Browsing by Subject "Readmissions"

Now showing 1 - 6 of 6
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    Clinical Outcomes and Predictors of Thirty-Day Readmissions of Hypertriglyceridemia-Induced Acute Pancreatitis
    (Elmer Press, 2022) Kichloo, Asim; El-amir, Zain; Aucar, Maria; Dahiya, Dushyant Singh; Al-Haddad, Mohammad; Pisipati, Sailaja; Beiz, Hassan; Singh, Gurdeep; Gandhi, Darshan; Singh, Jagmeet; Pathappillil, Patrick; Mohideen, Haseeb; Shaka, Hafeez; Medicine, School of Medicine
    Background: Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis often leading to significant morbidity, mortality, and healthcare burden. This study aimed to describe the rate, reasons, and predictors of HTG-induced acute pancreatitis (HTG-AP) in the USA. Methods: This retrospective study analyzed the Nationwide Readmissions Database (NRD) for 2018 to determine all adults (≥ 18 years) readmitted within 30 days of an index hospitalization of HTG-AP. Hospitalization characteristics and adverse outcomes for 30-day readmissions were highlighted and compared with index admissions of HTG-AP. Furthermore, independent predictors for 30-day readmissions of HTG-AP were also identified. P values ≤ 0.05 were considered statistically significant. Results: In 2018, the rate of 30-day readmission of HTG-AP was noted to be 13.5%. At the time of readmission, AP (45.2%) was identified as the most common principal diagnosis, followed by chronic pancreatitis (6.3%) and unspecified sepsis (4.8%). Compared to index admissions, 30-day readmissions of HTG-AP had a higher proportion of patients with Charlson Comorbidity Index (CCI) scores ≥ 3 (48.5% vs. 33.8%, P < 0.001). Furthermore, we noted higher rates of inpatient mortality (1.7% vs. 0.7%, odds ratio (OR): 2.55, 95% confidence interval (CI): 1.83 - 3.57, P < 0.001), mean length of stay (LOS) (5.6 vs. 4.1 days, OR: 1.5, 95% CI: 1.2 - 1.7, P < 0.001), and mean total healthcare charge (THC) ($56,799 vs. $36,078, OR: 18,702, 95% CI: 15,136 - 22,267, P < 0.001) for 30-day readmissions of HTG-AP compared to index admissions. Independent predictors for 30-day all-cause readmissions of HTG-AP included hypertension, protein energy malnutrition (PEM), CCI scores ≥ 3, chronic kidney disease and discharge against medical advice. Conclusions: AP was the principal diagnosis on presentation in only 45.2% patients for 30-day readmissions of HTG-AP. Compared to index admissions, 30-day readmissions of HTG-AP had a higher comorbidity burden, inpatient mortality, mean LOS and mean THC.
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    Crucial Conversations for High-Risk Populations before Surgery: Advance Care Planning in a Preoperative Setting
    (Mary Ann Liebert, Inc., 2021-10-06) Patel, Roma; Torke, Alexia; Nation, Barb; Cottingham, Ann; Hur, Jennifer; Gruber, Rachel; Sinha, Shilpee; Medicine, School of Medicine
    Background: High-risk patients undergoing elective surgery are at risk for perioperative complications, including readmissions and death. Advance care planning (ACP) may allow for preparation for such events. Objectives: (1) To assess the completion rate of advance directives (ADs) and their association with one year readmissions and mortality (2) to examine clinical events for decedents. Design: This is an observational cohort study conducted through chart review. Setting/Subjects: Subjects were 400 patients undergoing preoperative evaluation for elective surgery at two hospitals in the United States. Measurements: The prevalence of ADs at the time of surgery and at one year, readmissions, and mortality at one year were determined. Results: Three-hundred ninety patients were included. In total, 102 (26.4%) patients were readmitted, yet did not complete an AD. Seventeen (4.4%) patients filed an AD during follow-up. Nineteen patients died and mortality rate was 4.9%. There was a significant association between completing an AD before death. Of the decedents, seven (37%) underwent resuscitation, but only four had ADs. Conclusions: Many high-risk surgical patients would benefit from ADs before clinical decline. Preoperative clinics present a missed opportunity to ensure ACP occurs before complications arise.
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    Increasing thirty-day readmissions of Crohn's disease and ulcerative colitis in the United States: A national dilemma
    (Baishideng Publishing Group, 2022) Dahiya, Dushyant Singh; Perisetti, Abhilash; Kichloo, Asim; Singh, Amandeep; Goyal, Hemant; Rotundo, Laura; Vennikandam, Madhu; Shaka, Hafeez; Singh, Gurdeep; Singh, Jagmeet; Pisipati, Sailaja; Al-Haddad, Mohammad; Sanaka, Madhusudhan R.; Inamdar, Sumant; Medicine, School of Medicine
    Background: The prevalence of Crohn's disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization. Aim: To identify trends and adverse outcomes for 30 d readmissions for CD and UC. Methods: This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant. Results: Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions. Conclusion: There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.
