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For: Szekendi MK, Williams MV, Carrier D, Hensley L, Thomas S, Cerese J. The characteristics of patients frequently admitted to academic medical centers in the United States. J Hosp Med 2015;10:563-8. [PMID: 26018340 PMCID: PMC5032986 DOI: 10.1002/jhm.2375] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/19/2015] [Accepted: 04/13/2015] [Indexed: 12/26/2022]

For:	Szekendi MK, Williams MV, Carrier D, Hensley L, Thomas S, Cerese J. The characteristics of patients frequently admitted to academic medical centers in the United States. J Hosp Med 2015;10:563-8. [PMID: 26018340 PMCID: PMC5032986 DOI: 10.1002/jhm.2375] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/19/2015] [Accepted: 04/13/2015] [Indexed: 12/26/2022]

Number

Cited by Other Article(s)

Chang JP, Lin H, Loi P, Ng JP, De Roza M, Kumar R, Tan H, Ho CK, Teo W, Chung AHH, Raj P. Validation of ICD-10 Consensus Code Set for Cirrhosis Detection Using Electronic Health Records in an Asian Population. JGH Open 2025;9:e70156. [PMID: 40330254 PMCID: PMC12053512 DOI: 10.1002/jgh3.70156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 04/01/2025] [Indexed: 05/08/2025]

Abstract

Background

Systematic identification of patients with cirrhosis through electronic healthcare records (EHRs) using ICD-10 codes is essential for epidemiological research but is prone to discrepancies. We aim to validate and improve a recent consensus code set of nine ICD-10 codes to identify cirrhosis in a multi-ethnic Asian population.

Methods

We applied an initial broad algorithm of 25 ICD-10 codes related to cirrhosis and its complications to identify patients potentially with cirrhosis admitted to Singapore General Hospital in 2018 and confirmed true cirrhosis cases via manual EHR review. We evaluated the consensus code set's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in identifying cirrhosis cases. We examined alternative code sets to improve cirrhosis identification and validated them in another local hospital.

Results

One thousand, seven hundred thirty-three patients potentially with cirrhosis were identified, with 937 (54.1%) confirmed. The median age at diagnosis was 71 years (IQR: 64-78), with 65.6% males, 75.2%/8.8%/9.3%/6.7% Chinese/Indians/Malays/Others, and 56.7% Child-Pugh A. The main etiologies were chronic hepatitis B (29.5%) and metabolic dysfunction-associated steatotic liver disease (25.5%). The consensus code set demonstrated sensitivity/specificity/PPV/NPV of 76.1%/82.0%/83.3%/74.5%, respectively. We identified a set of 10 ICD-10 codes (SingHealth Chronic Liver Disease Registry [SoLiDaRity]-10) with sensitivity/specificity/PPV/NPV of 76.5%/84.8%/85.6%/75.4%, respectively, demonstrating an improved specificity versus the consensus code set (p = 0.001). External validation in another local hospital with 578 patients potentially with cirrhosis demonstrated improved sensitivity of the SoLiDaRity-10 code set versus the consensus code set (p = 0.033) (sensitivity/specificity/PPV/NPV: 78.0%/93.6%/94.1%/76.4% vs. 76.2%/93.6%/94.0%/75.0%, respectively).

Conclusions

While the consensus code set performs well in identifying patients with cirrhosis in a multi-ethnic Asian population, we propose the improved SoLiDaRity-10 code set.

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Michael GC, Umar ZA, Grema BA. Exploring the Prevalence and Predictors of Persistently High Primary Care Use Among National Health Insurance Patients in a Nigerian Medical Facility. J Eval Clin Pract 2025;31:e70081. [PMID: 40189786 DOI: 10.1111/jep.70081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/15/2024] [Accepted: 03/14/2025] [Indexed: 05/17/2025]

Valles BT, Etzler SP, Meyer JR, Kittle LD, Burns MR, Buckner Petty SA, Curtis BL, Zehring CM, Peters AL, Dangerfield BS. Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community. Prof Case Manag 2024;29:189-197. [PMID: 38888408 DOI: 10.1097/ncm.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]

Abstract

PURPOSE

Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program. With typical care management models, patients are assigned to registered nurse case managers and social workers according to the inpatient nursing unit rather than patient care complexity. Patients with complex care needs may not receive the amount of time needed to ensure an efficient and effective transition to the community setting. Furthermore, after transitioning to the community, patients with complex care needs often do not have access to care management resources if further care coordination needs arise.

PRIMARY PRACTICE SETTING

Acute care hospital in the US Southwest.

METHODOLOGY AND SAMPLE

The CCTT was composed of a registered nurse case manager, social worker, and care management assistant, with physician advisor support. The CCTT followed patients with complex care needs during their hospitalization and transition to the community for 90 days after discharge. The number of inpatient admissions and hospital readmission rates were compared between 6 months before and after enrollment in the CCTT program. Cost savings for decreased hospital length of stay, emergency department visits, and hospital readmissions were also determined.

