Readmissions Reduction Research Articles

Revascularisation for Ischaemic Cardiomyopathy.

Coronary artery disease is a leading cause of heart failure with reduced ejection fraction. Coronary artery bypass grafting appears to provide clinical benefits such as improvements in quality of life, reductions in readmissions and MI, and favourable effects on long-term mortality; however, there is a significant short-term procedural risk when left ventricular function is severely impaired, which poses a conundrum for many patients. Could percutaneous coronary intervention provide the same benefits without the hazard of surgery? There have been no randomised studies to support this practice until recently. The REVIVED-BCIS2 trial (NCT01920048) assessed the outcomes of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular dysfunction and stable coronary artery disease. This review examines the trial results in detail, suggests a pathway for investigation and revascularisation in ischaemic cardiomyopathy, and explores some of the remaining unanswered questions.

Enhanced Recovery After Surgery (ERAS®) Society Guidelines for Gynecologic Oncology: Addressing Implementation Challenges - 2023 Update

ABSTRACT Implementation of the Enhanced Recovery after Surgery (ERAS) Society Guidelines in 2016 has resulted in an approximate decrease in hospital length of stay (LOS), reduction in complications and readmission, and cost saving. Recent publications however have demonstrated that barriers and gaps in understanding may result in many ERAS recommendations being poorly adhered to in gynecologic oncology patients. The aims of this second update to the ERAS Society Guidelines for gynecologic oncology is to summarize and update the evidence investigating specific implementation challenges to increase ERAS uptake and improve clinical outcomes for patients. A literature search was conducted for topics specified to 9 ERAS implementation challenges identified: perioperative oral intake safety, preoperative medication importance, penicillin allergies, intraoperative analgesia, how to manage urinary drainage, venous thromboembolism prophylaxis, postoperative opioid prescription practices, same-day discharge programs, and how can I overcome barriers to ERAS implementation. The quality of evidence and recommendations was evaluated, and recommendations graded as strong or weak based on quality, balance between desirable and undesirable effects on holistic clinical outcomes, and on values and preferences of practitioners. Regarding perioperative oral intake safety, patients should be encouraged to consume clear liquids in 2 hours before surgery and preoperative carbohydrate loading improves satisfaction and comfort. Optimal preoperative medications include nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentinoids. Patients with penicillin allergies should receive standard surgical antibiotic prophylaxis. For intraoperative analgesia, wound infiltration with local anesthetic and TAP block are preferred over thoracic epidural analgesia. Indwelling bladder catheters should be removed as early as possible in the postoperative period such as on the day of surgery for minimally invasive procedures and no later than postoperative day 1 for laparotomy. Patients at increased risk of venous thromboembolism should receive dual prophylaxis with compression and medications, and extended chemoprophylaxis should be prescribed to those with high-risk criteria or after laparotomy. Multimodal opioid-reduction is critical for all patients, and decreased postdischarge opioid proscribing is improved with a team approach and does not affect pain control or patient satisfaction. Patient controlled analgesia is a last resort for those requiring repeated treatment with intravenous opioids. Multidisciplinary same-day discharge programs should be considered in minimally invasive surgeries, and implementation requires a multidisciplinary team approach with patient education, case selection, and ERAS principles. Overcoming barriers to ERAS principles is more successful with changes at the management level and education. Communication of the economic benefits of ERAS to administrators may be a strong incentive to garner support. Although the evidence level varied between moderate and strong for each of these recommendations, the recommendation grade for each was strong. This updated ERAS guideline focuses on addressing implementation challenges and controversial aspects of ERAS defined by a stakeholder clinician group and offers suggestions based on objective data for overcoming these barriers.

Do advances in technology translate to improved outcomes? Comparing robotic bariatric surgery outcomes over two-time intervals utilizing the MBSAQIP database.

