Not All Discharge Settings Are Created Equal: Thirty-Day Readmission Risk after Elective Colorectal Surgery

Hoang, Chau M; Davids, Jennifer S.; Maykel, Justin A.; Flahive, Julie; Sturrock, Paul R.; Alavi, Karim

doi:10.1097/dcr.0000000000001727

Cited by 7 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Discharge to home with organized home health services, SNF, or rehabilitation facility is associated with increased adjusted risk of readmission compared with routine home discharge after elective colorectal surgery. 26 In this study, fifty percent of patients discharged to home with organized home health services, which is higher than literature reported rate of 24%. 26,27 Our rate is likely higher because it includes non-elective patients as well.…”

Section: Discussioncontrasting

confidence: 59%

“…26 In this study, fifty percent of patients discharged to home with organized home health services, which is higher than literature reported rate of 24%. 26,27 Our rate is likely higher because it includes non-elective patients as well. Further study is needed to identify the reasons for the variability in utilization and cost of post-acute care services.…”

Section: Discussioncontrasting

confidence: 59%

See 1 more Smart Citation

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Sibia,

Klune,

Saiolghalam

et al. 2024

The American Surgeon™

View full text Add to dashboard Cite

Background Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. Methods Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. Results A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). Conclusions Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.

show abstract

Section: Discussioncontrasting

confidence: 59%

Section: Discussioncontrasting

confidence: 59%

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Sibia,

Klune,

Saiolghalam

et al. 2024

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…Previous studies have demonstrated that discharge to home with the need for home health services is significantly associated with readmission compared with routine home discharge. 34 Improved coordination of services is needed to alleviate patient stress and ensure better post-operative outcomes. 35 Other themes which were identified to be barriers to the discharge process included the timing of discharge.…”

Section: Advanced Practice Nurse Utilizationmentioning

confidence: 99%

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

et al. 2022

View full text Add to dashboard Cite

Objective Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population. Methods A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding. Results Eight focus groups with a total of 38 participants were conducted. Participants included physicians ( n = 13), nursing/ancillary staff ( n = 14), advanced nurse practitioners ( n = 2), social worker/dietitian/pharmacist ( n = 3), and patients ( n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity. Conclusions Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients’ multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process.

show abstract

“…All locations besides long-term care were associated with a higher risk of readmission even after adjusting for confounders. 64…”

Section: Stepwise Guide To Implementing Older Adult–specific Cancer C...mentioning

confidence: 99%

“…All locations besides long-term care were associated with a higher risk of readmission even after adjusting for confounders. 64 Palliative or supportive care comanagement. Palliative or supportive care is a multidisciplinary approach focused on relief from suffering for any patient with serious illness and at any stage of disease.…”

Section: Stepwise Guide To Implementing Older Adult-specific Cancer C...mentioning

confidence: 99%

Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care

Montroni

Saur

Shahrokni

et al. 2021

JCO

View full text Add to dashboard Cite

show abstract

Not All Discharge Settings Are Created Equal: Thirty-Day Readmission Risk after Elective Colorectal Surgery

Cited by 7 publications

References 22 publications

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care

Contact Info

Product

Resources

About