Short-term Care Research Articles

Effects of care burden on the life of caregivers of the elderly: A mixed-method study model.

Determining the care burden of elderly caregivers in the early period allows for early intervention to protect them from the negative physical, social, and psychological effects of care. This mixed-method study aimed to determine the burden levels of caregivers of elderly individuals and evaluate their opinions on the difficulties they experienced while caregiving. This study was conducted with caregivers of 89 elderly people who were determined to need care by visiting the homes of elderly people aged 65 years and over living in Famagusta. While the KATZ index of independence in activities of daily living and the Zarit Burden Interview tool were used to collect quantitative data, face-to-face interviews were conducted with 28 selected participants to collect qualitative data. The mean age of the caregivers was 52 ± 12 years; they were mostly female spouses/children/relatives, and 29.2% had moderate-to-severe care burden perceptions. The perception of caregiver burden levels increased as the level of dependency of elderly individuals and the duration of caregiving increased. Considering that caregiving burden affects every aspect of caregivers' lives, it should be assessed regularly. To reduce care burden, it is recommended to expand home care services and short-term care facilities, use health technologies for continuous distance education and counseling in elderly care, and financially support caregivers who cannot work due to the responsibilities of providing elderly care.

The duration of intervention required to improve the motor function of pre-frail elderly people in a short-term intensive day care service.

The duration of intervention required to improve the motor function of pre-frail elderly people in a short-term intensive day care service.

Impact of margin thermal treatment after EMR of giant (≥40 mm) colorectal lateral spreading lesions

Increasing lesion size is a risk factor for recurrence after piecemeal EMR (pEMR). Snare-tip soft coagulation (STSC) treatment of the normal-appearing margin after pEMR of lesions≥ 20mm has been shown to reduce recurrence rates by 75% to 80%. We sought to evaluate the impact of STSC on giant (≥ 40mm) lateral spreading lesions treated by pEMR. We describe the relative risk and absolute risks of recurrence with and without STSC margin treatment after EMR of≥ 40-mm lesions. We performed a retrospective evaluation of a prospectively collected database on large lesions describing lesion size, location, and methods of resection. We excluded lesions< 40mm in maximum dimension, those that did not undergo follow-up care at our center, and those in which argon plasma coagulation was used for either ablative treatment of residual polyp or margin treatment. Propensity score analysis was used to account for potential differences between patients treated with and without STSC. There were 68 lesions≥ 40mm removed by pEMR without STSC treatment and 133 removed and treated with STSC. There were no differences between groups in demographics, polyp size, location, histologic features, and mean follow-up time. The recurrence rate in the no-treatment group was 35% versus 9% with STSC (P< .00001 by direct comparison and P= .008 by using the propensity score analysis). STSC treatment after pEMR of large lateral spreading lesions in the colorectum reduced recurrences by 75%. However, the absolute recurrence rate of 9% remained clinically significant in the STSC-treated group. Short-term follow-up care after STSC of lesions≥ 40mm is still warranted, and additional study of technical factors that eliminate recurrence after pEMR of giant lateral spreading lesions is warranted.

Non-invasive positive pressure ventilation for central sleep apnoea in adults.

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Predictive Risk Modeling for Recurrence of Child Maltreatment Using Cases from the National Child Maltreatment Data System in Korea: Exploratory Data Analysis Using Data Mining Algorithm.

The purpose of this study was to explore and identify patterns of risk predictors of maltreatment recurrence using predictive risk modeling (PRM). This study used the administrative dataset from the National Child Maltreatment Information System recorded by Korean CPS (Child Protective Service) workers. The information, including recurrent maltreatment, was collected in 2012; then, those reported cases werefollowed for 2years through 2014. The data included information about child, family, caregiver, maltreatment, and service characteristics and consisted of male (50.22%) and female (49.78%) children with an average age of 9years (n = 4319). We examined the association of risk factors with recurrence using conditional inference trees (CTREE): a tree-based data mining algorithm for classification that allows the exploration of the interconnection between hypothesized risk factors. Study findings showed that a history of prior CPS involvement was the first decision point in the decision tree structure of recurrence. The effect of other risk factors depended on the presence of prior CPS involvement. In the absence of prior CPS involvement, cases with (a) a single-parent status and (b) a caregiver's alcohol abuse living in other types of households (two-parent households, kinship care, andchildren without parents) were associated with recurrence. In the presence of prior CPS involvement, cases with out-of-home care or others (long- or short-term foster care and emergency placement) in the final decision of child placement (a) where in-home care in the initial decision of child placement within the presence of physical abuse and (b) where social isolation without physical abuse was related to recurrence. Cases with (a) a male caregiver and (b) a female caregiver with social isolation and without social isolation yet employed were at high risk for recurrence under the circumstance of in-home care in the final decision of child placement. This exploratory study found multiple connections among the factors in the prediction of recurrence. The CTREE helps unravel the complexity embedded in maltreatment recurrence by capturing its patterns. This information can deepen our knowledge of associations between risk factors in the prediction of recurrence and be used as a reference to inform child maltreatment policy and prevention.