This study aims to compare outcomes and utilization of robotics in bariatric procedures across two-time intervals, chosen because they correspond to drastic changes in technology utilization-namely, a new platform and a new stapling device. Outcomes of robotic Roux-en-Y gastric bypass (rRYGB) and robotic sleeve gastrectomy (rSG) across this changing landscape have not been well studied, despite increasing popularity. The MBSAQIP database was analyzed over early (2015-2016) and late (2019-2020) time intervals. Patients who underwent rSG and rRYGB were identified, and the cohorts were matched for 26 preoperative characteristics using Propensity Score Matching Analysis. We then compared 30-day outcomes and bariatric-specific complications between the early and late time frames for rSG and rRYGB. 49,442 rSG were identified: 13,526 cases in the early time frame and 35,916 in the late time frame. The matched cohorts were 13,526 for the two groups. 30-day outcomes showed that in the late time frame, rSG was associated with lower rates of pulmonary complications (0.1% vs 0.3%, p < 0.001), readmissions (2.5% vs 3.6%, p < 0.001), interventions (0.6% vs 1.4%, p < 0.001), reoperations (0.7% vs 1.0%, p = 0.024), length of stay (1.36 ± 1.01days vs 1.76 ± 1.79days, p < 0.001), operative time (92.47 ± 41.70min vs102.76 ± 45.67min p < 0.001), staple line leaks (0.2% vs 0.4%, p = 0.001) and strictures (0.0% vs 0.2%, p < 0.001). Similarly, 21,933 rRYGB were found: 6,514 cases were identified in the early time frame and 15,419 in the late time frame. The matched cohorts were 6,513 for the two groups. 30-day outcomes revealed that the late time fame rRYGB was associated with lower rates of pulmonary complications (0.1% vs 0.3%, p = 0.012), readmissions (6.3% vs 7.2%, p = 0.050), interventions (2.0% vs 3.1%, p < 0.001), length of stay (1.69 ± 1.46days vs 2.13 ± 2.12days p < 0.001), postoperative bleeding (0.4% vs 0.7%, p = 0.001), stricture (0.4% vs 0.8%, p < 0.001) and anastomotic ulcer (0.2% vs 0.4%, p = 0.013). Compared to early robotic bariatric surgery outcomes, a significant reduction in pulmonary complications, readmissions, reoperations, interventions and length of stay were seen in 2019-20 after rSG and rRYGB. Potential contributing factors include increased surgical experience and advances in the robotic platform. A significant recent reduction in staple line leaks with faster operative times associated with rSG suggests that stapling technology has had a positive impact on patient outcomes.

Goals, Services, and Target Patient Populations of Community Paramedicine in Rural United States

Introduction: Rural areas contain one-fifth of the US population and only 10% of the nation’s physicians. Community paramedicine (CP) is a growing healthcare delivery model in which emergency medical personnel provide non-emergent medical care. Community paramedics may help fill the primary healthcare gap for rural residents. This literature review provides an overview of the common goals, services, target populations, and setbacks of rural CP programs in the US.&#x0D; Methods: A systematic search following PRISMA protocols was completed on PubMed and Google scholar using the search terms: “community paramedicine/paramedic” and “rural, remote, frontier” between 2000-2021.&#x0D; Results: Rural CP program goals are to aid patients in chronic disease management and reduce emergency department visits, hospital admissions/readmissions, and healthcare costs. Programs target services toward patients who are chronically ill, post-hospital discharge, and frequent EMS users.&#x0D; Conclusion: CP provision of preventative and primary care services has improved health outcomes for patients with chronic disease. Programs report cost savings for the healthcare payer and patient and a reduction in ED transports and hospital readmissions. The problems identified are acquiring sustainable funding to develop CP programs and reimburse CP services, lack of consistency between CP scope of practice and educational requirements across states, role tensions with other healthcare professions, and lack of research about the safety of CP programs for patients. Future research is needed to investigate patient outcomes secondary to CP preventative and primary care services, which may identify if CPs are an effective means of helping fill the primary care gap for rural communities.