RESULTS

The CCTT selected patients according to a complex care algorithm , which identified patients who required high use of the health care system. The CCTT then followed this cohort of patients for an average of 90 days after discharge. A total of 123 patients were enrolled in the CCTT program from July 1, 2019, to April 30, 2021, and 80 patients successfully graduated from the program. Readmission rates decreased from 51.2% at 6 months before the intervention to 22.0% at 6 months after the intervention. This reduced readmission rate resulted in a cost savings of more than $1 million.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

The outcomes resulting from implementation of the multidisciplinary CCTT highlight the need for a patient-specific approach to transitioning care to the outpatient setting. The patient social determinants of health that often contributed to overuse of health care resources included poor access to outpatient specialists, difficulty navigating the health care system due to illness or poor health literacy, and limited social support. The success of the CCTT program prompted the implementation of other specialty-specific pilot programs at Mayo Clinic in Arizona. The investment of time and resources, including dedicated personnel to follow patients with high hospital service usage, allows health care systems to reduce emergency department visits and hospital admissions and to provide patients with the best opportunity for success as they transition from the inpatient to outpatient setting.

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Affiliation(s)

Brittane T Valles Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Sydney P Etzler Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Jillian R Meyer Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Laura D Kittle Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Michelle R Burns Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Skye A Buckner Petty Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Belinda L Curtis Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Cathleen M Zehring Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Ariana L Peters Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona
Benjamin S Dangerfield Brittane T. Valles, MD , is an internist and fellow of the American College of Physicians. She has worked at Mayo Clinic in Arizona in the Division of Hospital Internal Medicine since 2017. In 2022, she obtained Care Management Physician Certification through the Association of Physician Leadership in Care Management. Sydney P. Etzler is a licensed master social worker who has worked in acute care hospitals since 2017. Sydney joined Mayo Clinic in Arizona in 2018 and has worked as a complex care social worker from early 2020 to 2023. Sydney holds a bachelor's degree in psychology and a master's degree in social work Jillian R. Meyer is an inpatient float registered nurse case manager at Mayo Clinic in Arizona. Jillian, along with her team, launched the complex care transition team in July 2019 and remained with the program until February 2023. Jillian obtained her Bachelor of Science in Nursing from Montana State University and is an accredited registered nurse case manager with the American Case Management Association Laura D. Kittle is the manager of ambulatory and post discharge case managers (utilization management) and the complex care transition case manager. She has worked for Mayo Clinic for more than 12 years. She holds a master's degree in nursing with a specialty in case management. She has obtained both Commission for Case Manager and Accredited Case Manager certifications Michelle R. Burns is the social work manager at Mayo Clinic in Arizona and has worked in both the inpatient and outpatient setting for more than 13 years. Michelle holds a bachelor's and master's degree in social work from Arizona State University. Additionally, Michelle is an adjunct faculty member at Grand Canyon University and assists in teaching at Mayo Clinic College of Medicine and Science in Arizona Skye A. Buckner Petty is a senior biostatistician at Mayo Clinic in Arizona. He has 12 years of experience as a biostatistician, working in public health and clinical research Belinda L. Curtis is a nursing education specialist for care management in the Division of Nursing Professional Development at Mayo Clinic in Arizona. She has education responsibilities for orientation, competency, and continuing education for registered nurse case managers, utilization management, case management assistants, and chaplains. She has held positions in nursing education, management, and administration for the past 30 years Cathleen M. Zehring has been a nurse administrator of care management and occupational health services at Mayo Clinic in Arizona since 2000. Cathleen holds a Bachelor of Science in Nursing and master's degree in organizational management. She has Commission for Case Manager, Accredited Case Manager, and Change Management certifications Ariana L. Peters, DO , graduated from Kirksville College of Osteopathic Medicine in 2003 and completed her residency in internal medicine in 2007. She is a fellow in the American College of Osteopathic Internists and the Society of Hospital Medicine. She is the care management medical director at Mayo Clinic in Arizona Benjamin S. Dangerfield, DO , is a consultant in the Division of Hospital Internal Medicine at Mayo Clinic in Arizona. He joined Mayo Clinic in 2015 as an assistant professor of medicine and serves as the medical director for the Arizona Operations Command Center at Mayo Clinic in Arizona

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Leth SV, Graversen SB, Lisby M, StØvring H, SandbÆk A. Patients with repeated acute admissions to somatic departments: sociodemographic characteristics, disease burden, and contact with primary healthcare sector - a retrospective register-based case-control study. Scand J Public Health 2024:14034948241230142. [PMID: 38385163 DOI: 10.1177/14034948241230142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]

Abstract

BACKGROUND

Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking.

OBJECTIVE

To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector.

METHODS

This matched register-based case-control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression.

RESULTS

Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions.

CONCLUSIONS

This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention.