Impact of a Very Short-Stay Post-Emergency Geriatric Unit on Early Readmissions.

In 2017, our French 1671-bed university hospital opened a 12-bed unit for very short stays, post-emergency (unit of transitory admission in geriatric [UTAG] area), dedicated to frail patients older than 75 years requiring short-term care. We sought to investigate whether this new organization's shortened length of stay (LOS) was associated or not with a higher rate of readmission. We conducted a retrospective descriptive study based on the daily activity of the UTAG over 6 months including all patients consecutively hospitalized in the unit via the computerized medical file of the hospital. The data collected included the Rockwood score, the primary diagnoses, the LOS and any 1-month readmission. From August 2019 to January 2020, 646 older adult patients were hospitalized in the UTAG. Two-thirds of the hospitalized patients were women; the mean age of this population was 86.7 ± 6.2 years. The main causes of hospitalization were infectious pathologies (19.8%), falls and their consequences (17.3%), and cardiac pathologies (17.2%). The mean LOS was of 2.7 ± 2.0. Seventy readmissions were observed in the month after discharge. One-month readmissions were more frequent when patients had presented with acute heart failure and among nursing home residents. The creation of the UTAG reduced LOS and so contributed to decreased iatrogenic disabilities without putting patients at increased risk of readmission. The development of cardiac and geriatric dedicated outpatient pathways and a community-based geriatric mobile team intervening in nursing homes could optimize the care of frail older adult patients and avoid readmissions.

Care pathways at end-of-life for cancer decedents: registry based analyses of the living situation, healthcare utilization and costs for all cancer decedents in Norway in 2009-2013 during their last 6 months of life

BackgroundResearch on end-of-life care is often fragmented, focusing on one level of healthcare or on a particular patient subgroup. Our aim was to describe the complete care pathways of all cancer decedents in Norway during the last six months of life.MethodsWe used six national registries linked at patient level and including all cancer decedents in Norway between 2009-2013 to describe patient use of secondary, primary-, and home- and community-based care. We described patient’s car pathway, including patients living situation, healthcare utilization, and costs. We then estimated how cancer type, individual and sociodemographic characteristics, and access to informal care influenced the care pathways. Regression models were used depending on the outcome, i.e., negative binomial (for healthcare utilization) and generalized linear models (for healthcare costs).ResultsIn total, 52,926 patients were included who died of lung (16%), colorectal (12%), prostate (9%), breast (6%), cervical (1%) or other (56%) cancers. On average, patients spent 123 days at home, 24 days in hospital, 16 days in short-term care and 24 days in long-term care during their last 6 months of life. Healthcare utilization increased towards end-of-life. Total costs were high (on average, NOK 379,801). 60% of the total costs were in the secondary care setting, 3% in the primary care setting, and 37% in the home- and community-based care setting. Age (total cost-range NOK 361,363-418,618) and marital status (total cost-range NOK354,100-411,047) were stronger determining factors of care pathway than cancer type (total cost-range NOK341,318- 392,655). When patients died of cancer types requiring higher amounts of secondary care (e.g., cervical cancer), there was a corresponding lower utilization of primary, and home- and community-based care, and vice versa.ConclusionCancer patient’s care pathways at end-of-life are more strongly associated with age and access to informal care than underlying type of cancer. More care in one care setting (e.g., the secondary care) is associated with less care in other settings (primary- and home- and community based care setting) as demonstrated by the substitution between the different levels of care in this study. Care at end-of-life should therefore not be evaluated in one healthcare level alone since this might bias results and lead to suboptimal priorities.