Current approaches to preventing heart failure readmissions and decompensated disease.

Heart failure is a resource-intensive condition to manage and typically involves a multi-disciplinary and multi-modality approach leading to an expensive treatment paradigm. It is worth noting that hospital admissions constitute over 80% of heart failure management costs. In the past two decades, healthcare systems have developed new ways of following patients remotely to prevent them from being readmitted to the hospital. However, despite these efforts, hospital admissions have still increased. Many successful readmission reduction programs prioritize education and self-care to increase patients' awareness of their disease and promote lasting lifestyle changes. While socioeconomic factors impact success, interventions tend to be effective when medication adherence and guideline-directed medical therapy are emphasized. Monitoring intracardiac pressure can improve resource allocation efficiency and has demonstrated significant reductions in readmissions with improved quality of life in outpatient and remote settings. Data from several studies focused on remote monitoring devices strongly suggest that understanding congestion using physiological biomarkers is an effective management strategy. Since most cases of heart failure are first presented in acute hospitalization settings, immediate access to intracardiac pressure for treatment and decision-making purposes could result in substantial management improvements. However, a notable technology gap needs to be addressed to enable this at a low cost with less reliability on scarce specialist care resources. Contemporary evidence is conclusive that direct hemodynamic are the vital signs in heart failure with the highest clinical utility. Therefore, future ability to obtain these insights reliably using non-invasive methods will be a paradigm-changing technology.

P90: Silverlon: A Weapon Against Driveline Infections in LVAD Patients

Heart disease is the leading cause of death in the western world. Approximately five million people in the United States have congestive heart failure (CHF), with two hundred fifty thousand of those people in the most advanced stages of CHF. Left ventricular assist devices (LVAD) are currently the state-of-the-art treatment for patients with end stage cardiac failure who are not a candidate for heart transplant. LVADs are powered by external power sources that connect to the pump via a percutaneous lead (driveline). The driveline exits the body, typically from the right quadrant, creating a chronic wound that renders that site prone to infection. Infectious complications are a leading cause of mortality in the LVAD patient population. The driveline site is often the entry point of infection which can lead to blood stream and pump pocket infections. LVAD driveline infection rates, on average, are around 13%. At Lehigh Valley Hospital (LVH), our infection rate from 2013-2020 was 19%. In November 2020, the LVAD program here at LVH placed Silverlon patches in all dressing kits for all newly implanted LVAD patients. The addition of Silverlon was the only intervention done to the driveline dressing kits. From November 2020 to September 2022, the driveline infection rate went from 19% to 0%. This innovative plan of care has allowed our team to implement a simple, cost-effective method to decrease infectious complications and improve patient outcomes. A secondary finding was a decrease in the readmission rates. In 2021, 30% of all readmissions were directly related to driveline site infections. So far in 2022, we have had “0” readmissions related to driveline site infections. This is a 100% reduction in readmissions related to driveline site infections. This decreased our total readmissions by 34%. Based on the results of our “best practice” change, a treatment regime involving the use of Silverlon on drivelines has demonstrated significant reduction of driveline related bloodstream and pocket infections, as well as decreased readmissions.Figure 1. Data graphs depicting the decrease in driveline site infections and readmission rates

Sex-specific analysis of the rapid up-titration of guideline-directed medical therapies after a hospitalisation for acute heart failure: insights from the STRONG-HF trial.

