A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2013 / The aim of this study was to establish whether the management of dual diagnosis patients in an integrated psychiatric unit influenced relapse and readmission rates. A retrospective record review was conducted to illustrate the influence of an admission to the Dual Diagnosis Unit (DDU) at Sterkfontein Hospital (SFH) on readmission rates of patients. These results were compared to readmission rates of a matched standard care (SC) group. Statistical data analysis revealed a larger presence of schizophrenia in the SC group, likely explained by the DDU’s patient selection procedure. Though not significant, readmission rates in the DDU group were lower than in the SC group, even though substance use levels in the DDU group was higher. This demonstrates the potential positive impact of the DDU program. The findings presented in this paper warrant further investigation in assessing the effectiveness of a DDU, using a larger sample size.

Thesis (Ph. D.)--Case Western Reserve University, 2008. / Frances Payne Bolton [School of Nursing]. Includes bibliographical references.

In an effort to reduce hospital 30-day readmissions a Transitional Care Coach Program (TCCP) was developed in 2014 at a Southwest Urban Medical Center. The CDC Framework for Program Evaluation (2012) applies insight and experience gained from past program experience to effect change in practice and improve patient outcomes. The evaluation seeks to determine TCCP utilization, to assess its impact on 30-day readmission rates for high-risk patients, to inform stakeholders of a viable follow-up program, and to determine evidence-based interventions for program improvement. This TCCP program evaluation describes characteristics of patients who participated in the program, assesses whether interventions were delivered as intended, and determines if interventions reduced hospital 30-day readmission rates compared to readmission rates prior to program implementation. Descriptive statistics are used to describe the patient population, health status, and program utilization. For the diagnoses of acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), and pneumonia (PNA), Chi-square test analyses were performed to compare 30-day readmission rates of the TCCP participants and readmission rates for this medical center for the time period prior to program implementation. The primary finding of this program evaluation is an overall numerical decrease in hospital readmission rate by 3% compared to the baseline data. Although the change (a decrease) was in the desired direction, the degree of change was not statistically significant based on pooled data. A statistically significant decrease was observed only for the AMI diagnosis. However, as any decrease in readmissions decreases the financial burden to both the organization and the patient, the TCCP appears to have had a positive impact. It is recommended that a renewed TCCP be conducted to allow for (1) an increased timespan for data collection, (2) an increased number of medical categories assessed to allow for more non-parametric statistical analysis (e.g. adding categories of Total Joint Replacement and Sepsis diagnoses), (3) tracking of number of days to readmittance to allow for improvement to be measured and analyzed beyond a single dichotomous category. Evidence-based recommendations have been made to continue and improve interventions that further reduce hospital readmissions.

Class of 2014 Abstract / Specific Aims: The objective of this study was to perform follow-up phone calls to patients after discharge to determine if it had a significant effect in lowering 30- day readmission rates. Methods: Men and women aged 18 years and older who provided informed consent participated in this prospective, pre-post study. The intervention consisted of a scripted follow-up phone call to each patient after discharge. At three to seven days post-discharge, a pharmacy student on an advanced pharmacy practice experience rotation at a teaching hospital called each patient discharged from a designated ward (Med/Surg I), which admits patients with a variety of conditions, such as liver cirrhosis, pneumonia, osteomyelitis, those who are uninsured, or those who require placement after discharge. Information was collected regarding prescription filling, understanding of medication(s), concerns regarding medications, and the community pharmacy he/she used to fill the discharge medications. The specified community pharmacy was then called to verify that the patient filled discharge medications at that pharmacy. The results were compared to the readmission rate in the same ward over the same time period one year prior to implementation of the intervention. Chi-square and descriptive analysis was used and the alpha a priori is 0.05. The institutional review board approved this study. Main Results: Of the 315 people contacted, a total of 89 people completed the survey (28% response rate) and 11 of these participants were readmitted at least once. There was no statistically significant difference between the participant readmission rate and the readmission rates of the total unique admission population of Med/Surg I in 2013 (χ2 = 1.206; p = 0.272). Conclusion: Follow-up phone calls did not significantly impact 30-day readmission rates; however, a downward trend was observed in the participant group.

Background-Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results-Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998-2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years; 58% women; 18% non-white). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio associated with hospice referral, 0.12; 95% confidence interval, 0.06-0.24). Hazard ratios (95% confidence intervals) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post discharge were 0.03 (0.04-0.21) and 0.17 (0.08-0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% versus 27%), it was similar at 90 days (64% versus 67% among hospice-eligible patients). Conclusions-A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized patients with HF. However, most patients with HF who died within 6 months of hospital discharge did not receive a discharge hospice referral.

Aims: The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. Methods and results: We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database. / National Institutes of Health / Revisión por pares

Background and Aims: The opioid epidemic has become increasingly concerning, with the ever-increasing prescribing of opioid medications in recent years, especially in inflammatory bowel disease [IBD] patients with chronic pain. We aimed to isolate the effect of opioid use disorder [OUD] on 30-day readmission risk after an IBD-related hospitalization. Methods: We retrospectively extracted IBD-related adult hospitalizations and 30-day, any-cause, readmissions from the National Readmissions Database [period 2010-2014]. OUD and 30-day readmission trends were calculated. Conventional and exact-matched [EM] logistic regression and time-to-event analyses were conducted among patients who did not undergo surgery during the index hospitalization, to estimate the effect of OUD on 30-day readmission risk. Results: In total, 487 728 cases were identified: 6633 [1.4%] had documented OUD And 308 845 patients [63.3%] had Crohn's disease. Mean age was 44.8 ± 0.1 years, and 54.3% were women. Overall, 30-day readmission rate was 19.4% [n = 94,546], being higher in OUD patients [32.6% vs 19.2%; p < 0.001]. OUD cases have been increasing [1.1% to 1.7%; p-trend < 0.001], while 30-day readmission rates were stable [p-trend = 0.191]. In time-to-event EM analysis, OUD patients were 47% more likely (hazard ratio 1.47; 95% confidence interval [CI]:1.28-1.69; p < 0.001) to be readmitted, on average being readmitted 32% earlier [time ratio 0.68; 95% CI: 0.59-0.78; p < 0.001]. Conclusion: OUD prevalence has been increasing in hospitalized IBD patients from 2010 to 2014. On average, one in five patients will be readmitted within 30 days, with up to one in three among the OUD subgroup. OUD is significantly associated with increased 30-day readmission risk in IBD patients and further measures relating to closer post-discharge outpatient follow-up and pain management should be considered to minimize 30-day readmission risk.

Thesis (M.S.)--Boston University

Yes / Conference abstract from the British Geriatrics Society Autumn Meeting, 14-16 Nov 2018, London, UK.

No description available.