39.1 Crisis Assessments, Triage, and Intervention: Coordinating With Schools

The top tier of our multitiered school mental health program provides dedicated access for our partnering school districts (21 districts, over 100 schools) to 2 community-embedded behavioral health crisis centers that allows our child and adolescent psychiatry–led clinical teams to help support schools with triage, crisis evaluations (same or next day access), short-term care and care coordination to both higher levels, and ongoing long-term care.

Desire-Driven Reasoning Considering Personalized Care Preferences

Care robots have been developed to address the shortage of caregivers in hospitals and homes. However, providing care services considering abstract physiological desires (e.g., hunger, thirst, hot, and cold) rather than specific commands (e.g., serve a cup of water) has not been fully investigated. The key to such services that satisfy abstract requests, e.g., thirst, is to evaluate the available options (e.g., milk, tea, biscuit, and Coke) with the consideration of the care recipient’s preferences. In this study, we argue that both general taste (long-term care preferences) and sequential influence [short-term care preferences (STCPs)] should be considered for a robot to provide satisfying services. In this article, a long STCP model (LSTCPM) is introduced. The model can be initialized and updated incorporating the feedback from the care recipients. Then, a virtual agent-based simulation system is presented, which provides a way to evaluate and fine-tune the LSTCPM prior to its deployment to actual care robots. Finally, experiments were conducted in a real household domain using our care robot KUT-PCR to demonstrate the feasibility of the proposed approach.

The effect of hospital discharge price increases on publicly reported measures of quality.

To determine if increases in hospital discharge prices are associated with improvements in clinical quality or patient experience. This study used Medicare cost report data and publicly available Medicare.gov Care Compare quality measures for approximately 3000 short-term care general hospitals between 2011 and 2018. We separately regressed quality measure scores on a lag of case mix adjusted discharge price, hospital fixed effects, and year indicators. Clinical quality measures included 30-day readmission rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, hip and knee replacement, and pneumonia; risk-adjusted 30-day mortality rates for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, and stroke; and 90-day complication rate for hip and knee replacement. Patient experience measures included the summary star rating and 10 domain measures reported through the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We tested for heterogeneous effects by hospital ownership, number of beds, the commercial share of overall discharges, and market concentration. We linked hospitals identified in Medicare cost reports to Medicare.gov Care Compare quality measures. We excluded hospitals for which we could not identify a discharge price or that had an unrealistic price. There was no positive association between lagged discharge price and any clinical quality measure. For patient experience measures, a 2% increase in discharge price was not associated with overall patient satisfaction but was associated with small, statistically significant increases ranging from 0.01% to 0.02% (relative to mean scores) for seven of ten domain measures. There was a positive association for five of ten patient experience measures in competitive markets and one measure in both moderately concentrated and heavily concentrated markets. We found no evidence that hospitals use higher prices to make investments in clinical quality; patient experience improved, but only negligibly.

The type and scope of physiotherapy is under-utilised in Australian residential aged care facilities: a national, cross-sectional survey of physiotherapists

BackgroundWith an increasingly ageing population in Australia, more older adults who are frail are living in residential aged care facilities (RACFs). The aim of this study was to detail the type, scope, and funding of physiotherapy utilised in Australian RACFs.MethodsRegistered physiotherapists (n = 219, 72% female, mean age (SD) = 38.6 (12.9) years) working in Australian RACFs participated in a nationwide, cross-sectional online survey. The survey was developed iteratively through a review of the literature and clinical guidelines, consensus of final survey items by an expert panel of five senior physiotherapists and aged care managers. Survey questions related to the characteristics of the physiotherapists (e.g., age, gender, employment status), characteristics of the RACFs (e.g., state, remoteness, sector), the type and scope of physiotherapy provided by respondents, and the availability of equipment and certain spaces (e.g., gyms) in the RACFs that respondents worked in. Survey responses were analysed and presented descriptively. Correlation using Spearman’s rho (ρ) and the associated 95% confidence intervals (CI) were used to determine whether the availability of equipment or space at the RACF was associated with the time dedicated to performing non-Aged Care Funding Instrument (ACFI) tasks.ResultsCommon reasons for physiotherapy referral were chronic pain management as per the ACFI framework (89.7%), falls (69.2%), and reduced mobility (35.9%). Rehabilitation or short-term restorative care was provided in only 22.2% of the facilities. The ACFI funded 91.4% of all participants, which limited physiotherapists to low-value chronic pain management including massage and electrical stimulation. Respondents spent 64.5% of their time on ACFI tasks, which equated to 19 h per week. More time was spent on non-ACFI tasks particularly when resistance bands (ρ = 0.28, 95%CI 0.14–0.41) and a dedicated therapy space or gym (ρ = 0.19, 95%CI 0.04–0.33) were available.ConclusionsThe expertise of physiotherapists is currently being under-utilised in Australian RACFs, which may be related to the availability of public funding, equipment, and space for therapy. Therefore, public health policy should address the urgent need for high-value, evidence-based physiotherapy that supports the reablement and independence of older adults living in RACFs.