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Gopaldas M, Wenzel K, Campbell ANC, Jalali A, Fishman M, Rotrosen J, Nunes EV, Murphy SM. Impact of Medication-Based Treatment on Health Care Utilization Among Individuals With Opioid Use Disorder. Psychiatr Serv 2023;74:1227-1233. [PMID: 37337675 PMCID: PMC10730760 DOI: 10.1176/appi.ps.20220549] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]

Affiliation(s)

Manesh Gopaldas New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Kevin Wenzel New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Aimee N C Campbell New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Ali Jalali New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Marc Fishman New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
John Rotrosen New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Edward V Nunes New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
Sean M Murphy New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)

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Shannon B, Bowles KA, Williams C, Ravipati T, Deighton E, Andrew N. Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study. BMJ Open 2023;13:e077195. [PMID: 37751947 PMCID: PMC10533720 DOI: 10.1136/bmjopen-2023-077195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open

Abstract

OBJECTIVE

The Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme participants and identify factors associated with enrolment into the programme.

DESIGN

This observational cohort study was conducted using routinely collected data from the National Centre for Healthy Ageing data platform.

SETTING

The study was carried out at Peninsula Health, a health service provider serving a population in Melbourne, Victoria, Australia.

PARTICIPANTS

We included all adults with unplanned ED presentation or hospital admission to Peninsula Health between 1 November 2016 and 31 October 2017, the programme's first operational year.

OUTCOME MEASURES

Community Care programme enrolment was the primary outcome. Participants' demographics, health factors and enrolment influences were analysed using a staged multivariable logistic regression.

RESULTS

We included 47 148 adults, of these, 914 were enrolled in the Community Care programme. Participants were older (median 66 vs 51 years), less likely to have a partner (34% vs 57%) and had more frequent hospitalisations and ED visits. In the multivariable analysis, factors most strongly associated with enrolment included not having a partner (adjusted OR (aOR) 1.83, 95% CI 1.57 to 2.12), increasing age (aOR 1.01, 95% CI 1.01 to 1.02), frequent hospitalisations (aOR 7.32, 95% CI 5.78 to 9.24), frequent ED visits (aOR 2.0, 95% CI 1.37 to 2.85) and having chronic diseases, such as chronic pulmonary disease (aOR 2.48, 95% CI 2.06 to 2.98), obesity (aOR 2.06, 95% CI 1.39 to 2.99) and diabetes mellitus (complicated) (aOR 1.75, 95% CI 1.44 to 2.13). Residing in aged care home and having high socioeconomic status) independently associated with reduced odds of enrolment.

CONCLUSIONS

The Community Care programme targets patients with high-readmission risks under-representation of individuals residing in residential aged care homes warrants further investigation. This study aids service planning and offers valuable feedback to clinicians about programme beneficiaries.

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Borden CG, Ashe EM, Buitron de la Vega P, Gast V, Saint-Phard T, Brody-Fialkin J, Power J, Wang N, Lasser KE. A novel pharmacy liaison program to address health-related social needs at an urban safety-net hospital. Am J Health Syst Pharm 2023;80:1071-1081. [PMID: 37210728 DOI: 10.1093/ajhp/zxad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 05/23/2023] Open

Abstract

PURPOSE

Patients with unmet health-related social needs (HRSNs) often experience poor health outcomes and have high levels of healthcare utilization. We describe a program where dually trained pharmacy liaison-patient navigators (PL-PNs) screen for and address HRSNs while providing medication management services to patients with high levels of acute care utilization in a Medicaid Accountable Care Organization. We are unaware of prior studies that have described this PL-PN role.

METHODS

We analyzed case management spreadsheets for the 2 PL-PNs who staffed the program to identify the HRSNs that patients faced and the ways PL-PNs addressed them. We administered surveys, including an 8-item client satisfaction questionnaire (CSQ-8), to characterize patient perceptions of the program.

RESULTS

Initially, 182 patients (86.6% English speaking, 80.2% from a marginalized racial or ethnic group, and 63.2% with a significant medical comorbidity) were enrolled in the program. Non-English-speaking patients were more likely to receive the minimum intervention dose (completion of an HRSN screener). Case management spreadsheet data (available for 160 patients who engaged with the program) indicated that 71% of participants faced at least one HRSN, most often food insecurity (30%), lack of transportation (21%), difficulty paying for utilities (19%), and housing insecurity (19%). Forty-three participants (27%) completed the survey with an average CSQ-8 score of 27.9, indicating high levels of satisfaction with the program. Survey participants reported receiving medication management services, social needs referrals, health-system navigation assistance, and social support.

CONCLUSION

Integration of pharmacy medication adherence and patient navigation services is a promising approach to streamline the HRSN screening and referral process at an urban safety-net hospital.

