Use of Hospital-Based Acute Care Among Patients Recently Discharged From the Hospital

Vashi, Anita; Fox, Justin P.; Carr, Brendan G.; D’Onofrio, Gail; Pines, Jesse M.; Ross, Joseph S.; Gross, Cary P.

doi:10.1001/jama.2012.216219

Cited by 161 publications

(147 citation statements)

References 19 publications

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“…A 2013 study using the SIDs found that 40% of 30-day acute care encounters after hospital discharge were to an ED (10). Vashi et al (10) suggested that, given the high proportion of treat and release ED visits, discharge and transition planning should focus more attention toward this common modality of care rather than hospital readmissions alone. This sentiment is likely salient for the transplant population, in which ED visits are common but relatively understudied and evaluated as an intervention for quality improvement.…”

Section: Discussionmentioning

confidence: 99%

“…In certain contexts, acute care after hospitalization is considered an indication of poor quality of care, and hospitals with high rates face reduction of Medicare reimbursement (8)(9)(10). However, controversies exist regarding the exact interpretations of the use of acute care services and the correlation with quality of care (7,(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Department Visits after Kidney Transplantation

Schold¹,

Elfadawy

Buccini

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives In 2011, there were approximately 131 million visits to an emergency department in the United States. Emergency department visits have increased over time, far outpacing growth of the general population. There is a paucity of data evaluating emergency department visits among kidney transplant recipients. We sought to evaluate the incidence and risk factors for emergency department visits after initial hospital discharge after transplantation in the United States.Design, setting, participants, & measurements We identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012 using the State Inpatient and Emergency Department Databases included in the Healthcare Cost and Utilization Project. We used multivariable Poisson and Cox proportional hazard models to evaluate adjusted incidence rates and time to emergency department visits after transplantation.Results There were 17,575 emergency department visits over 13,845 follow-up years (overall rate =126.9/100 patient-years; 95% confidence interval, 125.1 to 128.8). The cumulative incidences of emergency department visits at 1, 12, and 24 months were 12%, 40%, and 57%, respectively, with median time =19 months; 48% of emergency department visits led to hospital admission. Risk factors for higher emergency department rates included younger age, women, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and emergency department use before transplant. There was wide variation in emergency department visits by individual transplant center (10th percentile =70.0/100 patient-years; median =124.6/100 patient-years; and 90th percentile =187.4/100 patient-years).Conclusions The majority of kidney transplant recipients will visit an emergency department in the first 2 years post-transplantation, with significant variation by patient characteristics and individual centers. As such, coordination of care through the emergency department is a critical component of post-transplant management, and specific acumen of transplant-related care is needed among emergency department providers. Additional research assessing best processes of care for post-transplant management and health care expenditures and outcomes associated with emergency department visits for transplant recipients are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency Department Visits after Kidney Transplantation

Schold¹,

Elfadawy

Buccini

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…11 In order to combat the increasing number of ED visits, studies have indicated that improving primary care (PC) access will contribute to the reduction of ED visits. [12][13][14][15][16] In these examples, Coleman et al (2001) and Coleman (2003) demonstrated that by improving transistion of care through visits with a care team that included a physician, nurse, and pharmacist the number of ED visits was reduced.…”

Section: Participantsmentioning

confidence: 99%

Evaluation of the Influence of a Pharmacist-led Patient-Centered Medication Therapy Management and Reconciliation Service in Collaboration with Emergency Department Physicians

Okere¹,

Renier²,

Tomsche³

2015

JMCP

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“…The data in the present study indicate a base readmission rate of nearly 20%, a rate that is comparable to rates observed in various studies of US populations. [1][2][3] Thus, the 29% reduction on such a high base rate translates to a significant decrease in admissions. Of note, the HODI intervention was not tested in isolation, so the effect is incremental over all other initiatives in place to reduce preventable admissions and readmissions.…”

Section: Discussionmentioning

confidence: 99%

“…1 In the US Medicare population, approximately 20% return to the hospital within 30 days. Estimates were that only one-tenth of these readmissions were likely planned, whereas the total costs of these unplanned readmissions were over US$17 billion.…”

mentioning

confidence: 99%

Effect of post-hospital discharge telephonic intervention on hospital readmissions in a privately insured population in Australia

Hamar

Coberley²,

Pope

et al. 2018

Aust. Health Review

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Objective. The aim of the present study was to evaluate the effect of telephone support after hospital discharge to reduce early hospital readmission among members of the disease management program My Health Guardian (MHG) offered by the Hospitals Contribution Fund of Australia (HCF).Methods. A quasi-experimental retrospective design compared 28-day readmissions of patients with chronic disease between two groups: (1) a treatment group, consisting of MHG program members who participated in a hospital discharge (HODI) call; and (2) a comparison group of non-participating MHG members. Study groups were matched for age, gender, length of stay, index admission diagnoses and prior MHG program exposure. Adjusted incidence rate ratios (IRR) and odds ratios (OR) were estimated using zero-inflated negative binomial and logistic regression models respectively.Results. The treatment group exhibited a 29% lower incidence of 28-day readmissions than the comparison group (adjusted IRR 0.71; 95% confidence interval (CI) 0.59-0.86). The odds of treatment group members being readmitted at least once within 28 days of discharge were 25% lower than the odds for comparison members (adjusted OR 0.75; 95% CI 0.63-0.89). Reduction in readmission incidence was estimated to avoid A$713 730 in cost.Conclusions. The HODI program post-discharge telephonic support to patients recently discharged from a hospital effectively reduced the incidence and odds of hospital 28-day readmission in a diseased population.What is known about the topic? High readmission rates are a recognised problem in Australia and contribute to the over 600 000 potentially preventable hospitalisations per year. What does this paper add? The present study is the first study of a scalable intervention delivered to an Australian population with a wide variety of conditions for the purpose of reducing readmissions. The intervention reduced 28-day readmission incidence by 29%. What are the implications for practitioners? The significant and sizable effect of the intervention support the delivery of telephonic support after hospital discharge as a scalable approach to reduce readmissions.

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Use of Hospital-Based Acute Care Among Patients Recently Discharged From the Hospital

Cited by 161 publications

References 19 publications

Emergency Department Visits after Kidney Transplantation

Emergency Department Visits after Kidney Transplantation

Evaluation of the Influence of a Pharmacist-led Patient-Centered Medication Therapy Management and Reconciliation Service in Collaboration with Emergency Department Physicians

Effect of post-hospital discharge telephonic intervention on hospital readmissions in a privately insured population in Australia

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