Improving Care Transitions Means More Than Reducing Hospital Readmissions

Cykert, Samuel

doi:10.18043/ncm.73.1.31

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…Hospital readmissions within 30 days of discharge are an essential quality measure as they represent a potentially preventable adverse outcome. 1-4 Readmissions not only drive costs 5 but also account, on average, for 20% of the Medicare beneficiaries being readmitted within 30 days of discharge from the hospital. 6,7 A variety of strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

Gupta

Zengul

Davlyatov

et al. 2019

INQUIRY

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Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.

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Section: Introductionmentioning

confidence: 99%

Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

Gupta

Zengul

Davlyatov

et al. 2019

INQUIRY

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“…O estudo das readmissões se torna relevante em razão da indicação de elementos disfuncionais do sistema ou serviços de saúde, além do fato de serem frequentemente evitáveis, perigosas e representarem elevados custos hospitalares 2 .…”

Section: Introductionunclassified

Ocorrência de readmissões hospitalares em um município de grande porte populacional

Dias

Zanetti²,

Chaves

et al. 2021

Rev. Adm. Saúde

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Objetivo: analisar as readmissões hospitalares em instituições públicas e privadas de um município de grande porte populacional. Método: Estudo observacional analítico das readmissões ocorridas em Ribeirão Preto, em 2011, em hospitais públicos e privados. Resultados: Identificou-se 16.123 readmissões hospitalares em 11 hospitais, com taxa média de readmissão de 14,2%. As readmissões mais frequentes ocorreram em pacientes em idade adulta, com no mínimo uma comorbidade associada. Predominaram as readmissões pelo Sistema Único de Saúde, em hospitais com mais de 100 leitos e elevada complexidade assistencial. A readmissão precoce está associada ao sexo, tipo de convênio e tempo de permanência na internação inicial. Conclusões: Os resultados sugerem que as readmissões estejam relacionadas à dinâmica da rede de serviços e à complexidade assistencial dos casos atendidos; seu monitoramento auxilia no processo de planejamento, programação e avaliação das ações em saúde; entretanto, a utilização desse indicador de desempenho deve acontecer em conjunto com outros indicadores, analisados de acordo com a realidade institucional e dos fatores intervenientes.Palavras-chave: Readmissão do Paciente; Indicadores de Qualidade em Assistência à Saúde; Acesso aos Serviços de Saúde. Occurrence of hospital readmissions in a large population municipalityABSTRACTObjective: to analyze hospital readmissions in public and private institutions in a large population size municipality. Method: Observational analytical study of readmissions in Ribeirão Preto in 2011, in public and private hospitals. Results: 16,123 hospital readmissions were identified in 11 hospitals, with a mean readmission rate of 14.2%. The most frequent readmissions occurred in adult patients, with at least one associated comorbidity. Readmissions were predominant in the Unified Health System, in hospitals with more than 100 beds and high complexity of care. Early readmission is associated with gender, type of health insurance plan and length of stay in the initial hospitalization. Conclusions: The results suggest that readmissions are related to the dynamics of the service network and to the complexity of care of the cases seen; its monitoring assists in the process of planning, programming and evaluating health actions; however, the use of this performance indicator should occur in conjunction with other indicators, analyzed according to the institutional reality and intervening factors.Keywords: Patient Readmission; Quality Indicators, Health Care; Health Services Accessibility.

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“…Considerando o fato de as readmissões hospitalares serem evitáveis, exporem os pacientes a riscos desnecessários e representarem elevados custos hospitalares (BIANCO et al, 2012;CYKERT, 2012), entende-se ser necessário o monitoramento do comportamento das readmissões e a identificação precoce do risco de readmissão.…”

Section: Relevânciaunclassified

Modelo preditivo do risco de readmissão hospitalar no contexto brasileiro

Dias¹

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Hospital readmission has been used as a health care outcome indicator. Considering that readmissions are considered avoidable, expose patients to unnecessary risks and represent excessive costs, it is relevant to identify patients with high risk of readmission. In this perspective, several predictive models have been developed, among which the LACE index (L -length of stay; A -acuity of the admission; C -Charlson comorbidity index score; e E -emergency department use) stands out as an easily applicable tool, structured in data frequently available in health services and with clinically relevant results. Objective: to analyze the predictive ability of hospital readmission by a score of identification of readmission risk in the Brazilian context. Methods: a retrospective analytical observational study was carried out in a general hospital with important insertion in the health care network. All hospital admissions whose discharges occurred in the period from January to December 2019 were considered eligible. The following variables were analyzed: age, age group, gender, main and secondary diagnosis, origin, length of stay, character of hospitalization, Charlson Comorbidity Index, emergency department visits, and LACE index. Analysis performed according to lines of care, conditions of interest and age groups.Demographic data and characterization of hospitalization were analyzed according to the outcome (readmitted or not readmitted), using the nonparametric Mann-Whitney test and the chi-square test. Analysis of the predictive capacity of the score was performed using the discrimination measure with calculation of the area under the curve of receiver operating characteristics. Results: 22,687 patients were included, of whom 13.44% were readmitted within 30 days. The median LACE index was 5 (IQR: 3.00; 8.00) and was higher for readmitted patients 6.00 (IQR: 4.00; 9.00), p<0.001. 12.86% of patients were classified as high risk for readmission and the index discrimination was 0.561 (CI: 0.549; 0.572). In the analysis of the LACE index across lines of care, conditions of interest and age groups, difference was observed between readmitted and non-readmitted for cardiovascular diseases (p=0.002), cancer (p=0.003), under 5 years (p<0.001), children and adolescents (p<0.001), adults (p<0.001), elderly (p<0.001). The discrimination by analysis group was 0.524 (p=0.209) for Primary Care Sensitive Conditions, 0.542 (p=0.374) for Diabetes Mellitus, 0.416 (p=0.244) for Systemic Arterial Hypertension, 0.548 (p=0.004) for Cardiovascular Diseases, 0, 644 (p=0.096) for Stroke, 0.525 (p=0.546) for Chronic Respiratory Diseases, 0.539 (p=0.003) for Cancer, 0.591 (p<0.001) for children under five, 0.593 (p<0.001) for children and adolescents, 0.543 (p<0.001) for adults, and 0.539 (p<0.001) for the elderly. Conclusions: the differences observed between the groups of readmitted and non-readmitted patients indicate that the LACE index helps to identify the risk of readmission, although its low predictive capacity prevents its isolated use. ...

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Improving Care Transitions Means More Than Reducing Hospital Readmissions

Cited by 6 publications

References 18 publications

Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

Ocorrência de readmissões hospitalares em um município de grande porte populacional

Modelo preditivo do risco de readmissão hospitalar no contexto brasileiro

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