scholarly journals Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

2020 ◽  
Vol 49 (4) ◽  
pp. 558-569 ◽  
Author(s):  
Justine Tomlinson ◽  
V-Lin Cheong ◽  
Beth Fylan ◽  
Jonathan Silcock ◽  
Heather Smith ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Older Patients ◽  
Medication Reconciliation ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Self Management ◽  
Multiple Time ◽  
Post Discharge

Abstract Background medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results twenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.

scholarly journals Successful hospital readmission reduction initiatives: Top five strategies to consider implementing today

2018 ◽  
Vol 7 (5) ◽  
pp. 16 ◽  
Author(s):  
Bita A. Kash ◽  
Juha Baek ◽  
Ohbet Cheon ◽  
Nana E. Coleman ◽  
Stephen L. Jones
Keyword(s):  
Hospital Readmission ◽  
Discharge Planning ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Readmission Rates ◽  
Effective Interventions ◽  
Hospital Readmission Rates ◽  
Weighted Means ◽  
Pubmed Database

Only one quarter of U.S. hospitals demonstrated low enough levels of 30 day readmission rates to avoid penalties imposed by the Hospital Readmissions Reduction Program (HRRP) in 2016. Previous work describes interventions for reducing hospital readmission rates; however, without a comprehensive analysis of these interventions, healthcare leaders cannot prioritize strategies for implementation within their healthcare environment. This comparative study identifies the most effective interventions to reduce unplanned 30-day readmissions. The MEDLINE-PubMed database was used to conduct a systematic review of existing literature about interventions for 30-day readmission reduction published from 2006 through 2017. Data were extracted on hospital type, setting, disease type, intervention type, study sample, and impact level. Of 4,886 citations, 508 articles were reviewed in full-text, and 90 articles met the inclusion criteria. Based on the three analytic methodologies of means, weighted means, and pooled estimated impact level, the most effective interventions to reduce unplanned 30-day admissions were identified as collaboration with clinical teams and/or community providers, post-discharge home visits, telephone follow-up calls, patient/family education, and discharge planning. Commonly, all five interventions identify patient level engagement for success. The findings reveal the need for shared accountability towards desired outcomes among health systems, providers, and patients while providing hospital leaders with actionable strategies that can effectively reduce 30-day readmission rates.

scholarly journals Decreasing Readmissions in Medically Complex Children

2020 ◽  
Author(s):  
◽  
Colleen Bartlett
Keyword(s):  
Medication Reconciliation ◽  
Hospital Readmissions ◽  
Outcome Evaluation ◽  
Evidence Based ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital System ◽  
Practice Problem ◽  
Telephone Calls

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions. PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe? Evidence: The literature revealed 18 pertinent studies that fit the inclusion and exclusion criteria that promoted a discharge intervention bundle. The themes within the evidence included post-discharge telephone calls, follow-up appointments, medication reconciliation, and education with teach-back to reduce overall readmission rates. Intervention: The evidence-based intervention utilized the bundle of post-discharge telephone calls within 72 hours, follow up appointments within 7 days, and medication reconciliation with education and teach-back through in-person and virtual care. The clinic nurses championed the intervention and tracked all the data using a check sheet. Outcome: Evaluation of the outcome measures confirmed a decrease in all-cause 30-day readmissions from 23% to 14.5% within the project timeframe. Implications of the findings support the existing evidence for implementing a multifaceted bundle to decrease readmissions. Conclusion: The evidence-based change project decreased all-cause 30-day readmissions rates. The results of the project proved that implementing consistent discharge standards in medically complex children helped guide medical staff, improved patient outcomes, saved costs to the organization, and reduced 30-day all-cause hospital readmissions.

scholarly journals Burden of Hospital Readmissions for Venous Thromboembolism Among Patients with Cancer

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 365-365
Author(s):  
Alpesh J. Amin ◽  
Steven Deitelzweig ◽  
Jay Lin ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Diagnosis Codes ◽  
The Mean

