Reduction In Number Of Hospitalizations Research Articles

Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020.

Access to advanced and sophisticated health technologies made it possible to increase the survival of children with complex chronic conditions. Thus, the profile of pediatric patients admitted to hospitals has changed in recent decades. In Brazil, there are few epidemiological studies on this subject. This study aims to evaluate the main characteristics and temporal trend of hospital admissions of children and adolescents with complex chronic conditions in Brazil, 2009-2020. This is a cross-sectional study with data on hospitalizations of children and adolescents with complex chronic conditions, extracted from the Hospital Information System of the Unified Health System, 2009-2020, in the 26 Brazilian states and the Federal District. The analysis included descriptive statistics and a generalized linear model. From 2009 to 2020, there were 1,337,120 hospitalizations of children and adolescents with complex chronic conditions, and of these, 735,820 (55.0%) were male. The percentage of hospital deaths during the analyzed period was 4.0%. The most recurrent diagnostic category was malignancy (41.0%), with an annual incidence increase of 2.61 (95% CI: 1.16-4.05). Between 2009 and 2019, the increase in hospitalizations for complex chronic conditions was 27.4% for boys and 25.2% for girls, and the reductions in the number of hospitalizations for other causes were 15.4% and 11.9% for boys and girls, respectively. Conclusions: Hospitalizations for complex chronic conditions in pediatrics are increasing in Brazil. This increase is a new challenge for the Brazilian public health system. What is Known: •The profile of pediatric patients admitted to hospitals has changed in recent decades, with a reduction in the total number of hospitalizations, but with an increase in the complexity and costs of these hospitalizations. •The world's scientific production on CCC is concentrated in the United States health care system. Epidemiological studies on the topic in universal health care systems are scarce. What is New: •This is the first study that evaluated the temporal trend of hospitalizations of children and adolescents with CCC in Brazil. •Hospitalizations for CCC in pediatrics are increasing in Brazil, with emphasis on the condition of malignancy, higher incidence in males and in children under one year of age. Furthermore, our study found a decrease in hospitalizations for other pediatric causes.

Abstract 13888: Impact of Atrial Fibrillation Ablation on Recurrent Cardiovascular Hospitalizations

Introduction: Atrial fibrillation (AF) ablation has been shown to improve quality of life in AF patients, however, its impact on healthcare resource utilization is not well established. We sought to evaluate the impact of AF ablation on cardiovascular hospitalizations as a surrogate for resource utilization. Methods: We retrospectively included consecutive patients undergoing AF ablation at our multi-hospital healthcare system (2013 - 2020). Hospital admissions were assessed in the 12-month period preceding the ablation procedure (or from the time of AF diagnosis, if AF was diagnosed <12 months before ablation), and up to 24 months post-ablation. In each patient, pre- and post-ablation hospitalization rates were compared using paired t-test. Results: We included 4,310 patients who underwent AF ablation in our hospital system. Mean age was 63 ± 10 years, 65.5% were males, and mean CHA2DS2-VASc was 2.1 ± 1.5. AF ablation was associated with a statistically significant reduction in the total number of hospitalizations (0.7 ± 1.9 admission per person-year pre-ablation vs. 0.3 ± 0.7 post-ablation, P<0.001), total number of cardiovascular hospitalizations (0.7 ± 1.2 admission per person-year pre-ablation vs. 0.2 ± 0.6 post-ablation, P<0.001), total number of AF-related hospitalizations (0.6 ± 1.1 admission per person-year pre-ablation vs. 0.1 ± 0.4 post-ablation, P<0.001), and total number of hospital admission days (2.2 ± 4.8 days per person-year pre-ablation vs. 1.3 ± 4.9 post-ablation, P<0.001). The percentage of patients who had a cardiovascular hospitalization during each quarter (3-month period) of the pre- and post-ablation study period are shown in the Figure. Conclusions: In a large multi-hospital US healthcare system, AF ablation was associated with a significant reduction in the rates of hospitalization, including total, cardiovascular and AF-related hospitalizations, which may have significant implications for healthcare resource utilization.