Municipal healthcare professionals’ interprofessional collaboration during older patients’ transitions in the municipal health and care services: a qualitative study

BackgroundInterprofessional collaboration is vital to assist patients towards a healthy transition in the municipal health and care services. However, no study has so far investigated municipal health care providers’ inter-professional collaboration during older patients’ transition in the municipal health and care services. The aim of this study is therefore to describe and explore what influence health care providers’ inter-professional collaboration within and across municipal facilities during older patients’ transitions in the municipal health and care services.MethodThe study has a descriptive, interpretive design. Focus group interviews and individual interviews with municipal health care providers different professions were performed.ResultsMunicipal health care providers’ inter-professional collaboration during older patients transitions in the municipal health and care services was challenging. Two main themes were identified: The patient situation itself and Professional. Personal, and Practical circumstances. The results show that the municipal priority of patients staying at home as long as possible facilitated inter-professional collaboration across the short-term care facility and the home care services. Inter-professional collaboration across facilities with the long-term care facility was downgraded and health care providers in this facility had to cope as best they could.ConclusionPrioritising and facilitating inter-professional collaboration between the short-term care facility and the home care services, contributed to health care providers experiencing doing a proper and safe patient assistance. Yet, this priority was at a cost: Health care providers in the long-term care facility, and in particular registered nurses felt squeezed and of less worth in the municipal health and care services. It was a strain on them to experiencing unplanned and often rushed patient transition into long-term care facility. To focus on municipal inter-professional and inter-facility collaboration during patients in transition to long-term care placement is vital to maintain the patients, and the health care providers working in these facilities.

Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up

BackgroundThe generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data.MethodsSeven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables.ResultsAt baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found.ConclusionsFor half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings.Trial registrationGerman Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018.

Restructuring Patient Review and Allocation in a South London Home Treatment Team

AimsLambeth Home Treatment Team (LHTT) provides short-term intensive community psychiatric care to a diverse South London population. The high turnover of patients requires a streamlined process to review and discuss their progress. We aimed to discuss patients in more frequent, targeted and shorter meetings, and to improve continuity of medical care using a ‘named doctor’ system. We assessed impact on length of stay with LHTT, on staff time as well as on both patient and staff satisfaction.MethodsThe system of once-weekly day-long discussions of entire caseload was replaced by twice-weekly discussions of new and concerning patients only. The system of medical reviews was changed from ad hoc to MDT-agreed allocation to a specific doctor for the duration of LHTT stay.Data on duration of treatment and caseload size were taken from regular LHTT statistical reports. Staff and patient questionnaires assessed impact on satisfaction and time spent in review discussions.ResultsQualitative reports of staff experience revealed that the new system was felt to provide better continuity of care, better time efficiency (less time spent learning about new patients) and improved learning experiences for doctors in training. Downsides included lack of ‘automatic second opinion’ when a patient was reviewed by a different doctor, felt to be mitigated by more frequent discussions in MDT reviews when needed.Patient feedback showed no significant change was noted in overall experience of LHTT, although patients were more likely to feel involved in their care (88% said ‘definitely’ compared to 68% before the change).Time spent discussing patients in clinical review meetings reduced from an average of 38.5 to 28.5 person-hours per week.Average caseload reduced from 57 to 42. However, duration of treatment increased from 18.8 days to 20.4 days.ConclusionThe reduction in staff time in reviews suggests that the system had been appropriately streamlined. While caseload size reduced, duration of stay slightly increased, so the new system was not found to have had a significant impact on objective measures of patient care.Staff feedback was generally favourable, highlighting continuity of care and time efficiency. Patient feedback, while good both before and after our change, suggested a greater feeling of involvement in their care, possibly due to clearer communication and discussion of plan from the start of LHTT care.