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Adhia AH, Feinglass JM, Schlick CJR, Merkow RP, Bilimoria KY, Odell DD. Hospital Volume Predicts Guideline-Concordant Care in Stage III Esophageal Cancer. Ann Thorac Surg 2022;114:1176-1182. [PMID: 34481801 PMCID: PMC8891387 DOI: 10.1016/j.athoracsur.2021.07.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]

Affiliation(s)

Akash H Adhia Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Joseph M Feinglass Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Cary Jo R Schlick Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Ryan P Merkow Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Karl Y Bilimoria Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
David D Odell Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Henschen BL, Theodorou ME, Chapman M, Barra M, Toms A, Cameron KA, Zhou S, Yeh C, Lee J, O'Leary KJ. An Intensive Intervention to Reduce Readmissions for Frequently Hospitalized Patients: the CHAMP Randomized Controlled Trial. J Gen Intern Med 2022;37:1877-1884. [PMID: 34472021 PMCID: PMC8409268 DOI: 10.1007/s11606-021-07048-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]

Abstract

BACKGROUND

A small number of patients are disproportionally readmitted to hospitals. The Complex High Admission Management Program (CHAMP) was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients.

OBJECTIVE

To compare hospital utilization metrics among patients enrolled in CHAMP and usual care.

DESIGN

Pragmatic randomized controlled trial.

PARTICIPANTS

Inclusion criteria were as follows: 3 or more, 30-day inpatient readmissions in the previous year; or 2 inpatient readmissions plus either a referral or 3 observation admissions in previous 6 months.

INTERVENTIONS

Patients randomized to CHAMP were managed by an interdisciplinary team including social work, physicians, and pharmacists. The CHAMP team used comprehensive care planning and inpatient, outpatient, and community visits to address both medical and social needs. Control patients were randomized to usual care and contacted 18 months after initial identification if still eligible.

MAIN MEASURES

Primary outcome was number of 30-day inpatient readmissions 180 days following enrollment. Secondary outcomes were number of hospital admissions, total hospital days, emergency department visits, and outpatient clinic visits 180 days after enrollment.

KEY RESULTS

There were 75 patients enrolled in CHAMP, 76 in control. Groups were similar in demographic characteristics and baseline readmissions. At 180 days following enrollment, CHAMP patients had more inpatient 30-day readmissions [CHAMP incidence rate 1.3 (95% CI 0.9-1.8) vs. control 0.8 (95% CI 0.5-1.1), p=0.04], though both groups had fewer readmissions compared to 180 days prior to enrollment. We found no differences in secondary outcomes.

CONCLUSIONS

Frequently hospitalized patients experienced reductions in utilization over time. Though most outcomes showed no difference, CHAMP was associated with higher readmissions compared to a control group, possibly due to consolidation of care at a single hospital. Future research should seek to identify subsets of patients with persistently high utilization for whom tailored interventions may be beneficial.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03097640; https://clinicaltrials.gov/ct2/show/NCT03097640.

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Heneghan JA, Akande M, Goodman DM, Ramgopal S. High-Frequency Utilization of the PICU. Pediatr Crit Care Med 2022;23:e230-e239. [PMID: 35245276 DOI: 10.1097/pcc.0000000000002920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Abstract

OBJECTIVES

To describe the demographic, clinical, outcome, and cost differences between children with high-frequency PICU admission and those without.

DESIGN

Retrospective, cross-sectional cohort study.

SETTING

United States.

PATIENTS

Children less than or equal to 18 years old admitted to PICUs participating in the Pediatric Health Information System database in 2018.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We assessed survivors of PICU admissions for repeat PICU admissions within a year of their index visit. Children with greater than or equal to 3 PICU admissions within a year were classified as high-frequency PICU utilization (HFPICU). We compared demographic, clinical, outcome, and cost characteristics between children with HFPICU and those with only an index or two admissions per year (nHFPICU). Of 95,465 children who survived an index admission, 5,880 (6.2%) met HFPICU criteria. HFPICU patients were more frequently younger, technology dependent, and publicly insured. HFPICU patients had longer lengths of stay and were more frequently discharged to a rehabilitation facility or with home nursing services. HFPICU patients accounted for 24.8% of annual hospital utilization costs among patients requiring PICU admission. Time to readmission for children with HFPICU was 58% sooner (95% CI, 56-59%) than in those with nHFPICU with two admissions using an accelerated failure time model. Among demographic and clinical factors that were associated with development of HFPICU status calculated from a multivariable analysis, the greatest effect size was for time to first readmission within 82 days.

CONCLUSIONS

Children identified as having HFPICU account for 6.2% of children surviving an index ICU admission. They are a high-risk patient population with increased medical resource utilization during index and subsequent ICU admissions. Patients readmitted within 82 days of discharge should be considered at higher risk of HFPICU status. Further research, including validation and exploration of interventions that may be of use in this patient population, are necessary.

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Han BH, Tuazon E, Y Wei M, Paone D. Multimorbidity and Inpatient Utilization Among Older Adults with Opioid Use Disorder in New York City. J Gen Intern Med 2022;37:1634-1640. [PMID: 34643872 PMCID: PMC9130354 DOI: 10.1007/s11606-021-07130-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022]

Abstract

BACKGROUND

Nationally, there is a sharp increase in older adults with opioid use disorder (OUD). However, we know little of the acute healthcare utilization patterns and medical comorbidities among this population.