Home telemonitoring in heart failure patients and the effect of study design on outcome: A literature review

Introduction A wide range of study designs have been utilized in evaluations of home telemonitoring and these studies have produced conflicting outcomes over the years. While some of the research has shown that telemonitoring is beneficial in reducing all-cause mortality, hospital admission, length of stay in hospital and emergency room visits, other studies have not shown such benefits. This study, therefore, aims to examine several home telemonitoring study designs and the influence of study design on study outcomes. Method Articles were obtained by searching PubMed database with the term heart failure combined with the following terms: telemonitoring, telehealth, home monitoring, and remote monitoring. Searches were limited to randomized controlled trial conducted between year January 1, 2000 and February 6, 2021. The characteristics of the study designs and study outcomes were extracted and analyzed. Result Our review of 34 randomized controlled trials of heart failure telemonitoring did not show any significant influence of study design on reduction in number of hospitalizations and/or decrease in mortality. Studies that were done outside North America (USA and Canada) and studies that selected patients at high risk of re-hospitalization were more likely to result in decreased hospitalization and/or mortality, though this was not statistically significant. All the studies that met our inclusion criteria were from high-income countries and only one study enrolled patients at high risk of re-hospitalization. Conclusion There is a need for more studies to understand why telemonitoring studies in Europe were more likely to reduce hospital admission and mortality compared to those in North America. There is also a need for more studies on the effect of telemonitoring in patients at high risk of hospital readmission.

Patient perspectives of ‘one stop shop’ preassessment

Introduction We decided to explore the patient perspective of our new ‘one stop shop’ cardiothoracic surgery pre-assessment service, in which the patient sees the surgeon, specialist nurse and anaesthetist in one hospital visit. The service aims to improve patient experience by reducing the number of preoperative hospital visits, and facilitate the move of all elective patients to day of surgery admission. Identification of anaesthetic concerns in advance of admission and discussion ofEnhanced Recovery following surgery were anticipated clinical advantages. As part of the service, we give a written leaflet (1) and introduced online information videos for patients to access at home following their ‘one stop shop’ preassessment. Methods In April 2019, a year following service implementation, we surveyed 30 post-operative inpatients by use of a bedside questionnaire. All patients had attended our pre-assessment clinic before their surgery. Results We visited 16 Cardiac and 14 Thoracic patients. 100% of patients felt they received enough information to feel adequately prepared for surgery. 88% (14/16) cardiac patients received the leaflet 'Anaesthesia for Heart Surgery'(1), with 86% (12/14) finding it useful. 30% (9/30) accessed our online videos. Feedback was positive. 24% (5/21) of non-viewers, were unaware of them, but of these, only one accessed other online information. The average time spent in hospital for the ‘one stop shop’ was 5 hours 22 minutes (median 5 hours IQR 2.25 hours). 97% (29/30) felt this was acceptable and did not wish to have separate visits to the hospital. Patients found it helpful to have their partner with them, and found it ‘overall a good experience’. Staff were rated as friendly, supportive and reassuring. Suggested areas to improve upon included: appointment duration with surgeon, diagrammatic explanation of their surgery and the timing of anaesthetic appointments. Discussion Patients appear to rate our 'one stop shop' highly, and favour the reduction in number of hospital visits despite the long day. We need to highlight the availability of our online videos, signposting patients towards them during their visit to the “one stop shop” more clearly. Production of a written patient information leaflet on anaesthesia for thoracic surgery is needed.