The aim of this study was to evaluate efficacy and safety of rapid up-titration of guideline directed medical therapies in men and women hospitalized for acute heart failure (AHF). In STRONG-HF AHF patients were randomised just prior to discharge to either usual care (UC) or a high-intensity care (HIC) strategy of guideline-directed medical therapies (GDMT) up-titration. In these analyses, we compare the implementation, efficacy, and safety of the HIC strategy between men and women. In the randomised AHF population, 416/1078 (39%) were women. By day 90, a higher proportion of both sexes in the HIC group had been up-titrated to full doses of GDMT compared to UC. Overall, there were no differences in the primary endpoint between the sexes. The primary endpoint, 180-day HF readmission or death, occurred in 15.8% HIC women vs 23.5% women in the UC group (adjusted HR 0.67 [95% CI 0.40-1.13]) and in 14.9% HIC men vs 23.5% UC men (adjusted HR 0.57 [95% CI 0.38-0.88]), adjusted interaction p = 0.65. There was no significant treatment-by-sex interaction in quality-of-life improvement or in adverse events, including serious or fatal adverse events. The results of the current analyses suggest that a rapid up-titration of GDMT immediately after an AHF hospitalisation can and should be implemented similarly in men and women, as it results in reduction of 180-day all-cause death or HF readmission, quality-of-life improvement in both men and women with a similar safety profile.

RWD114 Is Medicare's Hospital Readmissions Reduction Program (HRRP) Delivering on the Decade's Promise?: A Trend Analysis

To analyze nationwide trends in hospitalization for six targeted CMS health measures under HRRP and evaluate the program’s success with respect to reduction of preventable readmissions.

RWD148 A Comparative Evaluation of Medicare's Hospital Readmissions Reduction Program (HRRP) Effectiveness between New York State and the Nation

To compare and analyze the available HRRP 30-day inpatient readmissions data (2014-2019) longitudinally between NYS hospitals and the rest of the country and evaluate NYS hospital performance relative to six HRRP targeted health measures.

Reducing Surgical Site Infections with Silver-impregnated Dressings in Lower Extremity Bypass Patients

Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver-impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after LE bypass surgery. In 2018, our institutional SSI rate was 12.8%. To reduce this rate, we transitioned to silver-impregnated dressings for all LE bypass procedures and studied the subsequent impact on SSIs. We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Patients in 2019 underwent the standard of care surgery with standard sterile gauze postoperative dressings. Patients in 2020 underwent standard of care surgery and were treated with silver-impregnated dressings. NSQIP criteria were used to determine if patients developed SSIs within 30 days of surgery. The Fischer exact and χ2 tests were used to compare groups before and after the intervention. A total of 282 patients underwent LE bypass in 2019 and 2020. The standard of care cohort had 168 patients with sterile gauze dressings, whereas the cohort after intervention had 114 patients with silver-impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table). When considering all classifications of SSI, there were significantly fewer infections in the silver dressing group compared with the sterile gauze group (9.6 % vs 20.8%; P = .014). There was a non-statistically significant reduction in readmissions and unplanned return to the operating room in the silver dressing group. This study demonstrated a significantly lower rate of SSIs in patients undergoing LE bypass with use of a silver-impregnated dressing when compared with a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.TableDemographic and comorbidity differences between groups of patients who underwent lower extremity (LE) bypass surgery using sterile gauze dressing (2019) and silver-impregnated dressing (2020), and NSQIP-collected outcomes regarding postoperative surgical site infection (SSI), wound dehiscence, unplanned return to operating room, and readmission within 30 daysSterile gauze (n = 168)Silver dressing (n = 114)P-valueMale gender109 (64.8)79 (69.3).5Age, years67.1 (10.8)66.0 (11.2).4Race.7 Asian1 (0.6)2 (1.8) Black or African American25 (14.9)13 (11.4) Unknown11 (6.5)7 (6.1) White131 (78.0)92 (80.7)Emergent surgery10 (5.9)4 (3.5).4Active smoker78 (46.4)52 (45.6).9Diabetes.4 Yes, insulin-dependent47 (28.0)39 (34.2) Yes, non-insulin-dependent32 (19.1)23 (20.2) No89 (53.0)52 (45.6)Hypertension133 (79.2)93 (81.6).6Chronic obstructive pulmonary disease26 (15.5)15 (13.2).6Dialysis10 (5.9)10 (8.8).4Superficial SSI35 (20.8)11 (9.7).014Deep SSI5 (3.0)2 (1.8).7Organ space SSI2 (1.2)6 (5.3).07Wound dehiscence6 (3.6)5 (4.4).8Unplanned return to operating room43 (25.6)32 (28.1).7Readmission39 (23.2)30 (26.3).2Data are presented as mean (standard deviation) or number (%). Open table in a new tab

