Senior services in US hospitals and readmission risk in the Medicare population

Arbaje, Alicia I.; Yu, Qilu; Wang, Jiangxia; Leff, Bruce

doi:10.1093/intqhc/mzx112

Cited by 6 publications

(12 citation statements)

References 37 publications

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“…But the rates in the control group were similar to countrywide data [31]. Overall, readmission rates may be influenced by hospital characteristics [34].…”

Section: Secondary Outcomessupporting

confidence: 75%

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions

Brühwiler

Beeler

Böni

et al. 2019

International Journal for Quality in Health Care

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Objective To improve discharge prescription quality and information transfer to improve posthospital care with a pragmatic in-hospital service. Design A single-centre, randomized controlled trial Setting Internal medicine wards in a Swiss teaching hospital Participants Adult patients discharged to their homes, 76 each in the intervention and control group. Intervention Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription. Main Outcome Measures : At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome). Results The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p=0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p<0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p<0.01). Conclusions The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.

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“…But the rates in the control group were similar to countrywide data [31]. Overall, readmission rates may be influenced by hospital characteristics [34].…”

Section: Secondary Outcomessupporting

confidence: 75%

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions

Brühwiler

Beeler

Böni

et al. 2019

International Journal for Quality in Health Care

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“…The SCSS was found to be related to readmission risk in a prior study. (Arbaje et al, 2017) To update the SCSS regarding services relevant to the care of older adults since the passage of the ACA, we conducted confirmatory factor analysis (CFA) using the same list of 15 specific selected services for the 2013 round of the ASH (Table 1). A set of CFA models were fitted using correlation matrix for the services data.…”

Section: Senior Care Services Scalementioning

confidence: 99%

Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act

et al. 2023

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Background: The Senior Care Services Scale (SCSS) describes hospital provision of older adult services before the passage of the Affordable Care Act. Objectives: Since act passage, (1) update SCSS service groups; and (2) investigate hospital SCSS scores’ relationship to readmission or mortality among Medicare beneficiaries. Methods: Retrospective cohort analysis of older adults ≥65 years ( n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes: Hospital readmission, or death, within 30 and 90 days of discharge. Results: The updated SCSS had three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days (RR .94, 95% CI .91–.98), and 90 days (RR .94, 95% CI .91–.97). There was no significant association between Home-Care-and-Hospice and Post-Acute-Community-Care scores and study outcomes. Conclusion: Greater provision of hospital-level senior services may be associated with mortality reduction among Medicare beneficiaries.

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“…Covariates for our analysis will include patient and hospital characteristics collected during Aim 1 and will be supplemented by review of the covariates implemented for the analysis in Arbaje et al (2017). 34…”

Section: Aim 2: Determine If Access To Home and Community Resources Amentioning

confidence: 99%

“…33 To calculate an SCSS-PA score, we will mirror the analysis developed by Arbaje et al (2017). 34 We will create binary variables (yes/no) from the ASH data to assign to each service of interest within each health system, depending on availability. Senior Care Services Scale scores will be developed through factor analysis studying the variability of the PA services.…”

Section: Aim 2: Determine If Access To Home and Community Resources Amentioning

confidence: 99%

Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol

Hill

Cuthel

Grudzen

2020

Am J Hosp Palliat Care

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Objectives: The objective of this study is to identify contextual access factors to home and community health services for end-of-life support for older adults with serious life-limiting illness, as well as determine if access to home and community services is associated with health-care utilization. Design: This study includes an environmental scan, grey literature review, qualitative interviews, and health-care utilization analysis. This study is a subproject of the Grudzen et al. Primary Palliative Care for Emergency Medicine (PRIM-ER) study. Settings/Location: Analysis will include data collection from 17 health systems implementing the PRIM-ER intervention. Participants: For the qualitative interviews, one emergency medicine (EM) physician and one EM nurse will be interviewed from each of the 17 participating health systems. For the health-care utilization analysis, we will use the Senior Care Services Scale (SCSS), American Hospital Association Annual Survey of Hospitals (AHA-ASH), and Medicare claims for all emergency department (ED) visits for serious illness who present at each participating health system. Outcome Measures: The contextual analysis will obtain data on home and community services, such as hospice, home health services, assisted living, integrative medicine services, etc., available around each health system’s highest volume ED, federal and state regulations influencing access to services, as well as EM provider perspectives on access to services. The health-care utilization analysis will determine if SCSS scores, which measure service availability, are associated with health-care usage. High or low SCSS scores are determined by comparing health system service availability on the AHA-ASH to the national median SCSS value.

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Senior services in US hospitals and readmission risk in the Medicare population

Abstract: Senior services at the hospital-level represents a modifiable risk factor with important impact. Employing organization-level characteristics in readmission risk prediction tools should be expanded.

Cited by 6 publications

References 37 publications

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions

Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act

Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol

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