Predictors of runaway behavior in adolescent Saudi girls

The phenomenon of girls running away from home is an increasingly widespread social challenge confronted by families, welfare agencies, and governmental organizations in Jeddah, Saudia Arabia. This study compared runaway girls and a control group on various measures and investigated the predictors of runaway behavior among Saudi adolescent girls. A sample of young adolescent girls (N = 77, aged between 14 and 21 years) included a purposive sample of runaways (N = 33), comprised of all the girls living in a social care home in Jeddah who had left their homes at least once, and a control group (N = 44) selected via cluster sampling. The participants were assessed using a demographic questionnaire, the Family Cohesion Scale, and the Basic Psychological Need Satisfaction Scale. Inter-group differences were apparent and differences were also found based on the circumplex model. The results of the stepwise discriminant analysis showed six variables (family cohesion, age, education, number of sisters, number of brothers, and birth order) that remained and explained 80.82% of group membership variation. Lack of family cohesion, along with several demographic variables, can lead to complicated emotional attitudes among adolescent girls which trigger runaway behavior. Although runaway youth services must continue to stay focused on safety and short-term residential care, the underlying causal factors must be identified as well.

Awareness of Peripheral Intravenous Catheters Among Nurses, Physicians, and Students.

Peripheral intravenous catheters (PIVCs) are frequently used to meet patients' short-term health care needs. However, many PIVCs are not promptly removed at the completion of treatment, placing patients at risk of avoidable harm from serious complications including local and systemic infection. This study aims to report the proportion and accuracy of health care staff/students awareness of the presence of their patient's PIVC. We asked staff/students to recall the presence or absence of a PIVC in a patient under their care, as well as details of the date of insertion and PIVC location. We recorded concordance of responses with direct observations. To achieve this, face-to-face interviews were conducted with clinical staff/students at 2 adult hospitals. Overall, 90% (n = 216) of staff responses (94% of nurses, 100% of nursing students, 76% of medical staff) correctly identified the presence/absence of a PIVC. Clinicians correctly identified the PIVC location 55% (n = 71) of the time. Health care services must recognize the implications of this lack of awareness and implement and evaluate tailored quality improvement efforts to address this.

Is the Hospital Value-Based Purchasing Program Associated with Reduced Hospital Readmissions?

IntroductionHospital readmissions have been associated with adverse outcomes and elevated financial costs to patients, families, and hospitals across the United States. Historically, nearly 20% of all Medicare discharges had a readmission within 30 days. In an effort to address this issue, the Affordable Care Act (ACA) established the Hospital Readmission Reduction Program (HRRP) in 2012 to positively influence readmissions associated with acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and total hip and/or knee arthroplasty. However, as recently as 2018, there were still 3.8 million 30-day all-cause adult hospital readmissions, with a 14% readmission rate and an average readmission cost of $15,200. The ACA also produced the Hospital Value-Based Purchasing (HVBP) program with the stated intent to (1) reduce mortality and complications, (2) reduce healthcare-associated infections, (3) increase patient safety, (4) improve the patient experience, and (5) increase efficiency and reduce costs. Given the costs and quality implications of an average readmission, it is logical to believe that HVBP eligible hospitals are simultaneously seeking to meet the goals of both programs. However, to date, no studies have examined if that is the case. Thus, in this study, we seek to determine if HVBP eligible hospitals are associated with a reduction in the core set of HRRP readmission rates better than the facilities that are not eligible for the HVBP program.MethodsHospital-level data from calendar year 2019 for 3,276 short-term acute care hospitals in the United States were evaluated using multivariate regression analysis to examine the readmission rate performance between 2,719 HVBP eligible hospitals and 557 ineligible hospitals.ResultsOur six separate multivariable linear regressions revealed a statistically significant and positive association between HVBP participation and readmission rates after controlling for numerous organizational, clinical complexity, and environmental factors. In each case, the magnitude of the positive directional association is moderate, ranging from and increase of +0.19% (pneumonia readmissions) to as high as +0.37% (all cause readmissions) for HVBP eligible hospitals. When considered in the context of the average number of discharges in our data set (x- = 9570), a third of a percent increase from the average 15.56% all cause readmissions to 16.08% in HVBP eligible hospitals equates to 50 additional readmissions annually (9570 × 15.56% = 1,489 vs 9570 × 16.08% = 1,539). At an average cost of $15,200 per readmission, which equates to an average additional cost to the average HVBP eligible hospital in excess of $760,000.DiscussionThe fact that there is a positive association between HVBP participating hospitals and readmissions at all, and that the same effect appears to be persistent across all dependent measures is concerning. One would logically expect hospitals that are focused on quality-based care to thoroughly care for individuals in order for them to not be readmitted to the hospital. The results provided do not necessarily prove that either program is not working. But they also do not confirm that the HVBP and HRRP programs are working together and accomplishing what they were originally designed to do: improve patient care and lower health-care costs.

