Inadequate discharge planning for individuals with chronic illnesses or injuries is associated with increased readmissions to the hospital or rehabilitation facility where the original treatments were administered. To help ensure the recovery of discharged patients and avoid readmissions, discharge planners guide medication and care processes. The rate of readmissions was high in a stand-alone rehabilitation center due to ineffective discharge plans. Patients, family members, and caregivers lacked knowledge about medications, treatments, and self-care guidelines after the patient left the facility. The purpose of this project was to ascertain the impact of improved discharge processes using the (a) IDEAL Discharge Planning Overview, Process, and Checklist; (b) the teach-back Method training for discharge nurses; and (c) the Postdischarge Rehabilitation Services Follow-Up Tool incorporating telephone calls to all participants during Weeks 1, 2, and 4 postdischarge. Lewin's theory of planned change undergirded this project. According to Centers for Medicare and Medicaid Services data, the rate of readmissions among the 50 participants was 4.4%, compared with 6% (all-facility readmission rate) during the same quarter of the prior year. Findings from this project suggest that reductions in readmissions were associated with improvements in discharge planning, training of caregivers, and the use of national tools to standardize practices in reducing readmissions. The implication of this project for positive social change is that patient-centered inpatient rehabilitation care and patient-centered care following discharge may reduce readmissions, reduce costs, improve reimbursement, and reduce deterioration of patients' conditions postdischarge.

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.

SAMMANFATTNING  Bakgrund: Hälso- och sjukvården belastas av många akuta återinläggningar. Omvårdnaden av patienter med cancer sker kontinuerligt under hela deras sjukdomstid.  Syfte: Syftet med studien är att undersöka orsakerna bakom de akuta inläggningarna av patienter med cancer på två onkologiska slutenvårdsavdelningar för att se om det finns några skillnader mellan patienter med olika cancerdiagnoser och olika behandlingsmål. Syftet med studien är även för att se hur länge den akuta inläggningen varade samt undersöka faktorer som kan vara av betydelse för vårdlängden.  Metod: Metoden som används är en kvantitativ undersökning med en retrospektiv och deskriptiv design. I studien ingår 100 patienter med en cancerdiagnos. Data inhämtades med hjälp av journalgranskning.  Resultat: I både Uppsala och Stockholm var 78 % av de akuta inläggningarna patienter med ett palliativt behandlingsmål. De vanligaste orsakerna bakom de akuta inläggningarna i Uppsala var illamående och kräkningar samt behandlingsbiverkningar för patienter med ett kurativt behandlingsmål medan de patienter med ett palliativt behandlingsmål lades in akut på grund av ileus/förstoppningsproblematik och smärta. I Stockholm var det behandlingsbiverkningar, där infektioner stod för den vanligaste orsaken till akut inläggning följt av nedsatt allmäntillstånd. De vanligaste diagnosgrupperna var gastrointestinal cancer, urogenital cancer och bröstcancer.  Slutsats: Studiens resultat visar på att patienter med ett palliativt behandlingsmål upptar en stor del av den akuta verksamheten inom den onkologiska slutenvården. Sjuksköterskan har en viktig ansvarsroll i planeringen och identifieringen av en cancerpatients vårdbehov och har möjlighet att förebygga många akuta återinläggningar. / ABSTRACT Background: Health care is burdened by many unnecessary emergency readmissions. Nursing care of patients with cancer occurs continuously throughout the patients illness. Aim: The aim of the study is to examine the reasons behind the emergency admissions of patients with cancer in inpatient care to see if there are any differences between patients with different cancer diagnoses and different treatment goals. The aim of the study is also to see how long the admission lasted and examine factors that may be important for length of the admission.  Method: The method used is a quantitative survey with a retrospective and descriptive design. The study included 100 patients with a diagnosis of cancer in Uppsala and Stockholm. Data were collected by reviewing medical records.  Results: In both Uppsala and Stockholm, 78% of emergency admissions were of patients with palliative treatment goals. The most common causes of acute admissions in Uppsala were nausea and vomiting and treatment of side effects for patients with a curative treatment goal, while patients with a palliative treatment goal were admitted acutely because of ileus/constipation or pain. In Stockholm, the treatment side effects such as infection accounted for the most common cause of acute admission followed by poor general condition. The most common diagnostic groups were gastrointestinal cancer, genitourinary cancer and breast cancer.  Conclusion: The study results show that patients with a palliative treatment goal occupy a large part of the emergency admissions of the oncology inpatient care. The nurse has an important role in the planning and identification of a cancer patient's care needs and are able to prevent many acute readmissions.

