associated with a significant increase in patients discharged on defect-free GDMT. Further studies are needed to confirm the impact of increased GDMT on clinical outcomes.

SYSTEMATIC REVIEW OF BUSINESS INTELLIGENCE AND ANALYTICS CAPABILITIES IN HEALTHCARE USING PRISMA

This systematic review explores the role of Business Intelligence and Analytics (BI&amp;A) in healthcare, focusing on its applications, benefits, and challenges. Using the PRISMA framework, a total of 52 peer-reviewed studies published between 2010 and 2023 were analyzed to identify key BI&amp;A tools, such as Clinical Decision Support Systems (CDSS), predictive analytics, and data visualization platforms, and their impact on healthcare outcomes. The findings show that BI&amp;A significantly enhances clinical decision-making, improves patient outcomes, and optimizes operational efficiency, with 19 studies highlighting the effectiveness of CDSS and 16 studies demonstrating the value of predictive analytics in reducing patient readmissions and improving early disease detection. However, challenges such as data integration issues, privacy concerns, and resistance to technology adoption were evident across 25 studies, limiting the broader adoption of BI&amp;A. The review also identifies gaps in the literature, particularly the need for more longitudinal studies and research on emerging technologies like artificial intelligence (AI) and machine learning (ML). Future research should focus on addressing these challenges to fully unlock the potential of BI&amp;A in healthcare.

Insights into the Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors for the Length of Stay and Readmission in Chronic Heart Failure Patients.

This study evaluates the prognostic relationship between NLR, PLR, and, in a specific subcohort, N-terminal pro B-type natriuretic peptide (NT-proBNP), alongside length of stay (LOS) and 90-day readmission rates in CHF patients, irrespective of heart failure phenotype. A retrospective analysis of 427 CHF admissions (males = 57.84%) was conducted. The mean age of the entire population was 68.48 ± 11.53 years. The average LOS was 8.33 ± 5.26 days, with a readmission rate of 73 visits (17.09%) for 56 patients. The NLR (3.79 ± 3.32) showed a low but positive correlation with the LOS (r = 0.222, p < 0.001). Conversely, the PLR (144.84 ± 83.08) did not demonstrate a significant association with the LOS. The NLR presented a low negative correlation for days until the next admission (r = -0.023, p = 0.048). In a prespecified subanalysis of 323 admissions, the NT-proBNP exhibited a low positive Pearson correlation with the NLR (r = 0.241, p < 0.001) and PLR (r = 0.151, p = 0.006). The impact of the NLR across heart failure phenotypes may suggest the role of systemic inflammation in understanding and managing CHF.

An analysis of length of stay and readmissions of COPD patients in the U.S. between 2010 and 2020

ABSTRACT Aim This study investigates the impact of hospital length of stay (LOS) on 30-day readmissions for Chronic Obstructive Pulmonary Disease (COPD) patients using a U.S. national dataset. It also aims to understand how discharge dispositions influence LOS and readmission risk trends and to offer valuable insights into the effectiveness of post-discharge care and its role in readmission outcomes. Methods Given the complexities of the relationship between LOS and readmissions, we employ instrumental variable (IV) analysis to mitigate potential biases. Our data cover 11 years to ensure the study's robustness and comprehensiveness. Results Our findings reveal that older, Medicare-insured patients, predominantly discharged routinely, constitute a significant portion of readmitted cases. Data visualization shows increasing readmission rates with extended LOS, particularly among patients discharged against medical advice. However, IV analysis indicates that longer LOS is associated with reduced readmission rates. Conclusions This study shows the critical role of insurance type, socio-economic factors, and hospital characteristics in determining both readmission rates and LOS among COPD patients. The results highlight the necessity for targeted interventions to reduce healthcare disparities, especially for Medicare and Medicaid beneficiaries. This study provides valuable insights for improving COPD patient care and addressing disparities in healthcare access and outcomes.

Predicting ICU Readmission from Electronic Health Records via BERTopic with Long Short Term Memory Network Approach.

Background: The increasing rate of intensive care unit (ICU) readmissions poses significant challenges in healthcare, impacting both costs and patient outcomes. Predicting patient readmission after discharge is crucial for improving medical quality and reducing expenses. Traditional analyses of electronic health record (EHR) data have primarily focused on numerical data, often neglecting valuable text data. Methods: This study employs a hybrid model combining BERTopic and Long Short-Term Memory (LSTM) networks to predict ICU readmissions. Leveraging the MIMIC-III database, we utilize both quantitative and text data to enhance predictive capabilities. Our approach integrates the strengths of unsupervised topic modeling with supervised deep learning, extracting potential topics from patient records and transforming discharge summaries into topic vectors for more interpretable and personalized predictions. Results: Utilizing a comprehensive dataset of 36,232 ICU patient records, our model achieved an AUROC score of 0.80, thereby surpassing the performance of traditional machine learning models. The implementation of BERTopic facilitated effective utilization of unstructured data, generating themes that effectively guide the selection of relevant predictive factors for patient readmission prognosis. This significantly enhanced the model's interpretative accuracy and predictive capability. Additionally, the integration of importance ranking methods into our machine learning framework allowed for an in-depth analysis of the significance of various variables. This approach provided crucial insights into how different input variables interact and impact predictions of patient readmission across various clinical contexts. Conclusions: The practical application of BERTopic technology in our hybrid model contributes to more efficient patient management and serves as a valuable tool for developing tailored treatment strategies and resource optimization. This study highlights the significance of integrating unstructured text data with traditional quantitative data to develop more accurate and interpretable predictive models in healthcare, emphasizing the importance of individualized care and cost-effective healthcare paradigms.

Factors influencing hospital readmission rates in alcohol use disorder

According to data from the Federal Statistical Office, the diagnosis of alcohol use disorder (AUD) (F10) is the second most common main diagnosis for hospital treatment. Those affected by this disorder are often repeatedly hospitalized at short intervals due to relapses; however, little is known about the factors that influence readmission rates after initial treatment. The aim of this retrospective analysis is to analyze the effects of treatment type (qualified withdrawal treatment(QE) versus physical detoxification) and discharge mode on the probability of readmission in alcohol-dependent patients after inpatient treatment. Data from 981 male and female alcohol-dependent patients who completed either qualified withdrawal treatment (QE) (68% men; mean age47.6 years) or inpatient detoxification (74% men; mean age48.0 years) were analyzed. Predictors of regular discharge were determined separately for both types of treatment using stepwise logistic regression. Patients who had completed aqualified withdrawal treatment were significantly more likely to be regularly discharged. Regular completion of the qualified withdrawal treatment (QE) led to arelative reduction in the readmission rate of 25.64% within 1 year compared to aphysical detoxification. In order to prevent readmission and chronic courses of alcohol use disorder (AUD), qualified withdrawal treatment should always be recommended to affected patients instead of physical detoxification. Aktuelle Daten des Statistischen Bundesamtes für das Jahr 2022 zeigen, dass die Diagnose "Psychische und Verhaltensstörungen durch Alkohol (F10.X)" die zweithäufigste Hauptdiagnose bei Krankenhausbehandlungen darstellt [13]. Im Gesundheitssystem entstehen durch dieses Erkrankungsbild und seine somatischen und psychischen Folgeerkrankungen jährlich ca.10 Mrd. € direkte Kosten [13]. Dieser Sachverhalt wird dadurch kontrastiert, dass die Krankenkassen die qualifizierte Entzugsbehandlung (QE) als leitliniengerechte Goldstandardtherapie [4] wiederholt infrage stellen [10].

Audit of readmissions in patients with learning disabilities

Audit of readmissions in patients with learning disabilities