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    Pilot Study Evaluating a Post Hospital Follow-Up Curriculum for Internal Medicine Interns
    (2023-04-19) Frontera, Eric D; Ho, Monling; Kochhar, Komal
    Objective or purpose of innovation Successful hospital follow-up visits can prevent medication errors and mitigate readmissions. Medical education curricula typically focus on how transitions of care are forwarded to providers within an inpatient setting, or from inpatient to outpatient; however, there is little formal training among Internal Medicine (IM) residents in performing ambulatory hospital follow-up visits. Innovation Design A novel curriculum was created whereby IM interns (PGY1) attended a one hour-long interactive lecture that was offered virtually and in-person. The interns observed patient scenarios that highlighted hospital follow-up tasks, which were then used to create a checklist for the learner to apply to their clinic patients. Evaluation Plan: methods and measures Before and after attending the interactive lecture, the interns were asked to complete a pre-test (n=14) and post-test (n=12) regarding their knowledge and attitudes about hospital follow-up visits. PGY2&3 IM residents (n=26) were also asked to complete the pre-test, but were not asked to attend the interactive lecture. This was done to establish a baseline of clinical competence that might be expected in more experienced residents. Outcomes Chi-square analysis revealed no significant differences between the pre-test and post-test results of the PGY1 interns. In comparison to the more senior residents (PGY2&3), the interns remained significantly less likely (p< 0.05) to be confident in their ability to conduct hospital follow-up visits; to identify ways that hospital follow-up visits can help them understand inpatient care and management strategies; to consider social determinants of health as barriers and as possible triggers for readmission; and to be confident identifying next steps in patient care management following hospital discharge. Innovation’s strengths and limitations Our biggest limitation was the small sample size which may have obscured any impact of the intervention. There are ongoing efforts to replicate this intervention with larger sample size.
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    Predicting 30-day return hospital admissions in patients with COVID-19 discharged from the emergency department: A national retrospective cohort study
    (Wiley, 2021) Beiser, David G.; Jarou, Zachary J.; Kassir, Alaa A.; Puskarich, Michael A.; Vrablik, Marie C.; Rosenman, Elizabeth D.; McDonald, Samuel A.; Meltzer, Andrew C.; Courtney, D. Mark; Kabrhel, Christopher; Kline, Jeffrey A.; RECOVER Investigators; Emergency Medicine, School of Medicine
    Objectives: Identification of patients with coronavirus disease 2019 (COVID-19) at risk for deterioration after discharge from the emergency department (ED) remains a clinical challenge. Our objective was to develop a prediction model that identifies patients with COVID-19 at risk for return and hospital admission within 30 days of ED discharge. Methods: We performed a retrospective cohort study of discharged adult ED patients (n = 7529) with SARS-CoV-2 infection from 116 unique hospitals contributing to the National Registry of Suspected COVID-19 in Emergency Care. The primary outcome was return hospital admission within 30 days. Models were developed using classification and regression tree (CART), gradient boosted machine (GBM), random forest (RF), and least absolute shrinkage and selection (LASSO) approaches. Results: Among patients with COVID-19 discharged from the ED on their index encounter, 571 (7.6%) returned for hospital admission within 30 days. The machine-learning (ML) models (GBM, RF, and LASSO) performed similarly. The RF model yielded a test area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.71–0.78), with a sensitivity of 0.46 (95% CI, 0.39–0.54) and a specificity of 0.84 (95% CI, 0.82–0.85). Predictive variables, including lowest oxygen saturation, temperature, or history of hypertension, diabetes, hyperlipidemia, or obesity, were common to all ML models. Conclusions: A predictive model identifying adult ED patients with COVID-19 at risk for return for return hospital admission within 30 days is feasible. Ensemble/boot-strapped classification methods (eg, GBM, RF, and LASSO) outperform the single-tree CART method. Future efforts may focus on the application of ML models in the hospital setting to optimize the allocation of follow-up resources.
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    Severe Sepsis and Septic Shock Readmissions in Older Adults
    (2020-08) Hodge, Kimberly Sue; Fulton, Janet; Ebright, Patricia; Davis-Ajami, Mary Lynn; Huber, Lesa
    Hospital readmission is of growing importance in the healthcare industry because of associated patient and system costs, impact to the quality of patient care, and hospital Medicare payment penalties. The increasing interest in sepsis readmission prevention has highlighted the uniqueness of severe sepsis or septic shock survivors. The results of this study provide insight into the relationship between index hospital length of stay (LOS) and 30-day readmissions for older adults (> 65 years) who discharged home from an index hospital with a principle or secondary discharge diagnosis of severe sepsis or septic shock. The purpose of this study was to investigate the relationship between index hospital LOS and 30-day readmissions in older adults (> 65 years) whose expected primary payer was Medicare and who discharged home with a principle or secondary diagnosis of severe sepsis or septic shock. Data used to answer the proposed research questions consisted of older adult discharge records from the 2014 Nationwide Readmissions Database (NRD), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Differences in 30-day readmissions between older adult age groups, gender, and older adult location were examined. The number of days to readmission since discharge was evaluated for the subset of older adults with a readmission. Approximately 15.6% of older adults were readmitted within 30 days of their discharge. Readmissions were statistically different based on the older adult’s age, gender, and LOS. Location did not have a significant effect on readmissions. Mean LOS among readmitted older adults was 10.1 days. Analysis indicates that an older adult’s LOS had a significant effect on readmissions, although models performed poorly. Findings suggest that there are certain factors that can predict older adults who are at risk for being readmitted after being discharged with a principle or secondary discharge diagnosis of severe sepsis or septic shock.