Abstract Background: Cancer or history of cancer are important risk factors for hospitalized patients to develop venous thromboembolism (VTE), manifesting as deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Patients hospitalized for cancer are thus at risk for VTE. However, several studies show that VTE prophylaxis in these patients is challenging and underutilized, with almost 70% of patients with cancer not receiving any VTE prophylaxis as evaluated by our previous analysis. Therefore, this patient population is at risk of recurrent VTE and re-hospitalization. The clinical and economic burden of VTE-related hospital readmissions among these patients is not well understood in the real-world setting. The goal of this retrospective study was thus to analyze the frequency and associated cost of VTE-related hospital readmissions among patients with cancer in the US. Methods: Patients hospitalized for acute medical illness, including cancer, based on the primary hospital discharge diagnosis codes were identified from the MarketScan databases between 7/1/2011 and 3/31/2015. Eligible patients were ≥40 years and required to have continuous insurance enrollment in the 6 months prior to initial (index) hospitalizations (baseline period) and in the 6 months after hospital discharge (follow-up period). The study endpoints included the proportion of patients with VTE as either the primary or any position (VTE-related) of discharge diagnosis codes among hospital readmissions during the follow-up period, and the associated costs for VTE-related or primary VTE readmissions. Results: Of the whole study population of acute medically ill patients (n=12,785; mean age: 68.3 years; 51.6% female), 15.7% (n=2,002) were hospitalized for cancer; the mean age was 63.4 years (62% were <65 years) and 49.1% were female. Among patients with cancer, 3.9% had a VTE-related hospital readmission in the 6 months following hospital discharge, of which 51.3% were for a primary diagnosis of VTE (Table). The frequency of readmissions for patients with cancer were the highest among all medical illnesses investigated in this study (acute heart failure, infectious diseases, ischemic stroke, respiratory diseases, and rheumatic diseases). Over one-quarter (28.2%) of the VTE-related hospital readmissions occurred within the first 30 days of post-discharge (Table). For VTE-related readmissions, the mean length of hospital stay (LOS) was 7.6 days and the mean total cost for a hospital readmission was $35,012. For primary VTE readmissions, the mean LOS was 5.2 days and the mean total cost of a readmission was $19,961; for readmissions with a primary diagnosis of DVT, PE, and DVT/PE, mean total costs were $12,968, $13,029, and $41,574, respectively. Conclusions: In this real-world study, many patients hospitalized for cancer experienced a VTE event requiring re-hospitalization, which was the highest proportion of readmitted patients among acute medical illnesses analyzed in this study, with almost 30% readmitted within 30 days of post-discharge. Total costs of readmissions were substantial, as high as $41K for resubmissions due to primary diagnosis of DVT/PE. Improvement in VTE prophylaxis for patients with cancer may reduce the risk and frequency of VTE, and thus hospital readmissions, reducing the clinical and economic burden of VTE in this patient population. Sponsorship: Portola Pharmaceuticals Disclosures Amin: UC Irvine: Employment; Portola: Consultancy; BMS: Consultancy; Pfizer: Consultancy. Deitelzweig:Ochsner Health System: Employment; Portola: Consultancy, Research Funding, Speakers Bureau; BMS: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Boeringer Ingelheim: Consultancy. Lin:Bristol-Myers Squibb: Consultancy; Novosys Health: Employment. Lingohr-Smith:Novosys Health: Employment. Menges:Novosys Health: Employment. Neuman:Portola Pharmaceuticals: Employment.

scholarly journals 113. Improving Transitions-of-Care for Patients Discharged on High-Risk Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S171-S171
Author(s):  
Ryan Zabrosky ◽  
Ellen C Rubin ◽  
Erica Liu ◽  
Karrine Brade ◽  
Hope Serafin ◽  
...  
Keyword(s):  
Infectious Disease ◽  
High Risk ◽  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Post Discharge ◽  
Healthcare Improvement ◽  
Medication Counseling ◽  
Risk Patients

Abstract Background Providing effective transitions-of-care (TOC) services improves outcomes for patients discharged on high-risk medications. Literature has shown that successful TOC for certain antimicrobials reduces hospital readmissions, medication errors, and improves post-discharge follow-up and laboratory monitoring. Prior to this quality improvement (QI) initiative, there was no formal TOC process for patients discharged on high-risk antimicrobial therapy (HAT) at our institution. Without standardization, only 55.1% of patients discharged on HAT had successful TOC. The aim of this initiative was to develop and implement a TOC protocol in at least 90% of patients discharged on HAT. Methods This QI initiative utilized the Institute of Healthcare Improvement model for improvement. A workgroup of key stakeholders developed a protocol to identify and standardize TOC services provided to patients discharged on HAT. Successful protocol completion was achieved if the following process metrics were evaluated, obtained, and documented prior to discharge: baseline laboratory values, pharmacokinetic monitoring, appropriate intravenous access, drug-drug interactions, medication availability, discharge medication counseling, and formal pharmacist documentation in a discharge note. Outcome metrics included referral to outpatient infectious disease (ID) follow-up, 90-day readmissions, and successful TOC. Balancing metrics included pharmacist time and protocol initiation for patients not discharged on HAT. Results Between October 2020 and May 2021, 218 patients met protocol inclusion criteria. Of these, 203/218 (93.1%) were appropriately identified with the new TOC process. The protocol was successfully followed in 78.9% of patients identified. Readmission rates were 42.8%, which was unchanged from baseline. Inpatient ID involvement increased from 80.9% to 95.7% and referral to outpatient ID follow-up from 59% to 94.8%. Conclusion This newly developed TOC protocol successfully identifies patients discharged on HAT, improves provision of TOC services to these high-risk patients, and significantly improves the rate of infectious disease involvement while inpatient and after discharge. Disclosures All Authors: No reported disclosures

scholarly journals Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lamis R. Karaoui ◽  
Elsy Ramia ◽  
Hanine Mansour ◽  
Nisrine Haddad ◽  
Nibal Chamoun
Keyword(s):  
Tertiary Care ◽  
Intervention Group ◽  
Bleeding Event ◽  
Transitions Of Care ◽  
Control Group ◽  
Published Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