Medical errors occur at the prescription step due to lack adequate knowledge of medications by the physician, failure to adhere to policies and procedures, memory lapses, confusion in nomenclature, and illegible handwriting. Unfortunately, these errors can lead to patient readmission within 30 days of dismissal. Hospital leaders lose 0.25% to 1% of Medicare’s annual reimbursement for a patient readmitted within 30 days for the same illness. United States, lawmakers posited the use of health information technology, such as computerized physician order entry scores systems (CPOES), reduced hospital readmission, improved the quality of service, and reduced the cost of healthcare. Grounded in systems theory, the purpose of this correlational study was to examine the relationship between computerized physician order entry scores, medication reconciliation scores, and 30-day readmission rates. Archival data were collected from 117 hospitals in the southeastern region of the United States. Using multiple linear regression to analyze the data, the model as a whole did not significantly predict 30-day hospital readmission rate, F (2, 114) = 1.928, p = .150, R2 = .033. However, medical reconciliation scores provided a slightly higher contribution to the model (β = .173) than CPOES (β = .059. The implications for positive social change included the potential to provide hospital administrators with a better understanding of factors that may relate to 30-day readmission rates. Patients stand to benefit from improved service, decreased cost, and quality of healthcare.

Objectives: This Study wanted to analysis the characteristics of the elder adult who had hospitalized with pneumonia. We also evaluated the factors that will affect the unexpected readmission in elderly pneumonia patients. Methods: This is a retrospective cohort study design. The study data was collected 341 pneumonia patients who have hospitalized in a general teaching hospital in Kaohsiung city from year 2009 to 2010. The study population was divided into two groups, the sample size of the old group (age >= 65yrs), and the young group (age < 65yrs) was 173 and 168, respectively. The methods of stepwise multiple logistic regressions were needed to evaluate the association between aging and different days of unplanned readmission in adult pneumonia patients. Results: All the 341 adult pneumonia patients, we found 613 male and 926 female. The demography characteristic of the study subjects, the means of age was 61.9yrs (s.d. = 19.3yrs), and BMI was 23.4 kg/m2 (s.d. = 4.5 kg/m2). The percentage of ICD-9-CM that code 486 was 95.6%. Most patients were community-acquired pneumonia (98.8%), hospitalized from emergency room (85.3%), and admission in general wards (92.7%). The unplanned readmission within 14/30 days, 60 days, and 90days were 9.1%, 11.7%, and 15.0%, respectively. The significant factors that were associated with readmission within 14 days include age, Hb, hospitalized days, hypertension, and other disease. When we used the multiple logistic regression analysis to adjust the other variables, only age still significant with readmission within 14 days (the crude OR of the old group was 4.561, adjusted OR was 2.714, 95% CI of OR from 1.002 to 7.353). In the stepwise multiple logistic regression models, the variable that was associated with readmission with 14 or 30 days were age (>= 65yrs, OR = 3.025), WBC (>=10750 mm3, OR=2.917), and Hb (>=12.4 g/dL, OR=0.390). We remain the elderly subjects to evaluate the factor that will influence readmission states. In all the stepwise logistic regression models, we found the experience with used endotracheal tube in the hospitalized period were the significant increases the readmission rate within 14 or 30 days, 60 days, and 90 days. Conclusion: In our study shows that the situations of unexpected readmission in pneumonia patients were strong association with aging. We suggest that the indicator of medical quality should be adjusted before we comparison the readmission rate in the different institute. The major factors that will be associated to affect the readmission states were endotracheal tube used (significant with 14 or 30 days readmission rate), CRP level (significant with 60 days and 90 days readmission rate), and Hb level (significant with 60 days and 90 days readmission rate).