Innovative eHealth at Home Program Reduces Hospitalization and Readmission Rates of Patients with Heart Failure

Introduction Hospital admission rates remain persistently high among patients with heart failure despite optimal medical management following prescribed guideline directed medical therapy. Few interventions or therapies have demonstrated a significant reduction in admission rates due to heart failure complications. In this study, we investigated the utility of evaluating patients with heart failure at home as part of the eHealth at Home Program to optimize management in the home setting to prevent hospitalization. Hypothesis Given preliminary data, our hypothesis is that the eHealth at Home Program significantly reduces hospitalization rates of patients with heart failure. Methods A total of 86 patients were enrolled in eHealth at Home Program between December 2016 and October 2018. Within 24-48 hours of enrollment, patients are seen by a registered nurse and pharmacist for reconciling and delivering medication and medical equipment. A provider evaluates the patient 3-5 days after enrollment and then weekly, communicating updates to the primary care provider and/or cardiologist. Key outcome measures studied included rate of inpatient hospitalizations, Emergency Department visits, Observation visits, length of stay on initial hospitalization, and the number of 30 day readmissions. Trends in the Minnesota Living with Heart Failure Questionnaire were also studied. Results were compared to the same outcome measures for the 12 months prior to enrolling in the program. Results Enrolling in the eHealth at Home Program showed significant reduction in number of hospitalizations (2.4 vs 3.9, p Conclusions The eHealth at Home Program offers significant benefit to patients with heart failure by reducing hospitalization and readmission rates, while also improving quality of life. Further investigation is underway to expand on these initial findings, and prospective randomized trials could be warranted based on this study.

Reducing Smoking in the US Federal Workforce: 5-Year Health and Economic Impacts From Improved Cardiovascular Disease Outcomes.

We estimated the reduction in number of hospitalizations for acute myocardial infarction and stroke as well as the associated health care costs resulting from reducing the number of smokers in the US federal workforce during a 5-year period. We developed a 5-year spreadsheet-based cohort model with parameter values from past literature and analysis of national survey data. We obtained 2015 data on the federal workforce population from the US Office of Personnel Management and data on smoking prevalence among federal workers from the 2013-2015 National Health Interview Survey. We adjusted medical costs and productivity losses for inflation to 2015 US dollars, and we updated future productivity losses for growth. Because of uncertainty about the achievable reduction in smoking prevalence and input values (eg, relative risk for acute myocardial infarction and stroke, medical costs, and absenteeism), we performed a Monte Carlo simulation and sensitivity analysis. We estimated smoking prevalence in the federal workforce to be 13%. A 5 percentage-point reduction in smoking prevalence could result in 1106 fewer hospitalizations for acute myocardial infarction (range, 925-1293), 799 fewer hospitalizations for stroke (range, 530-1091), and 493 fewer deaths (range, 494-598) during a 5-year period. Similarly, estimated costs averted would be $59 million (range, $49-$63 million) for medical costs, $332 million (range, $173-$490 million) for absenteeism, and $117 million (range, $93-$142 million) for productivity. Reductions in the prevalence of smoking in the federal workforce could substantially reduce the number of hospitalizations for acute myocardial infarction and stroke, lower medical costs, and improve productivity.

HOME TELEMONITORING FOR CHRONIC DISEASE MANAGEMENT: AN ECONOMIC ASSESSMENT

There have been very few assessments of the economics of home telemonitoring, and the quality of evidence has often been weakened by methodological flaws. This has made it difficult to compare telehomecare with traditional home care for the chronic diseases studied. This economic analysis is an attempt to address this gap in the literature. We have analyzed the consumption of healthcare services by 95 patients with various chronic diseases over a 21-month period, that is, 12 months before, 4 months during home telemonitoring use, and over 5 months after withdraw of the technology. Our findings indicate significant benefits to the home telemonitoring program as evidenced by large reductions in number of hospitalizations, length of average hospital stay, and, to a lesser extent, number of emergency room visits. Contrary to expectations, however, the number of home visits by nurses increased both during and after the telemonitoring intervention. In terms of the financial analysis, the telehomecare program resulted in significant savings: the equivalent of over CAD1,557 per patient as calculated on an annualized basis. This represents a net gain of 41 percent as compared to traditional home care. While the present economic analysis led to positive results, additional assessments should be conducted to confirm the cost-effectiveness of this mode of care delivery.

Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population

PurposeTo study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population.MethodsObservational cohort study. Using Swedish healthcare register data, we identified 3977 Region...