Coordinated Patient Outreach for Reduction of Unplanned Postoperative 30-Day Readmission

Coordinated Patient Outreach for Reduction of Unplanned Postoperative 30-Day Readmission

Implementation of a multidisciplinary inpatient heart failure service and its association with hospitalized patient outcomes: First experience from the Middle East and North Africa region

BackgroundMultidisciplinary care models have been associated with improved clinical outcomes and an increase in adherence to guideline-directed medical therapy among patients hospitalized with heart failure (HF). ObjectiveThis study aims to evaluate the association between the creation of a multidisciplinary inpatient HF service and patient outcomes at a tertiary care center in the Middle East/ North Africa. MethodsWe used electronic health records to retrospectively identify patients hospitalized for acute HF between June-2015 and June-2018. Patients were categorized by whether they were hospitalized before (n = 71) or after (n = 86) the implementation of a multidisciplinary HF team (HF-MDT), starting on 1/1/2017. The groups were compared for optimal use of guideline-directed medical therapy, hospital length of stay, 30-day hospital readmission, and in-hospital mortality. ResultsThe creation of the HF-MDT was associated with significantly better adherence to GDMT at discharge (27.5% vs. 55.4%, (OR 3.3, 95% CI [1.65–6.5]), P<0.001), shorter median hospital length of stay (8, IQR [4.8 - 19] vs. 5, IQR [3– 9], P = 0.02) and a reduction in 30-day hospital readmission (26.5% vs. 11%; OR 0.3, 95% CI [0.1–0.8], P = 0.02). However, there was no difference in-hospital mortality (10.5% vs. 3.5%; OR 0.3, 95% CI [0.1–1.2], P = 0.1). ConclusionsImplementing an HF-MDT in the care of patients hospitalized with HF is associated with better adherence to GDMT on discharge, reduced hospital length of stay, and lower 30-day readmission rates. The current data support the broader adoption of dedicated HF programs in the Middle East to improve outcomes of patients with HF.

Association of a Remote Blood Pressure Monitoring Program With Postpartum Adverse Outcomes.

To use administrative claims data to evaluate the association of a remote blood pressure monitoring program with adverse postpartum clinical outcomes in patients with a hypertensive disorder of pregnancy. This was a retrospective cohort study of Independence Blue Cross members with a hypertensive disorder of pregnancy diagnosis across three obstetric hospitals from 2017 to 2021. Patients who were enrolled in twice-daily text-based blood pressure monitoring for 10 days postpartum were compared with two propensity-score matched cohorts of patients who met the program criteria: an asynchronous cohort (cohort A), consisting of patients at any of the three participating hospitals before remote monitoring program implementation, and a contemporaneous cohort (cohort C), consisting of patients at other hospitals during the same time period as clinical use of the program. Patients with less than 16 months of continuous insurance enrollment before delivery were excluded. Claims for adverse clinical outcomes after delivery discharge were evaluated. Health care service utilization and total medical costs were evaluated. The 1,700 patients in remote blood pressure monitoring program were matched to 1,021 patients in cohort A and 1,276 in cohort C. Within the first 6 months after delivery, patients enrolled in remote monitoring were less likely to have the composite adverse outcome than those in cohort A (2.9% vs 4.7%; OR 0.61, 95% CI 0.40-0.98). There was no statistically significant difference relative to cohort C (3.2% vs 4.5%; OR 0.71, 95% CI 0.47-1.07). The remote monitoring group had more cardiology visits and fewer postnatal emergency department (ED) visits and readmissions compared with both comparison cohorts. Reductions in ED visits and readmissions drove overall lower total medical costs for the program cohort. Patients enrolled in a remote blood pressure monitoring program were less likely to experience an adverse outcome in the first 6 months after delivery. Reductions in ED visits and readmissions resulted in lower postpartum total medical costs compared with both control cohorts. Broad implementation of evidence-based remote monitoring programs may reduce postpartum adverse outcomes, thereby reducing morbidity and mortality in populations such as the one studied here.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia

BackgroundKangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of...

