Readmission Rates For Patients Research Articles

Abstract 13938: Trends in In-Hospital Implantation of Implantable Cardiac Monitors in the Unites States: 2016-2019

Introduction: Implantable cardiac monitors (ICM) are widely employed for long-term cardiac rhythm monitoring. While a majority of ICMs are implanted on an outpatient basis, national estimates on their use in the inpatient setting are lacking. Methods: The National Inpatient Sample and the National Readmission Database were queried to identify inpatient ICM implantations between 2016 and 2019. Baseline characteristics, in-hospital outcomes, readmission rates, and trends over time were assessed for the study population and compared between the largest diagnostic cohorts: neurologic and cardiac. Results: A total of 101,430 adults underwent in-hospital ICM implantation between 2016 and 2019 (52.9% neurologic, 39.2% cardiac). Patient characteristics and outcomes are shown in Table 1. There was a 170% increase in inpatient ICM procedures from 2016 to 2019. Significant changes in patient profiles and readmission rates were observed over the study period. The trends are shown in Table 2a. After adjusting for confounders, patients with cardiac indications were more likely to have complications and be readmitted, but had lower mortality, length of stay, and hospitalization cost compared with the neurology cohort. The ORs are shown in Table 2b. Conclusions: The number of inpatient ICM implantations has increased significantly, likely reflecting expanding indications. The profiles of patients receiving ICM also changed to include more primary neurologic indications, comorbidities, and non-white races. Small and medium sized hospitals performed the procedure more frequently. Complication rates were extremely low and remained constant during the study period.

Abstract 14806: Rate of In-Hospital Initiation of SGLT2 Inhibitors Remains Low Despite Reduction in Rate of 30-Day Readmission From Heart Failure Exacerbation

Introduction: Heart failure (HF) management guidelines recommend starting SGLT-2 inhibitors (SGLT2i) for symptomatic HF to reduce rates of HF hospitalization and cardiovascular mortality. However, in-hospital initiation of SGLT2i for titration has yet to be strongly recommended. In this study, we sought to evaluate the effect of in-hospital initiation of SGLT2i on the rate of 30-day HF-related readmission from an index admission for HF exacerbation at the University of Vermont Medical Center (UVMMC). Hypothesis: Patients who are admitted for an HF exacerbation who are discharged on SGLT2i from their index admission are less likely to be readmitted from an HF-related cause within 30 days of discharge compared to patients who are not started on an SGLT2i, though a minority of eligible patients will be started on SGLT2i during this time. Aims: The aims of this study are to 1) compare 30-day HF-related readmission rates between patients discharged on SGLT2i during their index admission, and patients not on SGLT2i, and 2) describe the proportion of patients not currently on SGLT2i who appear to be eligible. Methods: We conducted a chart review of 122 patients admitted to UVMMC from July to December 2022 with an HF exacerbation. We recorded patient and index admission descriptors, including ejection fraction, other GDMT (BB, RAASi, MRA), comorbidities, demographics, and admission duration. We then determined if 1) an HF-related readmission occurred within 30 days, 2) the patient was an acceptable candidate for SGLT2i, and 3) SGLT2i was present on discharge. Results: Among 122 patients admitted with an HF exacerbation at UVMMC, the 30-day HF-related readmission rate of patients discharged on SGLT2i was 3.7%, compared to 8.5% for patients not started on SGLT2i. Of these 122 patients, while 116 (95.1%) were acceptable candidates for SGLT2i, only 27 (23.3%) were discharged on SGLT2i, with 8 more (6.9%) eventually started on SGLT2i. Conclusions: Our review affirms guidelines that recommend starting SGLT2i in patients with symptomatic HF to reduce rates of HF hospitalization. Despite these guidelines, adoption rates remain low due to a variety of factors. Improving in-hospital SGLT2i initiation rates would benefit HF patients and the healthcare systems that support them.

Natriuretic Peptides and Need for Reliable Tool to Assess Pulmonary Congestion for Treatment Monitoring in Heart Failure.