Hospitalizations for Heart Failure in the United States—A Sign of Hope

HEART FAILURE (HF) IS THE MOST COMMON CAUSE OF hospitalization in patients older than 65 years in the United States. In the early 1990s, data from clinical trials and registries demonstrated that in patients hospitalized with HF, mortality and rehospitalization rates could be as high as 15% and 30%, respectively, at 60 to 90 days after discharge. During this period, major efforts were directed toward reducing the length of stay in patients hospitalized with HF. Performance measures were developed and later adopted by the Centers for Medicare & Medicaid Services (CMS) with the intent to improve postdischarge outcomes. Although these measures were implemented across the country, the rehospitalization rate for patients with HF did not appear to decrease. Recently, because of changes in CMS reimbursement patterns, the focus has shifted toward 30-day postdischarge readmission rates as a measure of care. In this issue of JAMA, Chen et al reviewed administrative data of more than 55 million Medicare fee-for-service beneficiaries,withameanageof79years,whowerehospitalizedwith a discharge diagnosis of HF. Black patients represented 11% of the total studypopulation.Theoverall ratesof risk-adjusted hospitalizationforHFdeclined30%over thestudyperiodfrom 2845 per 100 000 person-years in 1998 to 2007 per 100 000 person-years in2008.Theauthorsattribute thisdecline inhospitalizations to reductions in the incidence of coronary artery disease, improved control of blood pressure, increased use of evidence-based therapies, and possibly changes in admission thresholds. In contrast to this significant reduction in hospitalizations forHF,1-year risk-adjustedall-causemortality rate declined minimally but remained high at approximately 30%. This report is a substantial contribution to existing HF epidemiological literature because it is the first to document an improvementinhospitalizationrates inHFintheUnitedStates. These improvementsappear tobemoreevident inrecentyears during which major progress has been made in promoting evidence-basedtherapies forcoronaryarterydisease.However, thissubstantialdecline inhospitalizationrateswassignificantly less in black men than in white men. Another important observation was that the decreases in hospitalization rates across states were not uniform. The authors also noted that comorbidities such as hypertension and renal dysfunction increased over time. Approximately 40% of these patients had diabetes and 30% had chronic obstructive pulmonary disease. The general reduction in admission rates may reflect improvements in overall management of HF risk factors, as suggested by Chen et al, but the persistently high 1-year mortality rates suggest that postdischarge practices for patients with HF have not been as effective. Although the admission rates for HF have decreased based on Medicare data reported by Chen et al, the available data suggest that rehospitalization rates after an index admission for HF have remained unchanged or have even increased over a similar time frame. It is important to recognize that among patients discharged following hospital admission for HF, a significant number of rehospitalizations are not related to HF. In the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome StudywithTolvaptan) trial conducted inpatientsadmitted for worsening HF with reduced ejection fraction, the total rehospitalizationrateexceeded50%at9.9months,andless thanhalf of rehospitalizations were due to HF. This occurred despite the studypopulationbeing relativelyyoung forHF(meanage, 62years),withfewmajorcomorbidconditions.IntheDIG(Digitalis Investigation Group) ancillary trial that studied outpatients with HF and preserved ejection fraction, the total hospitalization rate exceeded 65% during a mean follow-up of 37 months.Ofthesehospitalizations,only35%wererelatedtoHF. Inbothstudies,totalcardiovascularhospitalizationsrepresented a large proportion of the hospitalizations. Targeting total rehospitalization rather than rehospitalization for HF rates may be especially important given the aging population and their associated cardiac and noncardiac comorbid conditions. Chen et al suggested that the reduction in HF admissions may be related to changes in the threshold for admission in emergency departments. Lee et al reported that patients with HF who were discharged home directly from the emergency department, representing 30% of total HF presentations in their cohort, had a high risk-adjusted early death compared with patients who were admitted. If the reduction in number of hospitalizations noted by Chen et al is

Increased Continuity of Care Associated with Decreased Hospital Care and Emergency Department Visits for Patients with Asthma