OBJECTIVE

This study describes the prevalence of chronic conditions, patterns of inpatient utilization, and correlates of high inpatient utilization among older adults with OUD in New York City (NYC).

DESIGN

Retrospective longitudinal cohort study.

PARTICIPANTS

Patients aged ≥55 with OUD hospitalized in NYC in 2012 identified using data from New York State's Statewide Planning and Research Cooperative System (SPARCS).

MAIN MEASURES

The prevalence of comorbid substance use diagnoses, chronic medical disease, and mental illness was measured using admission diagnoses from the index hospitalization. We calculated the ICD-Coded Multimorbidity-Weighted Index (MWI-ICD) for each patient to measure multimorbidity. We followed the cohort through September 30, 2015 and the outcome was the number of rehospitalizations for inpatient services in NYC. We compared patient-level factors between patients with the highest use of inpatient services (≥7 rehospitalizations) during the study period to low utilizers. We used multiple logistic regression to examine possible correlates of high inpatient utilization.

KEY RESULTS

Of 3669 adults aged ≥55 with OUD with a hospitalization in 2012, 76.4% (n=2803) had a subsequent hospitalization and accounted for a total of 22,801 rehospitalizations during the study period. A total of 24.7% of the cohort (n=906) were considered high utilizers and had a higher prevalence of alcohol and cocaine-related diagnoses, congestive heart failure, diabetes, schizophrenia, and chronic obstructive pulmonary disease. Multivariable predictors of high utilization included being a Medicaid beneficiary (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.37-2.11), alcohol-related diagnoses (aOR=1.43, 95% CI: 1.21-1.69), and increasing comorbidity measured by MWI-ICD (highest MWI-ICD quartile: aOR=1.98, 95% CI=1.59-2.48).

CONCLUSIONS

Among older adults with OUD admitted to the hospital, multimorbidity is strongly associated with high inpatient utilization.

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Xie F, Liu N, Yan L, Ning Y, Lim KK, Gong C, Kwan YH, Ho AFW, Low LL, Chakraborty B, Ong MEH. Development and validation of an interpretable machine learning scoring tool for estimating time to emergency readmissions. EClinicalMedicine 2022;45:101315. [PMID: 35284804 PMCID: PMC8904223 DOI: 10.1016/j.eclinm.2022.101315] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 01/06/2023] Open

Abstract

BACKGROUND

Emergency readmission poses an additional burden on both patients and healthcare systems. Risk stratification is the first step of transitional care interventions targeted at reducing readmission. To accurately predict the short- and intermediate-term risks of readmission and provide information for further temporal risk stratification, we developed and validated an interpretable machine learning risk scoring system.

METHODS

In this retrospective study, all emergency admission episodes from January 1st 2009 to December 31st 2016 at a tertiary hospital in Singapore were assessed. The primary outcome was time to emergency readmission within 90 days post discharge. The Score for Emergency ReAdmission Prediction (SERAP) tool was derived via an interpretable machine learning-based system for time-to-event outcomes. SERAP is six-variable survival score, and takes the number of emergency admissions last year, age, history of malignancy, history of renal diseases, serum creatinine level, and serum albumin level during index admission into consideration.

FINDINGS

A total of 293,589 ED admission episodes were finally included in the whole cohort. Among them, 203,748 episodes were included in the training cohort, 50,937 episodes in the validation cohort, and 38,904 in the testing cohort. Readmission within 90 days was documented in 80,213 (27.3%) episodes, with a median time to emergency readmission of 22 days (Interquartile range: 8-47). For different time points, the readmission rates observed in the whole cohort were 6.7% at 7 days, 10.6% at 14 days, 13.6% at 21 days, 16.4% at 30 days, and 23.0% at 60 days. In the testing cohort, the SERAP achieved an integrated area under the curve of 0.737 (95% confidence interval: 0.730-0.743). For a specific 30-day readmission prediction, SERAP outperformed the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, and Emergency department visits in past six months) and the HOSPITAL score (Hemoglobin at discharge, discharge from an Oncology service, Sodium level at discharge, Procedure during the index admission, Index Type of admission, number of Admissions during the last 12 months, and Length of stay). Besides 30-day readmission, SERAP can predict readmission rates at any time point during the 90-day period.

INTERPRETATION

Better performance in risk prediction was achieved by the SERAP than other existing scores, and accurate information about time to emergency readmission was generated for further temporal risk stratification and clinical decision-making. In the future, external validation studies are needed to evaluate the SERAP at different settings and assess their real-world performance.

FUNDING

This study was supported by the Singapore National Medical Research Council under the PULSES Center Grant, and Duke-NUS Medical School.

