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Author Interviews, Hospital Readmissions, JAMA, Mayo Clinic / 13.05.2014

Aaron L. Leppin, MD Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with: Aaron L. Leppin, MD Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, Minnesota MedicalResearch.com: What are the main findings of the study? Dr. Leppin: We conducted a systematic review and meta-analysis of randomized trials assessing the effectiveness of hospital discharge interventions on reducing 30-day readmission rates. We identified 47 trials, 42 of which contributed to the primary meta-analysis. Overall, the interventions that have been tested to reduce early hospital readmissions reduce them by about 20%. The ones that are most effective, though, reduce them by almost 40% and use a consistent but complex approach. These interventions make a robust effort to fully understand the patient’s post-discharge context, often by visiting the patient’s home. They focus on identifying all the things the patient needs to do to be well—whether that’s organizing medications, getting a ride to the clinic, or paying the electric bill—and they determine whether the patient has the necessary resources and capacity to pull it all off. When limitations are found, these interventions have a strategy in place to support the patient through the post-discharge period. (more…)
Annals Thoracic Surgery, Author Interviews, Cost of Health Care, Hospital Readmissions, Pharmacology / 02.05.2014

Michael H. Hall, MD North Shore-LIJ Health SystemMedicalResearch.com Interview with: Michael H. Hall, MD North Shore-LIJ Health System MedicalResearch: What are the key points of your research? Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The  nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our  nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary. (more…)
Author Interviews, BMJ, Health Care Systems, Hospital Readmissions / 01.04.2014

MedicalResearch.com Interview with: dr_karen_e_lasser Karen E Lasser, MD MPH Associate Professor of Medicine Boston University School of Medicine, Boston, MA MedicalResearch.com: What are the main findings of the study? Dr. Lasser: After controlling for variables that could affect the risk of readmission, we found that:
  1. There was a slightly increased risk of all-cause readmission in Massachusetts (MA) relative to control states (New York and New Jersey) post-reform.
  2. Racial and ethnic disparities in all-cause readmission rates did not change in MA relative to control states.
  3. However, both blacks and whites in counties with the highest uninsurance rates had a decreased risk of readmission following MA health reform relative to blacks and whites in counties with lower uninsurance rates.
(more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Hospital Readmissions, Medical Research Centers / 31.12.2013

Dr. Jacques Donzé MD PhD Research Associate Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital Harvard Medical School, Boston, MA 02115, USADivision of General Internal Medicine, Bern University Hospital, 3010 Bern, SwitzerlandMedicalResearch.com Interview with: Dr. Jacques Donzé MD PhD Research Associate Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital Harvard Medical School, Boston, MA 02115, MedicalResearch.com: What are the main findings of the study? Dr. Donzé: In a large retrospective cohort study, we identified the primary diagnoses of 30-day potentially avoidable readmissions in medical patients according to the most common comorbidities. Interestingly, almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. Patients with cancer, heart failure, and chronic kidney disease had a significantly higher risk of potentially avoidable readmission than those without those comorbidities. Also, when readmitted, patients with chronic kidney disease had a 20% higher risk of having the readmission be potentially avoidable. (more…)
Author Interviews, General Medicine, Hospital Readmissions, Sleep Disorders / 06.12.2013

Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, JapaMedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan MedicalResearch.com: What are the main findings of the study? Dr. Kasai: Sleep disordered breathing, determined using predischarge nocturnal pulse oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure. (more…)
AHRQ, Author Interviews, Electronic Records, Hospital Readmissions, University of Pennsylvania / 28.11.2013

Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104MedicalResearch.com Interview with: Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104 MedicalResearch.com: What are the main findings of the study? Dr. Umscheid: We developed and successfully deployed into the electronic health record of the University of Pennsylvania Health System an automated prediction tool which identifies newly admitted patients who are at risk for readmission within 30 days of discharge.  Using local data, we found that having been admitted to the hospital two or more times in the 12 months prior to admission was the best way to predict which patients are at risk for being readmitted in the 30 days after discharge. Using this finding, our automated tool identifies patients who are “high risk” for readmission and creates a “flag” in their electronic health record (EHR). The flag appears next to the patient’s name in a column titled “readmission risk.” The flag can be double-clicked to display detailed information relevant to discharge planning.  In a one year prospective validation of the tool, we found that patients who triggered the readmission alert were subsequently readmitted 31 percent of the time. When an alert was not triggered, patients were readmitted only 11 percent of the time.  There was no evidence for an effect of the intervention on 30-day all-cause readmission rates in the 12-month period after implementation. (more…)
Author Interviews, BMJ, Hospital Readmissions / 21.11.2013

Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical CenterMedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical Center MedicalResearch.com: What were the main findings of the study Dr. Dharmarajan: In the United States, 1 in 5 older patients is readmitted to the hospital within 30 days of hospital discharge. However, there is great variation in rates of 30-day readmission across hospitals, and we do not know why some hospitals are able to achieve much lower readmission rates than others. We therefore wondered whether top performing hospitals with low 30-day readmission rates are systematically better at preventing readmissions from particular conditions or time periods after discharge. For example, are hospitals with low 30-day readmission rates after hospitalization for heart failure especially good at preventing readmissions due to recurrent heart failure or possible complications of treatment? Similarly, are top performing hospitals especially good at preventing readmissions that occur very soon after discharge, which may signify poor transitional care as the patient moves form the hospital back home? (more…)
Author Interviews, Heart Disease, Hospital Readmissions, JACC, Outcomes & Safety / 18.10.2013

Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine, New York, NY Department of Medicine, NYU School of Medicine, New York, NYMedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine Department of Medicine, NYU School of Medicine, New York, NY   MedicalResearch.com: What are the main findings of the study? Dr. Blecker: Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code. However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments. We found that in our sample, as compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a non–heart failure diagnosis had lower rates of guideline-concordant care, including assessment of left ventricular function and prescription for an ACE inhibitor or ARB, at time of discharge. This is important as our study suggests that these therapies were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization. (more…)
CMAJ, Cognitive Issues, General Medicine, Hospital Readmissions, Outcomes & Safety / 19.09.2013

Mark W. Ketterer, PhD, ABPP Senior Bioscientific Staff Henry Ford Hospital/A2 Detroit, MI 48202 Clinical Professor of Psychiatry & Behavioral Neurosciences Department of Psychiatry Wayne State UniversityMedicalResearch.com Interview with: Mark W. Ketterer, PhD, ABPP Senior Bioscientific Staff Henry Ford Hospital/A2 Detroit, MI 48202 Clinical Professor of Psychiatry & Behavioral Neurosciences Department of Psychiatry Wayne State University MedicalResearch.com: What are the main findings of the study: Dr. Ketterer:  A survey of 84 patients admitted to Henry Ford Hospital found 54% to have Moderate-Severe Cognitive Impairment (CI). (more…)
Author Interviews, Hospital Readmissions / 27.08.2013

Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba 820 Sherbrook St / GF-222 Winnipeg, Manitoba R3A 1R9MedicalResearch.com Interview with: Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba 820 Sherbrook St / GF-222 Winnipeg, Manitoba R3A 1R9   MedicalResearch.com: What are the main findings of the study? Answer:   Our study evaluated consequences of leaving the hospital against medical advice (AMA).  It is a large, population-based analysis, that evaluated all hospitalizations from which patients were discharged alive, among all adults in the Canadian province of Manitoba over a 19 year period; this was over 1.9 million hospitalizations.  Outcomes assessed were hospital readmission and death over 6 months after the event.  Specifically, we compared these outcomes for those who left the hospital against medical advice, compared to those who remained in the hospital until their doctors felt it was safe to be discharged -- and these comparisons adjusted for a variety of patient and illness characteristics. Among the 1.9 million hospitalizations, there were 21,417 that ended with the patients leaving against medical advice, this is 1.1% of the total.  Without adjustment for other variables, leaving against medical advice was associated with double the rate of unscheduled hospital readmission within 30 days (24.0 vs. 12.1%); after adjustment, the odds of unscheduled hospital readmission within 30 days was 3-fold higher for someone who left against medical advice compared to one who did not.  After adjustment, the odds of death at 90 days were 2.51-fold higher for those who left against medical advice. (more…)