Natriuretic peptides (NPs) play a significant role in the pathophysiology of heart failure (HF) and are considered reliable diagnostic and prognostic indicators of congestive HF. Pulmonary congestion in HF patients leads to clinical deterioration and hospitalizations. It remains an important aspect to address the management and treatment tailoring in HF patients. However, the role of NP-guided therapy remains debatable due to contrasting reports in the literature. Current guidelines do not recommend the use of NP-guided therapy in the treatment monitoring of HF. Therefore, there is an urgent need to identify reliable markers for treatment monitoring in congestive HF. For early detection of congestion, a technology-based approach to monitor pulmonary hemodynamics and absolute lung fluid measurement is found to be effective in guiding treatment. Remote dielectric sensing technology is one such non-invasive approach that measures pulmonary fluid levels in the lungs which results in reduced hospitalization and re-admission rate in HF patients. In this review, we summarized the role of natriuretic peptides and the need for a reliable tool to assess pulmonary congestion for treatment monitoring in HF.

Remote monitoring after hospital discharge.

561 Background: Strategies to improve transitions from the hospital to home for patients with cancer are considered an important component of quality, patient-centered care in oncology. CMS evaluates cancer hospital performance based on the 30-day unplanned hospital readmission rate, and this measure has been endorsed by the National Quality Forum. Nationally, the 30-day readmission rate for oncology patients ranges from 19%-27%. These readmissions come at high psychosocial, physical, and financial costs for patients and caregivers. A remote monitoring intervention that includes frequent contacts with the patient is likely to be effective in improving this transition. Methods: We evaluated the feasibility, acceptability, and perceived value of a mobile health intervention to monitor and manage symptoms of adult medical oncology patients discharged from an NCI-designated cancer center to home. Patients were monitored for 10 days, which is the median time to readmission for an oncology patient. The technology supporting the program included: 1) a patient portal enabling daily electronic patient-reported outcomes assessments; 2) alerts for concerning symptoms; 3) an application to allow staff to review and trend symptom data; 4) a secure platform to support communications and televisits between staff and patients; 5) an advanced feedback report to provide just-in-time patient symptom education. Feasibility and acceptability were evaluated through engagement (goal: >50% response rate) and symptom alerts and perceived value was measured through a patient engagement survey that included a net promoter score (how likely the patient is to recommend the program to similar patients; goal >0.70). Results: Between January 1, 2021 to December 31, 2022, the program enrolled 2,258 medical oncology patients (median age: 63 years, 55% female). Patients with gastrointestinal (25%) and thoracic (19%) malignancies were the most prevalent diagnoses. Of those enrolled, 66% of patients participated in home remote monitoring by self-reporting symptom data and 49% of patients generated a severe symptom alert. The most prevalent severe symptom alerts were pain (24%), constipation (7%), and fatigue (7%). Patients expressed a great deal of satisfaction with the intervention with a net promoter score of 0.86. In preliminary analysis, we found that 30-day readmission decreased by 3% (from 33% to 30%) representing savings of $2.3 - $5.8 MM annually. Conclusions: A remote monitoring program after discharge was feasible, acceptable, and perceived to be of value by oncology patients discharged from a cancer center. Future work will evaluate the value of a remote symptom monitoring platform in decreasing readmissions.

Gender disparities, causes and predictors of immediate and short-term cardiovascular readmissions following COVID-19-related hospitalisations in the USA

ObjectivesIn this study, we aimed to identify the causes, predictors and gender disparities of 30-day and 90-day cardiovascular readmissions after COVID-19-related hospitalisations using National Readmission Database (NRD) 2020.SettingWe used the...

Mechanical thrombectomy is associated with shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis.

To determine if mechanical thrombectomy (MT) for submassive pulmonary embolism (PE) positively impacts length of hospital stay (LOS), intensive care unit stay (ICU LOS), readmission rate, and in-hospital mortality compared with conservative therapy. This was a retrospective review of all patients with submassive PE who either underwent MT or conservative therapy (systemic anticoagulation and/or inferior vena cava filter) between November 2019 and October 2021. Pediatric patients (age <18) and those with low-risk and massive PEs were excluded from the study. Patient characteristics, comorbidities, vitals, laboratory values (cardiac biomarkers, hospital course, readmission rates, and in-hospital mortality) were recorded. A 2:1 propensity score match was performed on the conservative and MT cohorts based on age and the PE severity index (PESI) classification. Fischer's exact test, Pearson's χ2 test, and Student's t-tests were used to compare patient demographics, comorbidities, LOS, ICU LOS, readmission rates, and mortality rates, with statistical significance defined as P < 0.05. Additionally, a subgroup analysis based on PESI scores was assessed. After matching, 123 patients were analyzed in the study, 41 in the MT cohort and 82 in the conservative therapy cohort. There was no significant difference in patient demographics, comorbidities, or PESI classification between the cohorts, except for increased incidence of obesity in the MT cohort (P = 0.013). Patients in the MT cohort had a significantly shorter LOS compared with the conservative therapy cohort (5.37 ± 3.93 vs. 7.76 ± 9.53 days, P = 0.028). However, ICU LOS was not significantly different between the cohorts (2.34 ± 2.25 vs. 3.33 ± 4.49, P = 0.059). There was no significant difference for in-hospital mortality (7.31% vs. 12.2%, P = 0.411). Of those that were discharged from the hospital, there was significantly lower incidence of 30-day readmission in the MT cohort (5.26% vs. 26.4%, P < 0.001). A subgroup analysis did not demonstrate that the PESI score had a significant impact on LOS, ICU LOS, readmission, or in-hospital mortality rates. MT for submassive PE can reduce the total LOS and 30-day readmission rates compared with conservative therapy. However, in-hospital mortality and ICU LOS were not significantly different between the two groups.