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Affiliation(s)

Feng Xie Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
Nan Liu Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore Health Services Research Centre, Singapore Health Services, Singapore Institute of Data Science, National University of Singapore, Singapore Corresponding author at: Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
Linxuan Yan Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
Yilin Ning Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
Ka Keat Lim School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
Changlin Gong Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Yu Heng Kwan Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
Andrew Fu Wah Ho Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore Department of Emergency Medicine, Singapore General Hospital, Singapore
Lian Leng Low Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore Department of Post-Acute and Continuing Care, Outram Community Hospital, Singapore SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore
Bibhas Chakraborty Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore Department of Statistics and Data Science, National University of Singapore, Singapore Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
Marcus Eng Hock Ong Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore Health Services Research Centre, Singapore Health Services, Singapore Department of Emergency Medicine, Singapore General Hospital, Singapore

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Shemesh AJ, Golden DL, Kim AY, Rolon Y, Kelly L, Herman S, Weathers TN, Wright D, McGarvey T, Zhang Y, Steel PAD. Super-High-Utilizer Patients in an Urban Academic Emergency Department: Characteristics, Early Identification, and Impact of Strategic Care Management Interventions. HEALTH & SOCIAL WORK 2022;47:68-71. [PMID: 34910122 PMCID: PMC9989726 DOI: 10.1093/hsw/hlab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]

Laurent D, Bardhi O, Kubilis P, Corliss B, Adamczak S, Geh N, Dodd W, Vaziri S, Busl K, Fox WC. Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage. Surg Neurol Int 2021;12:277. [PMID: 34221608 PMCID: PMC8247662 DOI: 10.25259/sni_100_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open

Comorbidity Burden Contributing to Racial Disparities in Outpatient Versus Inpatient Total Knee Arthroplasty. J Am Acad Orthop Surg 2021;29:537-543. [PMID: 33720079 DOI: 10.5435/jaaos-d-20-01038] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/10/2021] [Indexed: 02/01/2023] Open

Abstract

INTRODUCTION

Outpatient total knee arthroplasty (TKA) is increasingly common in the setting of early-recovery protocols, value-based care, and removal from the inpatient-only list by the Centers for Medicare & Medicaid Services. Given the established racial disparities that exist in different aspects of total joint arthroplasty, we aimed to investigate whether racial and ethnic disparities exist in outpatient compared with inpatient TKA.

METHODS

This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program. We queried TKAs done in 2018. Demographics, inpatient (≥2 midnights) versus outpatient (≤1 midnight) status, comorbidities, and perioperative events/complications were recorded. We analyzed differences between racial/ethnic groups and predictors of inpatient versus outpatient surgery, and outcomes.

RESULTS

A total of 54,582 patients were included (83.2% Caucasian, 9.2% African American [AA], 4.5% Hispanic, 2.4% Asian, and 0.6% Native American). AA had the highest mean body mass index, American Society of Anesthesiologists score, and comorbidity burden. AA had the lowest rate of outpatient TKA (18.3%) and Asians the highest rate of outpatient TKA (31.4%, P < 0.0001). AA had the highest postoperative transfusion rate (1.8%, P < 0.0001) and highest rate of discharge to acute rehab (8.4%). Asians had the highest rate of postoperative cardiac arrest and urinary tract infection. AA had the highest rate of acute kidney injury within 30 days. Regression analyses revealed that AAs were more likely to undergo inpatient surgery (odds ratio [OR], 2.58; confidence interval [CI], 1.57-4.23; P = 0.001) and discharge to rehab/skilled nursing facility [SNF] (OR, 2.86; CI, 1.66-4.92; P = 0.001). Asian patients were more likely to undergo outpatient surgery (OR, 2.48, CI, 1.47-4.18, P = 0.001) and discharged to rehab/SNF (OR, 2.41, CI, 1.36-4.25, P = 0.001). Caucasians were more likely to undergo outpatient surgery (OR, 1.62, CI, 1.34-1.97, P = 0.001) and less likely discharged to rehab/SNF (OR, 0.73, CI, 0.60-0.88, P = 0.001). When controlling for comorbidities, race was not an independent risk factor for 30-day complications or inpatient versus outpatient surgery.

DISCUSSION

Differences in indications for outpatient TKA between races/ethnicities seem to be highly associated with comorbidity burden and preoperative baseline differences, not race alone. Appropriate patient optimization for either outpatient or inpatient TKA may reduce disparities between groups in either care setting.

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Tong B, Osborne C, Horwood CM, Hakendorf PH, Woodman RJ, Li JY. The prevalence, characteristics, and risk factors of frequently readmitted patients to an internal medicine service. Intern Med J 2021;52:1561-1568. [PMID: 34031965 DOI: 10.1111/imj.15395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]

Abstract

AIMS

To determine the prevalence, characteristics and risk factors associated with frequent readmissions to an internal medicine service at a tertiary public hospital.

METHOD

A retrospective observational study was conducted at an internal medicine service in a tertiary teaching hospital between 1st January 2010 and the 30th June 2016. Frequent readmission was defined as four or more readmissions within 12 months of discharge from the index admission. Demographic and clinical characteristics, and potential risk factors were evaluated.