Dissertation (Ph.D.).--University of Texas Graduate School of Biomedical Sciences at San Antonio, 2008. / Vita. Includes bibliographical references.

Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope. Methods and Results We identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013-2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58-83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6-0.7), female sex (OR, 0.9; 95% CI, 0.8-0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2-1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3-1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2-1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2-1.3), anemia (OR, 1.4; 95% CI, 1.4-1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3-1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5-1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6-1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4-1.6) or >5 days (OR, 2; 95% CI, 1.8-2), and having private insurance (OR, 0.6; 95% CI, 0.6-0.7). Conclusions The 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions. / Revisión por pares

The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that have been shown to be effective in reducing hospital readmissions. the purpose of this study is to review relevant literature related to the problem of hospital readmissions for our elder population. This study is designed to look at interventions, both disease based and non-disease based, that have been previously implemented and have shown effective reductions in readmission rates. This analysis and synthesis can provide an important contribution to our understanding of the factors and variables that influence the readmission rates of our elder population. This review has the potential to assist and direct hospital administrators and to discharge planners, social workers, and other health professions to implement intervention strategies that promote the continuing health status of our elder population while reducing their overall rates of readmissions.

Background - Heart failure costs Americans billions of dollars a year and takes a toll on the patients afflicted by the disease. Recent changes in how healthcare systems and providers are reimbursed have motivated them to find new ways to prevent heart failure readmission. There is no cure for heart failure so healthcare providers try to help patients manage their symptoms. Physical activity is one of the interventions healthcare providers recommend for their patients in the management of heart failure. The Physical Activity Vital Sign is a tool that can be quickly administer and has significant validity. Objective - The purpose of our research is to determine if physical activity, as measured by the Physical Activity Vital Sign, influences 30-day heart failure readmissions. Methods - A retrospective chart review was used to evaluate patients' charts that had a heart failure admission between January 1, 2016 and August 31, 2018. We used multiple regression to analyze how the Physical Activity Vital Sign predicts 30-day heart failure readmission rates, while controlling for age, sex, race, ejection fraction, body mass index, length of hospital stay, brain natriuretic peptide, and compliance with the heart failure core measures. Results - Data was analyzed from 270 heart failure admissions in the study period. The average duration of moderate intensity PA was 20.9 minutes per week; just less than three minutes per day on average. A Pearson Correlation matrix illustrated significant relationships between some of the independent variables. Multiple linear regression demonstrated p=0.376, which was statistically insignificant. Conclusions - The study did not find a significant relationship between physical activity, as measured by the Physical Activity Vital Sign, and heart failure readmissions but physical activity remains important in managing heart failure.

The rate of hospital readmissions within 30 days of discharge of heart failure (HF) patients affects patient outcomes, the financial stability of the health care facility, and the economy. Hospitals focus on strategies that will decrease the HF readmission rates by cultivating evidence-based interventions that improve patients' transition from the hospital to the community, including promoting self-management of their condition. The purpose of this quality improvement project was to develop, implement, and evaluate the use of health information technology along with written forms of plans of care to assist HF patients in managing their care, divert the HF patients to the physician's office rather than the emergency room, and decrease the hospitalization readmission rate within 30 days of discharge. A multidisciplinary team consisting of HF nurses, a cardiologist, and a pharmacist, utilized the Agency for Healthcare Research and Quality guidelines to develop a HF checklist to assist in data collection. Nurses communicated with HF patients post discharge using electronic devices to reinforce discharge instructions, assess medication compliance, and encourage self-management. The less than 30-day readmission rate for the 10 patients in the pilot group was 20%, an improvement over the hospital rate of 30%. The 20% that were readmitted did not used their written discharge instructions, but the 80% that were not readmitted used their written discharge instructions with their electronic devices. This DNP project will promote positive social change by improving HF patients' outcomes and quality of life, and present health care provider interventions to decrease HF hospital readmission rates.