30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

Congestive Heart Failure in the Light of Ancient Wisdom of Unani Medicine: A Review

Congestive heart failure is a complex clinical syndrome that causes functional impairment of ventricular filling and ejection of blood. It can cause dyspnea, fatigue, and fluid retention, affecting exercise tolerance and causing pulmonary and peripheral edema. Moreover, it is a burgeoning and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. Worldwide congestive heart failure affects more than 64 million people. Nowadays: congestive heart failure is correlated with Suqūṭ-e-Qalb Imtilāʼī, by modern Unani physicians. However, the disease is mentioned in classical Unani literature under the headings of Ikhtilāj-e-qalbi (arrhythmia), Rabw (cardiac asthma), Buhr (cardiac asthma), Khafaqān (palpitation), Istisqā’ Laḥmī (anasarca), Du‘f al-Qalb (weakness of heart), Intiṣāb al-Nafas (orthopnoea), Sudda-e-Urooq-e-Qalb (coronary artery obstruction), Ghashī (syncope), Tasallub-al- Sharāyīn (arteriosclerosis) and Imtilā’ bi Hasbil Aw’iya (congestion of blood vessels). Congestive heart failure and mortality are on the rise despite the significant advancements in contemporary medicine and guidelines directed medical therapy for congestive heart failure. Congestive heart failure hospitalizations make up 1-2% of Western hospital admissions, with the highest 30-day readmission rate (20-25%) in congestive heart failure patients reflecting due to high comorbidity burden. Unani drugs, despite advancements in modern medicine, still significantly impact patient health. They are traditionally used for cardiac ailments like palpitations, coronary artery disease, heart weakness, and cardiotonic. Unani medicine especially Khamīrajat (fermented confections) used in various cardiac diseases is cardio-protective and cardiotonic. According to reports, complementary and alternative medicine is used by up to 61% of cardiac patients with coronary artery disease and those at risk for arteriosclerosis. Therefore, a thorough evaluation of the Unani literature on cardiac illness and its treatment in the Unani system of medicine is needed to decrease congestive heart failure social and economic burdens have become a major global public health priority. This review is an effort to summarize the Unani classical literature on congestive heart failure.

Feasibility Study Of M-Health Transition Care Program For Traumatic Brain Injury Caregivers

Background: Caring in discharge transition for patients with moderate to severe traumatic brain injury (TBI) has impacted caregivers. MHealth has become popular for communication between a patient/caregiver and a health profession integrated into numerous public well-being programs in low-middle income countries but is limited for TBI caregivers.&#x0D; Purpose: This study aims to assess the feasibility of the mHealth supportive care transition program based on transitional care theory for improving discharge readiness and reducing caregivers' transition stress and burden of caregiving and the patient's readmission rate.&#x0D; Methods: Seven family caregivers who met inclusion criteria were recruited. The mHealth supportive care transition program includes education and face-to-face information assisted by an android-based application, skill demonstration, assessment of the readiness of hospital discharge, and weekly monitoring and follow-up after the patient's discharge is given. The outcomes were evaluated using a validated and standardized scale designed to measure transition stress and the burden of caregiving at the baseline, two weeks, and one-month post-discharge, including the patient's readmission one month (within 28 days) after discharge. Feedback through the mHealth satisfaction questionnaire on the trial feasibility was also collected.&#x0D; Results: The initial findings showed that all subjects experienced a decrease of stress transition and caregiver burden at two weeks and one-month post-discharge follow-up. High satisfaction scores on mHealth were also reported and no patient was readmitted within 28 days.&#x0D; Conclusion: This feasibility study showed the mHealth supportive care transition program is feasible for implementation, but it is required to test the effectiveness in the next phase on RCT with a larger sample size.

