Author Interviews, Diabetes, Hospital Readmissions / 16.02.2015

dr-syed-gillaniMedicalResearch.com Interview with: Dr Syed M R Gillani Diabetes Centre, New Cross Hospital, Wolverhampton, UK MedicalResearch: What is the background for this study? Dr. Gillani: NHS is facing the greatest challenge of its history in the form of A&E pressures and bed availabilities. Unplanned admissions are considered one of the key reasons. With an aging population, multiple co-morbidities and increasing pressures on social and primary care, we need to develop a proactive strategy to deal with this situation. It is a high priority agenda for the DOH. Initiatives such as “named GP for over 75” and “directly enhanced services to avoid unplanned admissions” have been rolled out by DOH in the last 2 years. In order to find an innovative way to assist in reduction of unplanned admissions, we decided to conduct an audit on all recurrent unplanned admissions with diabetes in the hospital over 12 months period. Its objective was to determine any unmet patient needs during an index admission to explore potential of changes in the service and to utilize available resources more effectively in an attempt to prevent next hospital admission for that patient. (more…)
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 03.02.2015

Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, IllinoisMedicalResearch.com Interview with: Dr. Ryan Merkow, M.D. M.S. American College of Surgeons Chicago, Illinois     MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Merkow: The measurement of hospital readmissions has become an important quality and cost-containment metric. Hospitals, policy makers, and individual practitioners are closely tracking readmissions. For the past decade the focus has been primarily on three medical conditions (pneumonia, heart failure and myocardial infarction) and although controversial, many thought leaders and policy makers believed that readmissions were preventable, and stemmed from poor transition of care, outpatient follow up or simply a failure of the medical system to appropriately care for these patients. Recently, the Center for Medicare and Medicaid Services has become increasingly interested in using readmissions as a quality measure and is now mandated by the Hospital Readmission Reduction Program to track hospital-wide readmissions (including all surgical patients), and for the first time, after individual surgical procedures (i.e., total hip and knee replacement). Future inclusion of additional surgical procedures is anticipated. However, despite the growing focus on readmissions after surgery, there have been few studies comprehensively evaluating the underlying reasons and factors associated with readmissions after surgical hospitalizations. Furthermore, the relationship between readmissions and complications that occur during the initial hospitalization after surgery is not clearly established. Importantly, unlike medical conditions, surgical patients undergo a discrete invasive event with known risks of complications. By studying this topic, initiatives to decrease readmissions can be more precisely determined, and national policy decisions that are now targeting readmissions can be appropriately formulated. The primary findings of our study identified surgical site infections as the most frequent reason that patients are readmitted after surgery, Importantly, in >95% of patients this complication was new, occurring after they left the hospital. The other common reason for readmission was obstruction or ileus, which was the second most frequent reason for readmission, particularly after abdominal surgery. Overall, the vast majority of readmissions were the result of new postdischarge, postoperative complications. With respect to factors associated with readmissions, most of the variation was due to differences in patient factors, such as ASA class, renal failure, ascites and/or steroid use. (more…)
Author Interviews, CHEST, Hospital Readmissions, Pulmonary Disease / 03.01.2015

Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of ChicagoMedicalResearch.com Interview with: Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of Chicago Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The reason why we undertook this study is to better understand the Medicare COPD population that falls under the purview of the CMS Hospital Readmissions Reduction Program (HRRP). This program places up to a 3% penalty on all Medicare revenues for hospitals that take care of beneficiaries should a hospital exceed its “expected readmission rate.” Previously 30 day readmissions after index admissions for congestive heart failure, acute myocardial infarction and pneumonia fell subject to the HRRP. As of October 2014, COPD has been added to the list, despite minimal evidence to guide hospitals in how to curb COPD readmissions. The goal of this research was to provide an epidemiological background for this population and identify trends as a hypothesis generating first step to predict who is most likely to be readmitted and to identify targets for successful future interventions on this group. Our study population is unique in that we longitudinally look at about 1/2 of all Medicare admissions for COPD exacerbations, using the CMS guideline definition which is based on discharge ICD-9 codes. As described in previous literature, there is a large discrepancy between identification of COPD by provider versus coding algorithm, however since the Hospital Readmissions Reduction Program is based on discharge coding it is important to examine this particular group. (more…)
Annals Internal Medicine, Author Interviews, Hospital Readmissions / 02.12.2014

Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705MedicalResearch.com Interview with: Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kind: By way of background: Socioeconomic disadvantage is a complex theoretical concept which describes the state of being challenged by low income, limited education and substandard living conditions for both the person and his or her neighborhood or social network. It is plausible that disadvantage would influence rehospitalization because vulnerable patients depend upon their neighborhood supports for stability, generally, and these needs are likely to be increased after a hospitalization. Yet, it is difficult to assess socioeconomic disadvantage during clinical encounters, yet the ADI provides an option for beginning such a discussion. ADI or Area Deprivation Index is a composite measure of neighborhood disadvantage, similar to other geographic measures of disadvantage employed in other countries for resource planning and health policy development. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, University of Pennsylvania / 10.11.2014

Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of PennsylvaniaMedicalResearch.com Interview with: Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized? We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice. (more…)
Author Interviews, Heart Disease, Hospital Readmissions / 07.10.2014

Elizabeth Blanchard Hills, BSN MSJ President, Informed Health SolutionsMedicalResearch.com Interview with: Elizabeth Blanchard Hills, BSN MSJ President, Informed Health Solutions Medical Research: What is your role? Response: My name is Elizabeth Blanchard Hills, BSN, MSJ.  My company, Informed Health Solutions, currently has the privilege of “transitioning” Dr. Smith’s work into clinical practice.  We have been conducting an on-going pilot project with the University of Kansas Hospital since November 2013, and our results are corroborating the results of Dr. Smith’s randomized clinical trial.  We have renamed SMAC-HF; it is now called CareConnext. Medical Research: What are the main findings of the study?  Response: That we could, in fact, significantly lower hospital readmissions among heart failure patients. (more…)
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 24.06.2014

Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of MedicineMedicalResearch.com Interview with: Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of Medicine MedicalResearch: What are the main findings of the study? Dr. Brooke: This study was designed to evaluate whether high-risk surgical patients who visit a primary care provider (PCP) during the early period following hospital discharge are less likely to be readmitted within 30-days.  We examined this question by performing a retrospective cohort analysis of Medicare beneficiaries (2003-2010) who underwent a high risk surgery (open thoracic aortic aneurysm repair) as well as a control group of patients who underwent a lower risk surgical procedure (open ventral hernia repair), and then determining whether there was evidence of early PCP follow-up. In risk-adjusted analyses, we found that early primary care provider-follow-up was associated with a significant lower likelihood of 30-day readmission for high-risk patients undergoing open thoracic aortic aneurysm repair, particularly if a post-operative complication had occurred.  In comparison, early primary care provider follow-up did not have a significant effect on lowering readmissions in uncomplicated patients and those undergoing lower-risk operations such as ventral hernia repair. (more…)
Author Interviews, Stroke, Wake Forest / 22.06.2014

Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC 27157MedicalResearch.com Interview with: Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC  27157 MedicalResearch: What are the main findings of the study? Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure). (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…)