Association Between Hospital Private Equity Acquisition and Outcomes of Acute Medical Conditions Among Medicare Beneficiaries

As private equity (PE) acquisitions of short-term acute care hospitals (ACHs) continue, their impact on the care of medically vulnerable older adults remains largely unexplored. To investigate the association between PE acquisition of ACHs and access to care, patient outcomes, and spending among Medicare beneficiaries hospitalized with acute medical conditions. This cross-sectional study used a generalized difference-in-differences approach to compare 21 091 222 patients admitted to PE-acquired vs non-PE-acquired short-term ACHs between January 1, 2001, and December 31, 2018, at least 3 years before to 3 years after PE acquisition. The analysis was conducted between December 28, 2020, and February 1, 2022. Differences were estimated using both facility and hospital service area fixed effects. To assess the robustness of findings, regressions were reestimated after including fixed effects of patient county of origin to account for geographic differences in underlying health risks. Two subset analyses were also conducted: (1) an analysis including only hospitals in hospital referral regions with at least 1 PE acquisition and (2) an analysis stratified by participation in the Hospital Corporation of America 2006 acquisition. The study included Medicare beneficiaries 66 years and older who were hospitalized with 1 of 5 acute medical conditions: acute myocardial infarction (AMI), acute stroke, chronic obstructive pulmonary disease exacerbation, congestive heart failure exacerbation, and pneumonia. Acquisition of hospitals by PE firms. Comorbidity burden (measured by Elixhauser comorbidity score), hospital length of stay, in-hospital mortality, 30-day mortality, 30-day readmission, and 30-day episode payments. Among 21 091 222 total Medicare beneficiaries admitted to ACHs between 2001 and 2018, 20 431 486 patients received care at non-PE-acquired hospitals, and 659 736 received care at PE-acquired hospitals. Across all admissions, the mean (SD) age was 79.45 (7.95) years; 11 727 439 patients (55.6%) were male, and 4 550 012 patients (21.6%) had dual insurance; 2 996 560 (14.2%) patients were members of racial or ethnic minority groups, including 2 085 128 [9.9%] Black and 371 648 [1.8%] Hispanic; 18 094 662 patients (85.8%) were White. Overall, 3 083 760 patients (14.6%) were hospitalized with AMI, 2 835 777 (13.4%) with acute stroke, 3 674 477 (17.4%) with chronic obstructive pulmonary disease exacerbation, 5 868 034 (27.8%) with congestive heart failure exacerbation, and 5 629 174 (26.7%) with pneumonia. Comorbidity burden decreased slightly among patients admitted with acute stroke (difference, -0.04 SDs; 95% CI, -0.004 to -0.07 SDs) at acquired hospitals compared with nonacquired hospitals but was unchanged across the other 4 conditions. Among patients with AMI, a greater decrease in in-hospital mortality was observed in PE-acquired hospitals compared with non-PE-acquired hospitals (difference, -1.14 percentage points, 95% CI, -1.86 to -0.42 percentage points). In addition, a greater decrease in 30-day mortality (difference, -1.41 percentage points; 95% CI, -2.26 to -0.56 percentage points) was found at acquired vs nonacquired hospitals. However, 30-day spending and readmission rates remained unchanged across all conditions. The extent and directionality of estimates were preserved across all robustness assessments and subset analyses. In this cross-sectional study using a difference-in-differences approach, PE acquisition had no substantial association with the patient-level outcomes examined, although it was associated with a moderate improvement in mortality among Medicare beneficiaries hospitalized with AMI.