Rehospitalisation rates after long-term follow-up of patients with severe mental illness admitted for more than one year: a systematic review

AimsThis study aimed to conduct a systematic review of studies on the outcomes of long-term hospitalisation of individuals with severe mental illness, considering readmission rates as the primary outcome.MethodsStudies considered were those in which participants were aged between 18 and 64 years with severe mental illness; exposure to psychiatric hospitals or wards was long-term (more than one year); primary outcomes were readmission rates; secondary outcomes were duration of readmission, employment, schooling, and social participation; and the study design was either observational or interventional with a randomised controlled trial (RCT) design. Relevant studies were searched using MEDLINE, PsycINFO, Web of Science, CINAHL, and the Japan Medical Society. The final search was conducted on 1 February 2022. The risk of bias in non-randomised studies of interventions was used to assess the methodological quality. A descriptive literature review is also conducted.ResultsOf the 11,999 studies initially searched, three cohort studies (2,293 participants) met the eligibility criteria. The risk of bias in these studies was rated as critical or serious. The 1–10 years readmission rate for patients with schizophrenia who had been hospitalised for more than one year ranged from 33 to 55%. The average of readmission durations described in the two studies was 70.5 ± 95.6 days per year (in the case of a 7.5-year follow-up) and 306 ± 399 days (in the case of a 3–8-year follow-up). None of the studies reported other outcomes defined in this study.ConclusionsThe readmission rates in the included studies varied. Differences in the follow-up period or the intensity of community services may have contributed to this variability. In countries preparing to implement de-institutionalisation, highly individualised community support should be designed to avoid relocation to residential services under supervision. The length of stay for readmissions was shorter than that for index admissions. The results also imply that discharge to the community contributes to improved clinical outcomes such as improved social functioning. The validity of retaining patients admitted because of the risk of rehospitalisation was considered low. Future research directions have also been discussed.

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.

Effect of extended pharmacist involvement in discharge transitions of care on hospital readmission rates: Prospective, randomized, parallel arm design trial

AbstractPharmacist involvement in transitions of care has been shown to improve patient outcomes and reduce readmission rates. Pharmacists reduce medication errors at discharge by ensuring all home medications continued are appropriate, provide pharmacist discharge patient medication education on new and existing medications therapies, and evaluate the safety and efficacy of the patient's medication therapy in order to decrease readmission rates. Results from this study may provide a financial benefit for hospital reimbursement by reducing 30 day readmission rates. The primary outcome was the comparison of composite emergency department (ED) and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus standard of care. Patients 18 years of age and older with a readmission risk score of 25 or greater, and admitted on general medicine floors from November 1, 2022 through February 28, 2023 were included. Patients were randomized into a standard of care (SOC) or extended SOC group. The primary outcome was the comparison of composite ED and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus SOC. A key secondary outcome included number of drug‐related problems identified and resolved. The primary outcome was analyzed using chi‐squared analysis (alpha of 0.05) and secondary outcomes as descriptive statistics. Data was analyzed using Stata® 16.1 statistical software. Two hundred and ninety‐six patients were included for analysis with 148 patients in both extended SOC and SOC groups. Extended SOC decreased the composite 30 day ED visit and hospital readmission rate by 7% (p = 0.63). Extended SOC group decreased 30 day ED visits by 4.9% and inpatient 30 day readmissions by 8.2% analyzed using descriptive statistics. Patients in extended SOC group resulted in a non‐statistical decrease in ED visits and inpatient readmissions 30 days after discharge compared to SOC group.

Oral anticoagulation in heart failure complicated by atrial fibrillation: A nationwide routine data study

BackgroundThis nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints. MethodsAnonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017–2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91–365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. Results180,316 cases were included [81 years (IQR 76–86), 55.6% female, CHA2DS2-VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75–0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71–0.76]; FXaI: HR 0.77, [0.75–0.78]; DTI: HR 0.71, [0.66–0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65–0.77]) was lower with OAC. ConclusionsNationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority.

