Risk Of Readmission Research Articles

Health Care Resource Utilization Following Acute Myocardial Infarction: Findings from the RECORD-MI Registry

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis.

Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants. To examine hospital readmissions for infants with and without NOWS. This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024. Neonatal opioid withdrawal syndrome. Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth. Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (>36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P < .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant. In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.

Comparison of Ticagrelor with Clopidogrel on Coronary Microvascular Dysfunction Following Acute Myocardial Infarction Using Angiography-Derived Index of Microcirculatory Resistance.

This research aimed to assess the impact of ticagrelor and clopidogrel on coronary microvascular dysfunction (CMD) and prognosis following acute myocardial infarction (AMI), using the angiography-derived index of microcirculatory resistance (angio-IMR) as a non-invasive assessment tool. In this retrospective study, angio-IMR was performed to evaluate CMD before and after dual antiplatelet therapy (DAPT) with either ticagrelor (90mg twice daily, n = 184) or clopidogrel (75mg once daily, n = 72). The primary endpoint is the improvement of CMD evaluated by angio-IMR (delta angio-IMR) following DAPT. Secondary endpoints included myocardial reinfarction and readmission for heart failure during 2-year follow-up. Compared with clopidogrel, ticagrelor exhibited a significantly higher delta angio-IMR [- 3.09 (5.14) versus - 1.99 (1.91), P = 0.008], indicating a superior improvement of CMD with ticagrelor treatment. Multivariate Cox regression indicated that ticagrelor treatment was related to a reduced risk of readmission for heart failure [8 (4.3) versus 9 (12.5), adjusted HR = 0.329; 95% CI = 0.116-0.934; P = 0.018] and myocardial reinfarction [7 (3.8) versus 8 (11.1), adjusted HR = 0.349; 95% CI = 0.125-0.975; P = 0.026]. Furthermore, ticagrelor treatment serves as an independent predictor of readmission for heart failure (HR = 0.322; 95% CI = 0.110-0.943; P = 0.039). The results of this study indicate a potential association between ticagrelor treatment and improved CMD, as well as a reduced risk of cardiovascular events, including myocardial reinfarction and readmission for heart failure in AMI patients. Further randomized controlled trials are necessary to confirm the potential benefits of ticagrelor on CMD and cardiovascular prognosis. This clinical trial was registered in www. gov (NCT05978726).

Readmissions in Sepsis Survivors: Discharge Setting Risks.

Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings. From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings. Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

Bowel preparation before elective right colectomy: Multitreatment machine-learning analysis on 2,617 patients

BackgroundIn the worldwide, real-life setting, some candidates for right colectomy still receive no bowel preparation, some receive oral antibiotics alone, some receive mechanical bowel preparation alone, and some receive mechanical bowel preparation with oral antibiotics, with varying degrees of compliance to preoperative intravenous antibiotic prophylaxis. Previous studies mainly focused on left-sided colorectal anastomoses while less attention has been devoted to right-sided ileocolic anastomoses. When high-level evidence from randomized clinical trials is lacking, multiple-treatment propensity score weighting analysis of prospective data on the basis of generalized boosted model is superior to a simple propensity score-matching analysis and to an inverse probability weighting in terms of external validity and bias reduction. MethodsThis is an analysis on the basis of machine-learning procedures of 2,617 patients who underwent elective right colectomies. ResultsThe risk of surgical-site infections (5.0% after no bowel preparation) was significantly lower after mechanical bowel preparation with oral antibiotics (4.0%, P = .017), significantly greater after mechanical bowel preparation alone (8.6%, P = .019), and comparable after oral antibiotics alone (3.9%). The risk of anastomotic leakage (3.2% after no bowel preparation) was significantly greater after oral antibiotics alone (4.8%, P = .013). Concerning secondary outcomes, no significant differences were recorded for the risk of overall morbidity and reoperation. The risk of readmission (3.0% after no bowel preparation) was significantly reduced after mechanical bowel preparation with oral antibiotics (1.5%, P = .046), and the risk of major morbidity (5.1% after no bowel preparation) was significantly greater after oral antibiotics alone (6.7%, P = .007). ConclusionThis multitreatment machine-learning analysis, despite some limitations, showed that mechanical bowel preparation with oral antibiotics is associated with a decrease in surgical-site infections after elective right colectomy compared with no bowel preparation.

Readmission Rates After Expedited Postpartum Discharge.

To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.

Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study.

Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes. Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia. Retrospective cohort. Medical ward at tertiary hospital setting. The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge). The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin. The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality. In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]). Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission. Single-centre design and retrospective nature.

537. ASSESSING THE EFFECT OF HIATAL HERNIA SIZE ON PERIOPERATIVE OUTCOMES AND HOSPITAL READMISSION RATES AFTER PRIMARY REPAIR

Abstract Background Minimally invasive hiatal hernia (HH) repair remains the gold standard for correcting mechanical defects due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including the HH size, may negatively impact the postoperative course. We aimed to determine if an increase in HH size was related to an increased risk of perioperative complications or hospital readmissions. Methods After IRB approval, we performed a retrospective analysis using a prospectively maintained database containing demographic, perioperative, and clinical data from all patients who underwent HH repair by a single experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the proportion of stomach at the thoracic cavity determined during the surgery: A (small HH: &amp;lt;25%), B (moderate HH: 25-49%), C (large HH: 50-74%), and D (intrathoracic stomach [ITS]: ≥75%). Non-parametric tests were used to assess differences between the groups, and logistic regressions were used to determine the relevant odds ratios (OR). Results A total of 391 patients who underwent primary HH repair met the inclusion criteria (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The distribution of groups was: A (n=160, 40.9%), B (n=63, 16.1%), C (n=64, 16.4%), and D (n=104, 26.6%). Patients presenting with ITS (group D) were older, had longer operative duration, greater blood loss (p&amp;lt;.001), and a significantly increased risk of presenting with early postoperative complications (OR 2.78 [CI95: 1.52-5.06]) and being admitted to the ICU (OR 12.35 [CI95: 3.41-44.71]). Conclusion The HH size, defined by the proportion of the stomach at the thoracic cavity, is associated with an increased risk of early postoperative complications and ICU admission; moreover, a trend toward higher 30- and 90-day hospital readmission rates was noted. This factor may be a consequence of the progressive nature of the disease; hence, it should be considered when choosing between continued medical observation and surgical treatment of patients presenting with asymptomatic HH. An early intervention may reduce the risk of postoperative comorbidity.

Extraction Laparotomy for Specimen Retrieval Does Not Alter Same-day Discharge Plans

Study ObjectiveTo evaluate if extraction laparotomy (EL) for intact specimen removal adversely impacted the feasibility or safety of same-day discharge (SDD) in patients undergoing minimally invasive surgery (MIS) for confirmed or suspected gynecologic malignancies. DesignRetrospective study SettingSingle institution study PatientsPatients undergoing minimally invasive surgery for gynecologic malignancy at a single institution, who underwent extraction laparotomy (N=67) and age matched controls (N=134) InterventionsComparing same day discharge rates, complications, readmission and outpatient follow up after between patients requiring extraction laparotomy to those that did not after minimally invasive gynecologic surgery. Measurements and Main ResultsA total of 1224 patients were identified. Sixty-seven patients underwent EL for specimen extraction. From the remainder, 134 patients were selected as age matched controls. SDD rate was 83% (EL) vs. 87% (no EL) (p=.39). There was no difference in median pain scores (1.8 vs. 1.9 p=.86), length of stay (LOS) (0 days for both) (p=.41), 30-day readmission rate (6% vs. 3%) (p=.45), ED visit (13% vs. 10%) (p=.76) or any patient contact (34% vs. 39%) (p=.53), between the groups. Specimen weight was higher for EL (524g vs 142g, p<.001), as was estimated blood loss (EBL) (104ml vs. 46ml, p<.001), and surgery time was increased by 22 minutes in the EL group (121 min vs. 99 min, p<.001). Patients who underwent EL did require more narcotics in PACU 20.5 vs 12.2 OME p=.033, however this did not translate to increased number of narcotics prescribed at discharge. On logistic regression a higher specimen weight trended to increase the likelihood of admission (OR 1.04 CI 1.01-1.08), however, surgery time, time in PACU, race, BMI, surgery type or need for EL did not predict SDD or need for admission. ConclusionsMinimally invasive surgery patients who require extraction laparotomy can still achieve SDD. Same-day discharge is safe and feasible without increased risk of readmission, pain score, or unscheduled patient contact post-operatively.