Predictors of Functional Improvement, Length of Stay, and Discharge Destination in the Context of an Assess and Restore Program in Hospitalized Older Adults.

Assess and restore programs such as Humber’s Elderly Assess and Restore Team (HEART) provide short-term restorative care to prevent functional decline in hospitalized older adults. The aim of this retrospective observational study was to determine which HEART participant characteristics are predictive of functional improvement, decreased length of stay, return to home, and decreased readmission to hospital. Electronic health records were retrospectively examined to gather predictor data. Differences in functional status, excessive length of stay, discharge destination, and hospital readmissions were compared in 547 HEART patients and 547 matched eligible non-participants using ANOVAs, Mann–Whitney, and chi-square tests. The greatest functional improvements (percent Barthel change) were seen in those requiring a one-person assist (M = 39.56) and using a walker (M = 46.07). Difference in excessive length of stay between HEART and non-HEART participants was greatest in those who used a walker (Mdn = 3.80), required a one-person assist (Mdn = 2.00), had a high falls risk (Mdn = 1.80), and had either a lower urinary tract infection (Mdn = 2.25) or pneumonia (Mdn = 1.70). Predictor variables did not affect readmission to the hospital nor return to home. Predictive characteristics should be considered when enrolling patients to assess and restore programs for optimal clinical outcomes.

Thirty-day Readmissions Among Patients With Cardiogenic Shock Who Underwent Extracorporeal Membrane Oxygenation Support In The United States: Insights From The Nationwide Readmissions Database

Background The use of Extracorporeal Membrane Oxygenation (ECMO) for cardiogenic shock has been increasing in the United States and is associated with significant morbidity, mortality, and healthcare resources utilization. We sought to explore rates and predictors of hospital readmissions in patients with cardiogenic shock after contemporary ECMO use. Methods Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who were hospitalized between January to November between 2016-2018 for cardiogenic shock (ICD code R57.0) requiring ECMO support (ICD-10-PCS 5A15223). Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. Results A total of 10,723 patients underwent ECMO for cardiogenic shock from 2016 to 2018. After excluding patients who died (n=5,602; 52%) and those who underwent LVAD or OHT during index admission (n=892; 8%), 4,229 patients discharged alive were included in our analysis. Of those, 694 (16.4%) were re-admitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR=1.77; 95% CI 1.32-2.37), chronic liver disease (OR=1.35; 95% CI 1.03-1.77), and prolonged LOS (≥30 days; OR =1.38; 95% CI 1.05-1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50-0.95) and short-term hospital post discharge care (OR = 0.53; 95% CI 0.28-0.99) conferred a lower risk. Sepsis, followed by congestive heart failure were the more common causes for readmission. Conclusions Proper identification of patients at increased risk for readmission may help improve prevention strategies and improve outcomes of cardiogenic shock after ECMO. The use of Extracorporeal Membrane Oxygenation (ECMO) for cardiogenic shock has been increasing in the United States and is associated with significant morbidity, mortality, and healthcare resources utilization. We sought to explore rates and predictors of hospital readmissions in patients with cardiogenic shock after contemporary ECMO use. Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who were hospitalized between January to November between 2016-2018 for cardiogenic shock (ICD code R57.0) requiring ECMO support (ICD-10-PCS 5A15223). Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. A total of 10,723 patients underwent ECMO for cardiogenic shock from 2016 to 2018. After excluding patients who died (n=5,602; 52%) and those who underwent LVAD or OHT during index admission (n=892; 8%), 4,229 patients discharged alive were included in our analysis. Of those, 694 (16.4%) were re-admitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR=1.77; 95% CI 1.32-2.37), chronic liver disease (OR=1.35; 95% CI 1.03-1.77), and prolonged LOS (≥30 days; OR =1.38; 95% CI 1.05-1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50-0.95) and short-term hospital post discharge care (OR = 0.53; 95% CI 0.28-0.99) conferred a lower risk. Sepsis, followed by congestive heart failure were the more common causes for readmission. Proper identification of patients at increased risk for readmission may help improve prevention strategies and improve outcomes of cardiogenic shock after ECMO.