Facilitating Home Hospice Transitions of Care in Oncology: Evaluation of Clinical Pharmacists’ Interventions, Hospice Program Satisfaction, and Patient Representation Rates

2018 ◽  
Vol 35 (9) ◽  
pp. 1181-1187 ◽  
Author(s):  
Alison P. Duffy ◽  
Nina M. Bemben ◽  
Jueli Li ◽  
James Trovato
Keyword(s):  
Medication Reconciliation ◽  
Transitions Of Care ◽  
Cancer Center ◽  
Discharge Process ◽  
Program Satisfaction ◽  
Discharge Medication ◽  
Pharmacist Interventions ◽  
Center Care ◽  
Discharge Readiness

Background: The importance of medication reconciliation and the pharmacist’s role within the interdisciplinary team at the point of transition to home hospice is understudied. A transitions of care pilot initiative was developed to streamline the transition for patients at end of life from inpatient cancer center care to home hospice. The initiative consisted of using a hospice discharge checklist, pharmacist-led discharge medication reconciliation in consultation with the primary team responsible for inpatient care, review of discharge prescriptions, and facilitation of bedside delivery of discharge medications. Methods: This was a single-center, prospective, pilot initiative. The objectives of this study were to characterize pharmacist interventions at the time of transition, to assess changes in hospice organizations’ perceptions of discharge readiness, and to evaluate differences in representation rates with the implementation of the pilot discharge process. Results: Fifteen patients in the preimplementation period and 12 patients in the postimplementation period were included. One hundred eleven pharmacist interventions were captured, an average of 9.3 interventions per patient, with an acceptance rate of 82.9% by providers. There was a statistically significant ( P = .035) improvement in hospice organizations’ perceptions of discharge readiness. There was no difference in 30-day representation rates postdischarge ( P = 1). Conclusion: This well-received pilot initiative demonstrated an improvement in local hospice’s perception of patient readiness for discharge and a high percentage of accepted pharmacist interventions during discharge medication reconciliation. A larger sample size of patients and longer follow-up period may be needed to demonstrate statistically significant improvements in representation rates postintervention.

Potentially Preventable Hospital Readmissions After Patients’ First Stroke—A National Population-Based Study In Taiwan

2021 ◽  
Author(s):  
Ling-Jan Chiou ◽  
Hui-Chu Lang
Keyword(s):  
Hospital Readmission ◽  
Discharge Planning ◽  
Multinomial Logistic Regression ◽  
Hospital Readmissions ◽  
Care Program ◽  
Severity Index ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Post Discharge ◽  
Important Indicator

Abstract Readmission is an important indicator of the quality of care. The purpose of this study was to explore the probabilities and predictors of 30-day and 1-year potentially preventable hospital readmission (PPR) after a patient’s first stroke. We used claims data from the National Health Insurance (NHI) from 2010 to 2018. Multinomial logistic regression was used to assess the predictors of 30-day and 1-year PPR. A total of 41,921 discharged stroke patients was identified. We found that hospital readmission rates were 15.48% within 30-days and 47.25% within 1-year. The PPR and non-PPR were 9.84% (4,123) and 5.65% (2,367) within 30-days, and 30.65% (12,849) and 16.60% (6,959) within 1-year, respectively. The factors of older patients, type of stroke, shorter length of stay, higher Charlson Comorbidity Index (CCI), higher stroke severity index (SSI), hospital level, hospital ownership, and urbanization level were associated significantly with the 30-day PPR. In addition, the factors of gender, hospitalization year, and monthly income were associated significantly with 1-year PPR. The results showed that better discharge planning and post-discharge follow-up programs could reduce PPR substantially. Also, implementing a post-acute care program for stroke patients has helped reduce the long-term PPR in Taiwan.

Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jonathan Muller ◽  
Barbara Gatton ◽  
Linda Fox ◽  
Joseph A Bove ◽  
Johanna Donovan Turner ◽  
...  
Keyword(s):  
Support Groups ◽  
Medical Information ◽  
Patient Adherence ◽  
Hospital Readmissions ◽  
Phone Call ◽  
Stroke Patients ◽  
Post Discharge ◽  
Phone Calls ◽  
Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

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