The objective of this study was to determine the association between continuity of care and emergency room visits/hospital care for patients with asthma. A population-based study was conducted using administrative healthcare datasets obtained from Alberta Health and Wellness, Alberta, Canada. The 4-year study period extended from April 1, 1996 to March 31, 2000, and took place at the Palliser Health Region in Alberta, Canada, which has a population of 88,000 people. A population-based sample of 2774 patients, diagnosed with asthma between ages 5 and 45 with two or more office visits for asthma and who lived in the Palliser Health Region for 2 consecutive years during the study period, was studied. The main outcome measure was the association of continuity of care with hospitalizations and emergency room visits for patients with asthma. Continuity of care was the proportion of total physician visits made to the most frequently visited physician. High continuity of care was associated with a decreased risk of an emergency visit (OR = 0.24: 95% CI 0.19-0.29), number of emergency visits (RR = 0.37; 95% CI 0.32-0.42), decreased risk of number of hospitalizations (RR = 0.69; 95% CI 0.54-0.89), and total days in hospital (average difference = 0.77; 95% CI 0.63-0.95), but not with ever hospitalized. High continuity of care was associated with a 60%-75% reduction in emergency room visits and an approximate 25% reduction in number of hospitalizations in patients with asthma. Interventions to improve continuity of care could have the potential to improve care and reduce cost.

Role of Clinical Pharmacist in a Heart Failure Clinic

Purpose To determine if the inclusion of a clinical pharmacist (CP) in a heart failure (HF) multidisciplinary team could lead to a reduction in the number of hospital admissions and additionally decrease the clinical signs and symptoms of HF patients with either Medicaid or no medical insurance. Methods Longitudinal study to determine the impact of a pharmaceutical-care service program to HF patients by comparing the 9-month period before (pre-intervention) and the 9-month period after (post-intervention) implementation of the program. The intervention of the CP was directed in two complementary functions. The first was direct patient contact and the second was to provide drug information to the medical clinicians. Results Twenty-nine outpatients completed the study. Over 9 months, the CP made a total of 216 interventions and had three in-person, follow-up contacts and three telephone contacts per patient. At post-intervention, there was a statistically significant reduction in the total number of hospitalizations (50 vs 23; P < 0.018) and length of stay (LOS) (263 days vs 108 days; P < 0.03). However, there was an insignificant reduction in HF hospitalizations, LOS, and total number of HF signs and symptoms. Conclusions Addition of a CP to an outpatient HF clinic can lead to fewer hospital admissions and a reduction in the LOS in patients with either Medicaid or no medical insurance.

Long-term effects of aspirin desensitization—Treatment for aspirin-sensitive rhinosinusitis-asthma

One hundred seven known aspirin (ASA)-sensitive patients with rhinosinusitis-asthma were studied from 1975 to 1988. Forty-two of the patients avoided ASA and served as the control group. Thirty-five patients were desensitized to ASA and treated with daily ASA treatment (Rx) for as long as 8 years (mean. 3.75 years) to May 1988 and were designated the continuous group. Thirty patients, initially desensitized to ASA and treated with daily ASA, who stopped Rx permanently after a mean duration of 2 years, were designated the discontinued group. Retrospective analyses of baselines revealed that both continuous and discontinued groups during ASA Rx demonstrated statistically significant reduction in number of hospitalizations per year, emergency room visits per year, outpatient visits per year, upper respiratory infectionssinusitis-antibiotics per year, need for nasal polypectomies and additional sinus operations, and improvement in sense of smell compared to the control group. Simultaneously, the ASA-Rx groups were able to significantly reduce systemic corticosteroid dosage, corticosteroid bursts per year, and, in the continuous group only, significantly reduce inhaled corticosteroids. All three groups maintained control of respiratory symptoms. ASA desensitization followed by long-term daily ASA Rx appears to improve ASA-sensitive rhinosinusitis-asthma and concomitantly allows reduction of systemic corticosteroids.