Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review

Snow, Katelin; Galavíz, Karla I.; Turbow, Sara

doi:10.1007/s11606-019-05366-z

Cited by 64 publications

(61 citation statements)

References 36 publications

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“…First, while a majority of the study of inter-hospital fragmentation has focused on readmissions to other hospitals, we show that that is just the tip of the iceberg (18). We nd that a majority of readmissions to other hospitals occur in patients who use multiple hospitals beyond a 30-day window.…”

Section: Discussionmentioning

confidence: 65%

“…Our understanding of this problem is limited because the majority of studies of fragmentation focus on readmissions to other hospitals in a short period of time. (18) Two studies have begun to address this area using single-state or urban regional data, and they demonstrate that as many as 20% of hospital super-utilizers experience some degree of fragmentation. (19,20) Investigation into the impact of inpatient care fragmentation on patient outcomes and cost are needed.…”

Section: Introductionmentioning

confidence: 99%

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Fragmented Care of Hospital Super-utilizers: A Cross-sectional Study

Kaltenborn¹,

Paul²,

Kirsch³

et al. 2020

Preprint

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Background: Super-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described.Objective: To determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes.Research Design: We analyzed inpatient data from the Health Care Utilization Project’s State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital’s ability to identify super-utilizers. Subjects: Adult patients with 4 or more inpatient stays in 1 year. Measures: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer. Results: Of the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer. Conclusions: Inpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Fragmented Care of Hospital Super-utilizers: A Cross-sectional Study

Kaltenborn¹,

Paul²,

Kirsch³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…33 To address the challenge of care transitions for patients and their caregivers, interventions to support effective communication and team-work across transitions of care are important. [34][35][36] Most interventions included in this review targeted administration of medications by caregivers. [22][23][24] While studies have shown that 50 to 70% of caregivers assist with medication administration in people living with dementia, caregivers are also engaged in other aspects of medication management.…”

Section: Discussionmentioning

confidence: 99%

Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: a Systematic Review

et al. 2021

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BACKGROUND: Hospital discharge has a significant impact on the continuity of care for people living with dementia. Clear guidance on medication management should be provided to caregivers of people living with dementia to ensure appropriate use of medications post-discharge. AIM: Identify and appraise the impact of interventions at hospital discharge to guide caregivers in the medication management for people living with dementia. METHOD: A systematic search of original studies was performed in Medline, Embase, PsycINFO, and CINAHL. Articles published in English that reported on interventions to guide caregivers in medication management for people living with dementia were included. Two authors independently reviewed titles and abstract. Full-text articles were assessed for eligibility and quality assessment was conducted by two authors. RESULTS: A total of five studies were included with a range of interventions that were typically delivered postdischarge by a multidisciplinary team and most targeted administration of medications by caregivers. Overall, three types of discharge interventions were identified including a pre-discharge caregiver educational intervention, a postdischarge multidisciplinary team intervention, and discharge summary documentation intervention at transitions of care. Of these, a pre-discharge caregiver education led to shorter hospital stay (25 days vs. 31 days, p = 0.005). A post-discharge intervention that included follow-up visits resulted in lower use of high-risk medications (19% vs. 40%), and reduction in 30-day re-hospitalization rates (11% vs. 20%). In contrast, in another post-discharge intervention study, no difference in one-month re-hospitalization rates (8.4% vs. 8.0%, p = 0.82) was demonstrated. In another study, a post-discharge hospital educational program provided to caregivers led to significantly reduced caregiver burden (31.7 ± 17.6 (SD) pre-intervention to 27.7 ± 16.9 (SD) post-intervention (p = 0.037)). DISCUSSION: Current findings suggest there is a need for well-designed interventions to guide caregivers in all aspects of medication management for people living with dementia, and should include support for caregivers in care coordination.

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“…Highly-fragmented healthcare organizations often have deficits in the coordination of tasks such as inefficient communication between providers and with patients. Deficits in care coordination have comprehensively been described in cancer care and other diseases and associations with patient outcomes such as higher mortality have been shown [7,8]. Therefore, achieving effective coordination of patient care has been declared by the Institute of Medicine [9] as a major challenge for healthcare organizations.…”

Section: Introductionmentioning

confidence: 99%

Measuring social capital of healthcare organizations reported by employees for creating positive workplaces - validation of the SOCAPO-E instrument

Hower

Wirtz

Kowalski

et al. 2020

BMC Health Serv Res

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Background: In highly segmented and complex healthcare organizations social capital is assumed to be of high relevance for the coordination of tasks in healthcare. So far, comprehensively validated instruments on social capital in healthcare organizations are lacking. The aim of this work is to validate an instrument measuring social capital in healthcare organizations. Methods: This validation study is based on a cross-sectional survey of 1050 hospital employees from 49 German hospitals which specialize in breast cancer care. Social capital was assessed by a six-item scale. Reliability analyses and confirmatory factor analyses were conducted to determine the content validity of items within the theorydriven one-dimensional scale structure. The scale's associations with measures of the social aspects of the work environment (identification, social support, open communication climate) were estimated to test convergent validity. Criterion-related validity was evaluated by conducting structural equation modelling to examine the predictive validity of the scale with measures of work engagement, well-being and burnout. Results: A one-dimensional structure of the instrument could be identified (CFI = .99; RMSEA = .06). Convergent validity was shown by hypothesis-consistent correlations with social support offered by supervisors and colleagues, a climate of open communication, and employee commitment to the organization. Criterion-related validity of the social capital scale was proved by its prediction of employee work engagement (R 2 = .10-.13 for the three subscales), well-being (R 2 = .13), and burnout (R 2 = .06-.11 for the three subscales). Conclusions: The confirmed associations between social capital and work engagement, burnout as well as wellbeing stress the importance of social capital as a vital resource for employee health and performance in healthcare organizations. In healthcare organizations this short instrument can be used as an efficient instrument to measure the organizations' social capital.

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Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review

Cited by 64 publications

References 36 publications

Fragmented Care of Hospital Super-utilizers: A Cross-sectional Study

Fragmented Care of Hospital Super-utilizers: A Cross-sectional Study

Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: a Systematic Review

Measuring social capital of healthcare organizations reported by employees for creating positive workplaces - validation of the SOCAPO-E instrument

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