Correlation between health literacy and utility-based health-related quality of life scores in patients undergoing cardiac rehabilitation: a multicenter clinical study

IntroductionHealth literacy (HL) is correlated with the risk of mortality and readmission during cardiac rehabilitation. However, the correlation between HL and utility-based health-related quality of life (HRQOL) scores has been poorly documented. Therefore, we examined the correlation between HL and utility-based HRQOL scores in participants undergoing cardiac rehabilitation.MethodsThe data of 448 participants undergoing cardiac rehabilitation from the Kobe-Cardiac Rehabilitation Project for People Around the World (K-CREW) clinical trial were analyzed. Participants were divided into low and high HL cohorts. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire to assess HRQOL at discharge. The utility scores of the EQ-5D-5L questionnaire were calculated. The median age was 71.0 [61.0–78.0] years, 75.7% of participants were male, and 60% had a low HL.ResultsMedian utility score was 0.88 [0.75–1.00]. Regarding the dimensions of the EQ-5D-5L questionnaire, more than 60% of participants responded positively to the severity level of “no problem.” In the comparative analysis, the low HL cohort had a statistically significantly lower utility score than that of the high HL cohort (p-value = 0.03). The multivariate analysis revealed that the HLS-14 scores were not statistically significantly correlated with the utility scores.ConclusionParticipants with low HL had lower HRQOL in the comparative analysis. However, multivariate analysis revealed that HL was not statistically significantly correlated with utility-based HRQOL scores. Future studies should explore the influence of confounding or intermediate variables on the correlation between HL and HRQOL.

Inappropriate prescribing and association with readmission or mortality in hospitalised older adults with frailty: a systematic review and meta-analysis

BackgroundInappropriate prescribing (IP) is common in hospitalised older adults with frailty. However, it is not known whether the presence of frailty confers an increased risk of mortality and readmissions from IP nor whether rectifying IP reduces this risk. This review was conducted to determine whether IP increases the risk of adverse outcomes in hospitalised middle-aged and older adults with frailty.MethodsA systematic review was conducted on IP in hospitalised middle-aged (45–64 years) and older adults (≥ 65 years) with frailty. This review considered multiple types of IP including potentially inappropriate medicines, prescribing omissions and drug interactions. Both observational and interventional studies were included. The outcomes were mortality and hospital readmissions. The databases searched included MEDLINE, CINAHL, EMBASE, World of Science, SCOPUS and the Cochrane Library. The search was updated to 12 July 2024. Meta-analysis was performed to pool risk estimates using the random effects model.ResultsA total of 569 studies were identified and seven met the inclusion criteria, all focused on the older population. One of the five observational studies found an association between IP and emergency department visits and readmissions at specific time points. Three of the observational studies were amenable to meta-analysis which showed no significant association between IP and hospital readmissions (OR 1.08, 95% CI 0.90–1.31). Meta-analysis of the subgroup assessing Beers criteria medicines demonstrated that there was a 27% increase in the risk of hospital readmissions (OR 1.27, 95% CI 1.03–1.57) with this type of IP. In meta-analysis of the two interventional studies, there was a 37% reduced risk of mortality (OR 0.63, 95% CI 0.40-1.00) with interventions that reduced IP compared to usual care but no difference in hospital readmissions (OR 0.83, 95% CI 0.19–3.67).ConclusionsInterventions to reduce IP were associated with reduced risk of mortality, but not readmissions, compared to usual care in older adults with frailty. The use of Beers criteria medicines was associated with hospital readmissions in this group. However, there was limited evidence of an association between IP more broadly and mortality or hospital readmissions. Further high-quality studies are needed to confirm these findings.

Elevated care at home: An alternative to traditional levels of care.

Elevated care at home (ECH) is a novel in-home care model supporting early hospital discharge and providing an alternative to institutional postacute care. This study compares patient characteristics, mortality, and readmission outcomes of hospitalized patients who transitioned to ECH to patients who transitioned to skilled nursing facilities (SNF) and skilled home health services (SHH). A retrospective study of patients between May 2020 and January 2022 transitioned from the hospital to ECH, SNF, or SHH. The analysis compared patient characteristics, 30-day mortality, and readmission stratified by COVID-19 infection status. Outcomes were assessed using logistic regression after propensity score matching. Of 32,132 eligible patients, 6.3% were transitioned to ECH, 39.7% to SNF, and 54.0% to SHH. After matching, all baseline characteristics except for age were balanced between groups. Postmatch and adjusting for age differences, ECH patients experienced lower risk of death compared to SNF (adjusted odds ratio [AOR] 0.61, 95% confidence interval [CI] 0.40, 0.92) and similar risk of hospital readmission compared to SNF patients (AOR 1.08, 95% CI 0.89, 1.31) and SHH patients (AOR 0.96, 95% CI 0.80, 1.16). COVID-19-negative ECH patients compared to matched SNF patients were more likely to readmit (AOR 1.30, 95% CI 1.02, 1.65) with no significant difference in risk of mortality (AOR 0.72, 95% CI 0.44, 1.18). ECH had similar or improved outcomes relative to SNF and SHH. COVID-19-negative ECH patients experienced higher readmissions relative to SNF. ECH supported patients to return home from the hospital and provided an alternative to an institutional postacute setting.

