Background Reducing hospital readmissions depends on ensuring safe care transitions, which requires a better understanding of the challenges experienced by key stakeholders. Objective Develop a descriptive framework illustrating the interconnected roles of patients, providers and caregivers in relation to readmissions. Design Multi-method qualitative study with four focus groups and 43 semi-structured interviews. Multiple perspectives were included to increase the trustworthiness (internal validity) and transferability (external validity) of the results. Data were analyzed using Grounded Theory to generate themes associated with readmission. Setting/Patients General medicine patients with same-site 30-day readmissions, their family members, and multiple care providers at a large urban academic medical center. Results A keynote generated from the multi-perspective responses was that care transitions were optimized by a well-coordinated multidiscipline support system, described as the Patient Care Circle. In addition, issues pertaining to readmissions were identified and classified into five main themes emphasizing the necessity of a coordinated support network: (1) Teamwork; (2) Health systems navigation and management; (3) Illness severity and health needs; (4) Psychosocial stability; (5) Medications. Conclusion A well-coordinated collaborative Patient Care Circle is fundamental to ensuring safe care transitions.

Anemia is common among general medical inpatients and adversely affects their length of stay and 30-day unplanned readmission rate.

BackgroundWe report patient outcomes after antiretroviral therapy (ART) initiation in a network of HIV facilities in Haiti, including temporal trends and differences across clinics, during the expansion of HIV services in the country.MethodsWe assessed outcomes at 12 months after ART initiation (baseline) using routinely collected data on adults (≥15 years) in 11 HIV facilities from July 2007-December 2013. Outcomes include death (ascertained from medical records), lost to follow-up (LTF) defined as no visit > 365 days from ART initiation, and retention defined as being alive and attending care ≥ 365 days from ART initiation. Outcomes were compared across calendar year of ART initiation and across facilities. Risk factors for death and LTF were assessed using Cox proportional hazards and competing risk regression models.ResultsCumulatively, 9,718 adults initiated ART with median age 37 years (IQR 30–46). Median CD4 count was 254 cells/uL (IQR 139–350). Twelve months after ART initiation, 4.4% (95% CI 4.0–4.8) of patients died, 21.7% (95% CI 20.9–22.6) were LTF, and 73.9% (95% CI 73.0–74.8) were retained in care. Twelve-month mortality decreased from 13.8% among adults who started ART in 2007 to 4.4% in 2013 (p<0.001). Twelve-month LTF after ART start was 29.2% in 2007, 18.7% in 2008, and increased to 30.1% in 2013 (p<0.001). Overall, twelve-month retention after ART start did not change over time but varied widely across facilities from 61.1% to 86.5%.ConclusionExpansion of HIV services across Haiti has been successful with increasing numbers of patients initiating ART and decreasing twelve-month mortality rates. However, overall retention has not improved, despite differences across facilities, suggesting additional strategies to improve engagement in care are needed.

Health care providers should be aware of the potential dangers of spinning-related rhabdomyolysis especially in otherwise healthy young people.