RESULTS

50 515 patients were included, 1657 (3.3%) had frequent readmissions and were associated with nearly 2.5 times higher in 12-month mortality rates. They were older, had higher rates of Indigenous Australians (3.2%), more disadvantaged status (Index of Relative Socio-Economic Disadvantage decile of 5.3), and more comorbidities (mean Charlson comorbidity index 1.4) in comparison, to infrequent readmission group. The mean length of hospital stay during the index admission was 6 days for frequent readmission group (21.4% staying more than 7 days) with higher incidence of discharge against medical advice (2.0% higher). Intensive care unit admission rate was 6.6% for frequent readmission group compared to 3.9% for infrequent readmission group. Multivariate analysis showed mental disease and disorders, neoplastic, and alcohol/drug use and alcohol/drug induced organic mental disorders are associated with frequent readmission.

CONCLUSION

The risk factors associated with frequent readmission were older age, indigenous status, being socially disadvantaged, having higher comorbidities, and discharging against medical advice. Conditions that lead to frequent readmissions were mental disorders, alcohol/drug use and alcohol/drug induced organic mental disorders, and neoplastic disorders.

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Goshtasbi K, Lehrich BM, Abouzari M, Abiri A, Birkenbeuel J, Lan MY, Wang WH, Cadena G, Hsu FPK, Kuan EC. Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study. J Neurosurg 2021;134:816-824. [PMID: 32168478 PMCID: PMC8080843 DOI: 10.3171/2020.1.jns193062] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/02/2020] [Indexed: 12/30/2022]

Abstract

OBJECTIVE

For symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.

METHODS

The National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES.

RESULTS

Of 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04).

CONCLUSIONS

There is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.

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Huang M, van der Borght C, Leithaus M, Flamaing J, Goderis G. Patients' perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC Geriatr 2020;20:332. [PMID: 32894056 PMCID: PMC7487888 DOI: 10.1186/s12877-020-01748-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/31/2020] [Indexed: 01/23/2023] Open

Abstract

BACKGROUND

Although 'frequent flyer' hospital admissions represent barely 3 to 8% of the total patient population in a hospital, they are responsible for a disproportionately high percentage (12 to 28%) of all admissions. Moreover, hospital admissions are an important contributor to health care costs and overpopulation in various hospitals. The aim of this research is to obtain a deeper insight into the phenomenon of frequent flyer hospital admissions. Our objectives were to understand the patients' perspectives on the cause of their frequent hospital admissions and to identify the perceived consequences of the frequent flyer status.

METHODS

This qualitative study took place at the University Hospital of Leuven. The COREQ guidelines were followed to provide rigor to the study. Patients were included when they had at least four overnight admissions in the past 12 months, an age above 65 years and hospital admission at the time of the study. Data were collected via semi-structured interviews and encoded in NVivo.

RESULTS

Thirteen interviews were collected. A total of 17 perceived causes for frequent hospital admission were identified, which could be divided into the following six themes: patient, drugs, primary care, secondary care, home and family. Most of the causes were preventable or modifiable. The perceived consequences of being a frequent flyer were divided into the following six themes: body, daily life functioning, social participation, mental status and spiritual dimension. Negative experiences were linked to frequent flying and could be situated mainly in the categories of social participation, mental status and spiritual dimensions.

CONCLUSIONS

Frequent hospital admissions may be conceived as an indicator, i.e., a 'red flag', of patients' situations characterized by physical, mental, spiritual and social deprivation in their home situation.

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Brom H, Carthon JMB, Ikeaba U, Chittams J. Leveraging Electronic Health Records and Machine Learning to Tailor Nursing Care for Patients at High Risk for Readmissions. J Nurs Care Qual 2020;35:27-33. [PMID: 31136529 PMCID: PMC6874718 DOI: 10.1097/ncq.0000000000000412] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Nijhawan AE, Higashi RT, Marks EG, Tiruneh YM, Lee SC. Patient and Provider Perspectives on 30-Day Readmissions, Preventability, and Strategies for Improving Transitions of Care for Patients with HIV at a Safety Net Hospital. J Int Assoc Provid AIDS Care 2020;18:2325958219827615. [PMID: 30760091 PMCID: PMC6748499 DOI: 10.1177/2325958219827615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open

Smith GM, Cenzer IS, Covinsky K, Reuben DB, Smith AK. Who Becomes a High Utilizer? A Case-Control Study of Older Adults in the USA. J Gen Intern Med 2020;35:596-598. [PMID: 31768905 PMCID: PMC7018874 DOI: 10.1007/s11606-019-05331-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/17/2018] [Accepted: 08/22/2019] [Indexed: 11/29/2022]

Maragh-Bass AC, Fields JC, Catanzarite Z, Knowlton AR. "We get tunnel vision": Emergency medical service providers' views on the opioid epidemic in Baltimore City. J Opioid Manag 2019;15:295-306. [PMID: 31637682 PMCID: PMC11502992 DOI: 10.5055/jom.2019.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Abstract

OBJECTIVE

To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting.