Patterns and Risk Factors for Rehospitalizations Within the First 90 Days Following Discharge After Heart Transplantation

BackgroundHeart transplantation (HT) recipients are at risk for urgent rehospitalizations following discharge. However, data on prevalence, risk factors and clinical outcomes associated with post-HT rehospitalization are limited. MethodsThis study aims to describe patterns of urgent rehospitalizations in HT recipients at a cardiology reference center in Brazil. Rehospitalizations and deaths occurring within the first 90 days following hospital discharge were identified. Regression models were used to identify variables associated with urgent rehospitalizations. ResultsA total of 239 patients were included. Of those, 118 (49.4%) presented with a rehospitalization within 90 days following hospital discharge and 5 (2.01%) died. Most patients who were rehospitalized had one new hospital admission (86.0%). The main cause of urgent rehospitalization was infection (55.0%). In the multivariate analysis, elevated C-reactive protein at discharge and the occurrence of intracranial bleeding at index hospitalization were associated with an increased risk of readmission. Longer duration of index hospitalization and use of lower doses of azathioprine were associated with a lower risk of rehospitalization. ConclusionAround half of HT recipients were rehospitalized within the first 90 days after hospital discharge. Understanding factors associated with post-HT rehospitalization may help the implementation of strategies to avoid patient morbidity and hospital costs.

Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.

Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%. The quality improvement project was implemented on two telemetry units at an acute care hospital. A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention. The evidence-based project was implemented over 7weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions. Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission.

Analysis of readmission and hospitalization expenditures of patients with ischemic stroke suffering from different comorbidities

BackgroundThe comorbidities of ischemic stroke (IS) are increasing worldwide. This study aimed to quantitatively assess the effect of different types of comorbidity on readmission and hospitalization expenditures of patients with IS. MethodsA retrospective observational study was conducted from the basic insurance claims database of a large city in China, between January 1, 2018, and May 31, 2022. We identified patients with IS aged 18 years and over, who experienced the first episode of IS and had one-year follow-up records. This study divided eighteen different comorbid conditions into two categories (concordant comorbidity and discordant comorbidity) and the IS patients were further categorized into four groups. Multivariable logistic regression models and generalized linear models with log-link and gamma distribution were to estimate the effect of different comorbidity groups on one-year readmission rates and annual hospitalization expenditures. ResultsIn total, 99,649 adult patients with IS were identified. Approximately 94.0 % of patients with IS had at least one comorbidity, and 63.8 % reported concordant comorbidity only. Patients with IS had a readmission rate of 26.7 %, and the mean of annual hospitalization expenditure and annual hospitalization out-of-pocket expenditure (OOPE) were 28086.6 Chinese Yuan (CNY) and 8267.3 CNY, respectively. After adjustment for covariates, the concordant comorbidity-only group had the highest readmission rate, annual hospitalization expenditure, and OOPE compared with the other groups, furthermore, these results increased as the number of comorbidity increased and had statistically significant positive associations. ConclusionsThe readmission and annual hospitalization expenditures of patients with IS were associated with different comorbidities. Concordant comorbidity increased hospital readmission risk and health expenditures. To better manage the comorbidities of patients with IS, especially concordant comorbidities, it is necessary to establish a routine care strategy specifically for comorbid conditions.

Associations Between Readmission and Length of Stay in the Acute Admission Unit for Patients with Alcohol-Related Diagnoses-A Cohort Study.