Weekend Discharge Is Not Associated With Increased Readmission After Hyperthermic Intraperitoneal Chemotherapy

IntroductionWe explored the association between weekend discharge and 30- and 90-d readmission rates in patients undergoing hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. MethodsThe US HIPEC Collaborative database, comprised of a longitudinal cohort of patients undergoing CRS/HIPEC for peritoneal carcinomatosis at twelve academic institutions between 2000 and 2017, was queried for date of discharge information. Patients were retrospectively divided into weekday and weekend/holiday discharge groups. Patients <18 y old, lacking day of discharge information, or who experienced intraoperative/in-hospital mortality were excluded. Comparisons were made between patients discharged on a weekday versus those discharged on a weekend or major holiday. Results1415 patients met inclusion criteria for the study: 1108 (78%) patients with a weekday discharge and 308 (22%) with a weekend/holiday discharge. Median age at time of surgery was 55 y (Interquartile Range: 46-63); 59% (n = 841) patients were female, 25% (n = 328) of patients had high volume disease (defined as a peritoneal cancer index >20 intraoperatively), and 92% (n = 1210) of patients had a complete cytoreduction (defined as a completeness of cytoreduction score of 0 or 1). Overall, 15% (n = 218) of patients were readmitted within 30 d and 19% (n = 265) within 90 d. In a linear mixed effects model, weekend discharge was not associated with higher 30- or 90-d readmissions (P = 0.291, P = 0.743). ConclusionsWeekend discharges are safe following CRS/HIPEC. Length of stay initiatives should focus on discharging the patient when medically ready, rather than avoiding weekend discharge out of an abundance of caution.

SAT130 Examining Rates Of Post-hospital Discharge Follow-up In An Endocrinology Clinic

Abstract Disclosure: T. Khan: None. A.M. Kumar: None. A. Champion: None. K.E. Izuora: None. Introduction: Outpatient follow up following hospital discharge is a critical factor in improving overall health outcomes especially among patients with chronic medical conditions. Previous research has demonstrated improved patient outcomes and lower readmission rates in patients with outpatient follow up after hospital discharge. In this single center QI project, we sought to understand the follow-up rate and the reasons for not following up among our patient population. Methods: This study is a root cause analysis following the Plan-Do-Study-Act cycle. All the patients seen by the UNLV inpatient endocrinology consult service in June and July 2022 were recorded. Patients discharged to hospice or discharged after July 31, 2022 were excluded from the study. After December 1, 2022 the number of patients that followed up at UNLV endocrinology clinic from the list was recorded. All patients that met inclusion criteria for the study and did not follow up at UNLV endocrinology clinic were contacted by phone and reason for not following up was recorded. Results: Over the 2 months of recruitment, 74 patients were consulted on by the endocrinology service and 67 met study inclusion criteria. From this group, only 13 patients had established follow-up care at the UNLV endocrinology clinic. From the remaining 54 patients, 5 had died. The 49 remaining patients who met criteria for the study but did not follow up were contacted via telephone (3 attempts). Of this, 8 patients either did not answer phone calls three separate times or did not have an active listed phone number. Of the 41 patients contacted, the most frequent reason for not following up was inability to contact the clinic (6 patients, 14.6%), unawareness of need for follow-up (5 patients, 12.2%), prior established endocrinology care outside of UNLV (5 patients, 12.2%), no indication for follow-up (5 patients, 12.2%), and PCP managing the condition (5 patients, 12.2%). Of the remaining, 4 patients were not instructed to follow up, 3 patients had insurance not accepted at the UNLV endocrinology clinic, 2 patients were unable to get a convenient appointment and 2 patients established care at other endocrine clinics. The following reasons for not following up were given by one patient per category: leaving the city, discharge to prison, appointment canceled by the clinic, and refusing to answer any questions. Conclusion: From these responses, we can formulate methods to improve clinic follow-up after clinic discharge. The primary method to improve clinic follow-up after hospital discharge is to improve ease of contact with the clinic such as ensuring phone lines are adequately attended. An additional measure would be to stress need for follow-up at time of hospital discharge in addition to having printed instructions for clinic follow-up in the discharge paperwork. Presentation: Saturday, June 17, 2023

The association of marital status with kidney cancer surgery morbidity - a retrospective cohort study.

