Diagnosis Related Groups of Patients Admitted from an Urban Academic Medical Center to a Virtual Hybrid Hospital-at-Home Program

Maniaci, Michael J.; Cowdell, Jed C.; Maita, Karla C.; Ávila, Francisco R.; Dugani, Sagar; Torres‐Guzman, Ricardo A.; Garcia, John P.; Forte, Antonio J.; Paulson, Margaret R.

doi:10.2147/rmhp.s402355

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…Future work may more closely consider how outcomes for HaH patients vary for the most common diagnoses of patients admitted to HaH programs. 31 Furthermore, differences in outcomes between HaH patients and traditional inpatients may depend on patient age. One possibility is that the gap in outcomes is even greater among older patients than among younger patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Hybrid Hospital at Home Program in Reducing Subacute Rehabilitation

Yadav,

Mahyoub,

Capriotti

et al. 2023

RMHP

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Purpose The purpose of this study was to compare health outcomes for patients receiving acute care in their homes through a Hospital at Home (HaH) program to outcomes for inpatients in the traditional hospital setting. Patients and Methods We compared outcomes for patients in a HaH program at Virtua Health in 2022 (N = 271) to traditional inpatients during the same year (N = 13,776) with the same diagnoses. We defined outcomes as recommendations for subacute rehabilitation (SAR) upon discharge as this recommendation indicates the need for additional therapy based on a physician’s assessment of the patient. Specifically, we searched notes in the electronic medical records for terms related to recommendation for SAR using text mining algorithms and a natural language processing (NLP) model to confirm these recommendations. We then compared the proportion of patients within each group that had a SAR recommendation, and controlled for differences in sample size, age, and diagnosis using bootstrapping analyses. Results We observed that the proportion of patients in the HaH program that were recommended for SAR (0.148) was significantly different from the proportion of patients who remained in the traditional hospital setting (0.363), with a reduced need for SAR for HaH patients. We obtained qualitatively similar results when we controlled for sample size and diagnosis. Controlling for age yielded an older control population, and the difference in the proportion of patients with SAR recommendations between the groups widened. Conclusion The reduced need for SAR for HaH patients in this study suggests that HaH programs are a promising alternative care model. Future work may consider how health outcomes vary for patients with different diagnoses, clinical histories and demographics, which may inform how HaH programs operate moving forward.

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Section: Discussionmentioning

confidence: 99%

The Impact of a Hybrid Hospital at Home Program in Reducing Subacute Rehabilitation

Yadav,

Mahyoub,

Capriotti

et al. 2023

RMHP

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…DRGs classify admissions according to the primary problem addressed and may be tied to hospital reimbursement, but may or may not overlap with chronic comorbidities that are more frequently used in retrospective analyses. 7,8 In this study, we use these data to determine how admission diagnosis modifies the association between sodium correction rate and hospital length of stay in an overall cohort and a surviving subset of patients with severe hyponatremia, defined as serum sodium <120 mEq/L. 3…”

Section: Introductionmentioning

confidence: 99%

A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

Gottlieb,

Celi

2024

Preprint

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Background Recent studies have challenged assumptions about slow correction of severe hyponatremia and have shown that rapid correction is associated with shorter hospital length of stay. However, the confounding effect of admission diagnosis has not been fully explored. The objective of this study was to determine whether rapid correction is still associated with shorter length of stay when controlling for admission diagnosis. Methods This retrospective cohort study is based on the Medical Information Mart for Intensive Care, including data from both MIMIC-III (2001-2012) and MIMIC-IV (2008-2019). Patients were identified who presented to the hospital with initial sodium <120 mEq/L and were categorized according to total sodium correction achieved in the first day (<6 mEq/L; 6-10 mEq/L; >10 mEq/L). Linear regression was used to assess for an association between correction rate and hospital length of stay, and to determine if this association was significant when controlling for admission diagnosis classifications based on diagnosis related groups (DRGs). Results There were 636 patients included in this study. Median [IQR] hospital length of stay was 7 [4, 11] days. Patients had a median [IQR] initial sodium value of 117 [114, 118] mEq/L and final sodium value of 124 [119, 128] mEq/L. In a univariate linear regression, the highest rate of correction (>10 mEq/L) was associated with a shorter length of stay than a moderate rate of correction (coef. -2.363, 95% CI [-4.710, -0.017], p=0.048), but the association was not significant when controlling for admission diagnosis group (coef. -1.685, 95% CI [-3.836, 0.467], p=0.125). Conclusions Faster sodium correction was not associated with shorter length of stay when controlling for admission diagnosis categories, suggesting that the disease state confounds this association. While some patients may be discharged earlier if sodium is corrected more rapidly, others may not benefit or may be harmed by this strategy.

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Diagnosis Related Groups of Patients Admitted from an Urban Academic Medical Center to a Virtual Hybrid Hospital-at-Home Program

Cited by 2 publications

References 20 publications

The Impact of a Hybrid Hospital at Home Program in Reducing Subacute Rehabilitation

The Impact of a Hybrid Hospital at Home Program in Reducing Subacute Rehabilitation

A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

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