Patients with alcohol-related diagnosis in emergency departments (ED) are at high risk of readmission. Evidence shows an association between alcohol related admissions and a wide range of diseases and disorders. Understanding the risk factors for readmission and the asso-ciation with length of stay in the ED may help identify those who would benefit from targeted interventions. Thus, the hypothesis of this study is that patients with alcohol-related diagnoses and a short length of stay in the ED have a higher risk for readmission. Therefore, this study aimed to investigate the association between length of stay in the ED and 30-day readmission for patients with alcohol-related acute admissions as well as to uncover possible risk factors for 30-day read-mission. The study used a retrospective cohort design and was carried out from March 1, 2019, to January 31, 2020. The inclusion criteria were ≥ 18 years, admitted to an ED, and having an alcohol-related primary or secondary diagnosis (based on ICD-10 codes). Patients were fol-lowed for 30 days after discharge from initial hospitalization to identify associations between length of stay and 30-day readmission. We included 1,174 patients and found that 17% (95% CI: 15-20) of the patients admitted with an alcohol-related primary or secondary diagnosis were readmitted within 30 days. The hazard ratio (HR) for readmission increased with length of stay when compared to admission ≤ 24 hr; admission > 24-48 hr HR 1.50 (95% CI: 1.08-2.08), admission > 48 hr HR 2.08 (95% CI: 1.23-3.52). The study revealed that patients with alcohol-related diagnoses were at a higher risk of ED readmission the longer they stayed in the ED. Furthermore, the risk of readmis-sion increased if patients had a medical or psychiatric diagnosis prior to admission or lived alone.

Serum Chloride and the Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload: A Post Hoc Analysis From the ADVOR Trial.

Chloride plays a crucial role in renal salt sensing. This study investigates whether serum chloride is associated with clinical outcomes and decongestive response to acetazolamide in patients with acute decompensated heart failure. This post hoc analysis includes all 519 patients from the ADVOR trial (Acetazolamide in Decompensated Heart Failure With Volume Overload), randomized to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The impact of baseline serum chloride on the main trial end points and the treatment effect of acetazolamide was assessed, as was the evolution of serum chloride under decongestive treatment. Hypochloremia (<96 mmol/L) and hyperchloremia (>106 mmol/L) were present in 80 (15%) and 53 (10%), respectively, at baseline. Hypochloremia was associated with significantly slower decongestion, a longer length of hospital stay, and increased risk of all-cause mortality and heart failure readmissions. Acetazolamide increased the odds of successful decongestion and reduced length of stay irrespectively of baseline serum chloride levels. No statistically significant interaction between serum chloride levels and the effect of acetazolamide on death or heart failure readmissions was observed. The placebo group exhibited a progressive decline in serum chloride, which was effectively prevented by acetazolamide (P<0.001). Hypochloremia is associated with diuretic resistance and worse clinical outcomes. Add-on acetazolamide therapy improves decongestion across the entire range of serum chloride and prevents the drop in chloride levels caused by loop diuretic monotherapy. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03505788.

Readmission Outcomes in Kidney Transplant Recipients With and Without Delayed Graft Function

Delayed graft function (DGF) is a common post-transplant event associated with increased resource utilization. As a center with experience in DGF, we aimed to assess differences in readmissions and post-transplant outcomes between patients with and without DGF. This was a retrospective review of deceased donor kidney transplant recipients at Mayo Clinic Arizona between 2015 and 2020. Recipients with at least one early readmission following kidney transplantation were included in the study. Two groups were identified: (1) recipients with DGF who required early readmission and (2) recipients without DGF who required early readmission. Among recipients with DGF, 43.9% (n = 405) required early readmission compared to 29.1% (n = 179) without DGF (P < .0001). There were no differences in the initial hospital length of stay (P = .08), and most recipients in both groups only required a single readmission (61.7% vs 72.1%, P = .02). Recipients with DGF were more likely to have ≥2 readmissions (P = .02) and a higher total readmission rate (P = .006). Recipients with DGF who required readmission also required more outpatient clinic visits (P = .003). When comparing recipients with and without DGF who required readmission, there were no differences in patient (P = .22) or death-censored (P = .72) graft survival. When comparing patients with and without DGF requiring one versus ≥2 readmissions, there were no differences in patient survival (P = .15), however patients with DGF and ≥2 readmissions had lower death-censored graft survival (P = .001). Recipients with DGF are at increased risk of readmission. Transplant center-level changes to reduce readmissions and infections could have an important impact on DGF outcomes.

A predictive model for readmission within 1-year post-discharge in patients with schizophrenia

BackgroundSchizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China.MethodsA prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model’s performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples.ResultsMultivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13–8.86), repeat admissions (aHR 3.49, 95% CI 2.08–5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34–3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04–3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model.ConclusionsA nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.