To better understand whether the marital status impacts 90-day postoperative outcomes following kidney cancer surgery. We performed a retrospective cohort study of adult patients undergoing elective partial or radical nephrectomy to manage kidney masses from 2003 to 2017 using the Premier Hospital Database, a national hospital discharge dataset. Multinomial logistic regression models controlling for a wide range of clinicodemographic, surgical, and hospital characteristics were used to assess an association between marital status and postoperative complications. The primary outcome was 90-day complications, including minor complications (Clavien grades 1-2), non-fatal major complications (Clavien grades 3-4), and mortality (Clavien grade 5). Secondary outcomes included patient disposition and readmission rates. The study cohort comprised 106,752 patients, of which 61,188 (57.32%) were married. The overall incidence of minor complications, major complications, and death was 24.04%, 6.00%, and 0.71%, respectively. Marriage was associated with a significantly lower incidence of minor (RR 0.97; 95% CI: 0.94-0.99) complications following open or radical nephrectomy and major complications (RR 0.89; 95% CI: 0.84-0.95) for all surgical types and approaches. There was no association between marital status and mortality (RR 0.94; 95% CI: 0.81-1.10). Marriage is associated with a significant reduction in major complications following kidney cancer surgery, likely because it is associated with greater social support, which is beneficial in the postoperative phase of care. Marital status and social support may play a role in the preoperative decision-making process and counseling for patients considering kidney cancer surgery.

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

Congestive Heart Failure Readmission Rates Decline After Patient Navigator Implementation in COVID-19 Era

Heart failure is a leading cause of hospitalizations, with a growing prevalence and a high readmission rate. Hospitalization and readmission affect both patient stress and hospital finances. The COVID-19 pandemic and broader economic conditions placed additional stress on hospitals in recent years. In response, our hospital implemented a heart failure navigator program during the COVID-19 pandemic to prevent readmissions. We monitored the readmission and mortality rates of patients hospitalized for heart failure in 2018 and 2019 (before implementation) against 2020 and 2021 (after implementation). There were 235 readmissions with 28 deaths before implementation and 156 readmissions with 17 deaths after implementation. The reduction in readmission was significant (p = .0185), with an insignificant reduction in mortality (p = .2674). This indicates that the reduction in readmission rate was secondary to navigator implementation, not patient mortality. In conclusion, a multifactorial HF navigator can reduce HF readmission, even when implemented during a pandemic that causes increased patient morbidity.

Machine Learning Algorithms for COPD Patients Readmission Prediction

Abstract: Patients' readmission might be seen as a crucial aspect in lowering costs while maintaining high-quality patient care. As a result, anticipating and reducing readmission rates for patients will considerably enhance healthcare delivery. The goal of this research is to use machine learning algorithms to predict readmission of COPD (Chronic Obstructive Pulmonary Disease) patients. The major metrics for measuring models' prediction capability in each time frame were Area under Curve (AUC) and Accuracy (ACC). Then, the factors' relevance for each result was clearly recognized, and specified key variables were discriminated. With%91 ACC, our research had the best accuracy in predicting readmission

Assessing the impact of recovery housing on healthcare utilization in Portland, Oregon

IntroductionCentral City Concern (CCC) operates several recovery housing sites in the Portland, Oregon metropolitan region, including the Blackburn Center (Blackburn) and the Richard L. Harris Building (Harris). This retrospective, observational study was designed to assess recovery housing's impact on inpatient detoxification readmission rates and healthcare utilization patterns. MethodsOur study population consisted of individuals discharged from CCC's Hooper Detox Stabilization Center from June 2019 to September 2020. A total of 75 clients housed at Blackburn, 63 clients housed at Harris, and 57 clients discharged as unhoused were included in the study sample. Using logistic regression for each of the two recovery housing groups relative to the unhoused group, we examined differences in readmissions to inpatient detoxification after their qualifying discharge. We then used Difference-In-Difference model to compare the per member per year (PMPY) use of different domains of health care before and after their qualifying discharge. ResultsCompared to clients discharged as unhoused, Blackburn and Harris residents had lower risk of readmissions to inpatient detoxification treatment at 90- and 180-days post-discharge. Additionally, while the mean number of PMPY emergency department visits increased for clients discharged as unhoused in the post period, the average number of emergency department visits decreased for clients who obtained recovery housing at Blackburn (DiD=-3.65 PMPY, p-value=0.02) and at Harris (DiD=-3.87 PMPY, p-value=0.01). ConclusionFindings highlight the impact and importance of recovery housing for individuals managing a substance use disorder and the value of healthcare system and public sector investment housing like Blackburn and Harris.