AP-453071-4 NOVEL COMANAGEMENT-BASED COMMUNITY VIRTUAL ATRIAL FIBRILLATION CENTER (AFC)

Delays in the management of AFib, and specifically delays in patient access to advanced therapies, can make antiarrhythmic interventions less successful and more complicated. A virtual atrial fibrillation center (AFC) has the potential to provide high-quality and expedited specialty electrophysiology care to individual patients that present to the hospital with atrial fibrillation. Utilizing a template designed around a patient comanagement strategy, we describe our experience with a novel AFC in a non-academic hospital setting. We describe the creation of a multi-disciplinary team of physicians and APPs in Emergency Medicine, Internal Medicine and Cardiac Electrophysiology. We then describe an admission criteria algorithm (Figure 1) that enables state-of-the-art, coordinated, and guideline-directed therapy for patients with atrial arrhythmias. Over a 1-year period, we tracked several quality metrics which were decided upon prior to deployment. Objective patient admission criteria to the AFC were established and included assessment of hemodynamics, serum biomarkers levels, EKG interpretation. These criteria were supplemented with clinical assessment at the time of presentation. Quality metrics for program assessment were determined prior to deployment and included time to EP consult, CHA2DS2-VASc assessment, time to outpatient EP follow-up, and time from presentation to cardiac ablation. A total of 247 patients were admitted to the AFC over a 1-year period following the admission algorithm. Time to EP consult was less than 24 hours (7.9hrs +/- 7.6 hrs.). 100% of patients underwent CHA2DS2-VASc assessment. Time to outpatient follow-up was less than 14 days (10.8 days +/- 4.5 days). Time from index presentation to advanced therapy (cardiac ablation) was reduced from 134 days to 60.5 days. Utilizing a multidisciplinary management team was an effective strategy to assist in the management of Afib patients that met the criteria for admission to the AFC. Results from our AFC model show expedited access to advanced therapy, including Afib ablation, and excellent compliance with guideline-directed medical therapy based on CHA2DS2-VASc assessment. These results also translated into a reduction in hospital readmissions for Afib and a decreased length of hospital stay. This specific model will allow for future growth of the AFC, including expansion of the criteria template to include other atrial arrhythmias.

Increasing person-centeredness in psychosis inpatient care: care consumption before and after a person-centered care intervention

Background Patients with psychotic disorders often need hospitalization with long stays. Person-centered care (PCC) has been shown to improve care quality and decrease the length of hospital stay in non-psychiatric settings. We carried out an educational intervention for inpatient staff, aiming to increase person-centeredness at a major Swedish psychosis clinic. The aim of this study was to test if the intervention could be associated with decreased length of hospital stay (LoS), involuntary stay (LoIS), and reduction in rapid readmissions. Methods Data from the clinic’s administrative registry were compared for patients with a discharge diagnosis within the schizophrenia-spectrum treated during the one-year periods before and after the PCC intervention. Results Contrary to our hypotheses, a quantile regression estimated longer LoS post-intervention, median difference 10.4 d (CI 4.73–16.10). Neither age, sex nor diagnostic category were associated with LoS. Of all inpatient days, ∼80% were involuntary. While LoIS was numerically longer post-intervention, the difference did not reach significance in the final regression model (median difference 7.95 d, CI −1.40 to 17.31). Proportions with readmission within 2 weeks of discharge did not differ (7.7% vs 5.2%, n.s.). Conclusions Increased length of inpatient care was observed after the PCPC intervention. This could reflect an increased focus on the unmet needs of persons with serious psychotic conditions, but it needs to be explored in future research using a more rigorous study design. Trial registration This study is part of a larger evaluation of Person-Centered Psychosis Care (PCPC), registered during data collection (after the study start, before analysis) at clinicaltrials.gov, identifier NCT03182283.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

Technologic Transformation of Perioperative Cardiac Care and Outcomes

BackgroundThe “Perfect Care” initiative engages, educates, and enrolls adult cardiac surgery patients into a comprehensive program that incorporates remote perioperative monitoring (RPM). This study investigated the impact of RPM on postoperative length of stay, 30-day readmission and mortality, and other outcomes. MethodsThis quality improvement project compared outcomes in 354 consecutive patients who underwent isolated coronary artery bypass and who were enrolled in RPM between July 2019 and March 2022 at 2 centers against outcomes in propensity-matched control patients from a pool of 1301 patients who underwent isolated coronary artery bypass from April 2018 to March 2022 without RPM. Data were extracted from The Society of Thoracic Surgeons Adult Cardiac Surgery Database, and outcomes were analyzed according to its definitions. RPM used perioperative standard practice routines, a digital health kit for remote monitoring, a smartphone application and platform, and nurse navigators. Propensity scores were generated with RPM as the outcome measure, and a 2:1 match was generated using a nearest-neighbor matching algorithm. ResultsPatients who underwent isolated coronary artery bypass and who were participating in RPM showed a statistically significant, 15.4% (1 day) reduction in postoperative length of stay (P < .0001) and a 44% reduction in 30-day readmission and mortality (P < .039) compared with matched control patients. Significantly more RPM participants were discharged directly home instead of to a facility (99.4% vs 92.0%; P < .0001). ConclusionsThe RPM platform and associated efforts to engage and monitor adult cardiac surgery patients remotely is feasible, is embraced by patients and clinicians, and transforms perioperative cardiac care by significantly improving outcomes and reducing variation.

Effect of Medicare Advantage on Hospital Readmission and Mortality Rankings.

Medicare links hospital performance on readmissions and mortality to payment solely on the basis of outcomes among fee-for-service (FFS) beneficiaries. Whether including Medicare Advantage (MA) beneficiaries, who account for nearly half of all Medicare beneficiaries, in the evaluation of hospital performance affects rankings is unknown. To determine if the inclusion of MA beneficiaries in readmission and mortality measures reclassifies hospital performance rankings compared with current measures. Cross-sectional. Population-based. Hospitals participating in the Hospital Readmissions Reduction Program or Hospital Value-Based Purchasing Program. Using the 100% Medicare files for FFS and MA claims, the authors calculated 30-day risk-adjusted readmissions and mortality for acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia on the basis of only FFS beneficiaries and then both FFS and MA beneficiaries. Hospitals were divided into quintiles of performance based on FFS beneficiaries only, and the proportion of hospitals that were reclassified to a different performance group with the inclusion of MA beneficiaries was calculated. Of the hospitals in the top-performing quintile for readmissions and mortality based on FFS beneficiaries, between 21.6% and 30.2% were reclassified to a lower-performing quintile with the inclusion of MA beneficiaries. Similar proportions of hospitals were reclassified from the bottom performance quintile to a higher one across all measures and conditions. Hospitals with a higher proportion of MA beneficiaries were more likely to improve in performance rankings. Hospital performance measurement and risk adjustment differed slightly from those used by Medicare. Approximately 1 in 4 top-performing hospitals is reclassified to a lower performance group when MA beneficiaries are included in the evaluation of hospital readmissions and mortality. These findings suggest that Medicare's current value-based programs provide an incomplete picture of hospital performance. Laura and John Arnold Foundation.