DESIGN

Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs.

SETTING

Baltimore City.

PARTICIPANTS

Twenty-two Baltimore City Fire Department EMS providers.

INTERVENTIONS

Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches.

MAIN OUTCOME MEASURE

Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison.

RESULTS

Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs.

CONCLUSIONS

EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.

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Traven SA, McGurk KM, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg 2019;28:1854-1860. [PMID: 31202629 DOI: 10.1016/j.jse.2019.03.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]

Abstract

HYPOTHESIS

The purpose of this study was to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications in patients undergoing total shoulder arthroplasty (TSA).

METHODS

We conducted a retrospective analysis of the National Surgical Quality Improvement Program database for patients undergoing TSA between the years 2005 and 2017. The mFI-5 score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications.

RESULTS

A total of 18,957 patients undergoing TSA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, and readmission (odds ratio ≥ 1.309, P ≤ .001). Length of stay also increased as the mFI-5 score increased (P < .001). However, among all the measured complications, the mFI-5 was the strongest predictor of mortality, with the risk more than doubling for each point increase in the mFI-5 score (odds ratio, 2.113; 95% confidence interval, 1.447-3.086; P < .001).

CONCLUSION

The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing TSA. All of the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and surgeons can use to identify high-risk surgical candidates, inform preoperative counseling, and guide perioperative care to optimize patient outcomes.

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Kumar A, Rao A, O'Rourke K, Hanrahan N. Relationship Between Depression and/or Anxiety and Hospital Readmission Among Women After Childbirth. J Obstet Gynecol Neonatal Nurs 2019;48:552-562. [PMID: 31356766 PMCID: PMC6756448 DOI: 10.1016/j.jogn.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open

O’Leary KJ, Chapman MM, Foster S, O’Hara L, Henschen BL, Cameron KA. Frequently Hospitalized Patients' Perceptions of Factors Contributing to High Hospital Use. J Hosp Med 2019;14:521-526. [PMID: 30897060 PMCID: PMC6715053 DOI: 10.12788/jhm.3175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 01/24/2023]

Rahman N, Ng SHX, Ramachandran S, Wang DD, Sridharan S, Tan CS, Khoo A, Tan XQ. Drivers of hospital expenditure and length of stay in an academic medical centre: a retrospective cross-sectional study. BMC Health Serv Res 2019;19:442. [PMID: 31266515 PMCID: PMC6604431 DOI: 10.1186/s12913-019-4248-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open

Abstract

BACKGROUND

As healthcare expenditure and utilization continue to rise, understanding key drivers of hospital expenditure and utilization is crucial in policy development and service planning. This study aims to investigate micro drivers of hospital expenditure and length of stay (LOS) in an Academic Medical Centre.

METHODS

Data corresponding to 285,767 patients and 207,426 inpatient visits was extracted from electronic medical records of the National University of Hospital in Singapore between 2005 to 2013. Generalized linear models and generalized estimating equations were employed to build patient and inpatient visit models respectively. The patient models provide insight on the factors affecting overall expenditure and LOS, whereas the inpatient visit models provide insight on how expenditure and LOS accumulate longitudinally.

RESULTS

Although adjusted expenditure and LOS per inpatient visit were largely similar across socio-economic status (SES) groups, patients of lower SES groups accumulated greater expenditure and LOS over time due to more frequent visits. Admission to a ward class with greater government subsidies was associated with higher expenditure and LOS per inpatient visit. Inpatient death was also associated with higher expenditure per inpatient visit. Conditions that drove patient expenditure and LOS were largely similar, with mental illnesses affecting LOS to a larger extent. These observations on condition drivers largely held true at visit-level.

CONCLUSIONS

The findings highlight the importance of distinguishing the drivers of patient expenditure and inpatient utilization at the patient-level from those at the visit-level. This allows better understanding of the drivers of healthcare utilization and how utilization accumulates longitudinally, important for health policy and service planning.

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Tang AM, Bakhsheshian J, Lin M, Jarvis CA, Yuan E, Buchanan IA, Ding L, Strickland BA, Chang E, Zada G, Mack WJ, Attenello FJ. Readmission following inpatient stereotactic radiosurgery for brain tumors. JOURNAL OF RADIOSURGERY AND SBRT 2019;6:101-119. [PMID: 31641547 PMCID: PMC6774493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/18/2019] [Indexed: 06/10/2023]

Rahman N, Wang DD, Ng SHX, Ramachandran S, Sridharan S, Khoo A, Tan CS, Goh WP, Tan XQ. Processing of Electronic Medical Records for Health Services Research in an Academic Medical Center: Methods and Validation. JMIR Med Inform 2018;6:e10933. [PMID: 30578188 PMCID: PMC6320424 DOI: 10.2196/10933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open

Abstract

Background

Electronic medical records (EMRs) contain a wealth of information that can support data-driven decision making in health care policy design and service planning. Although research using EMRs has become increasingly prevalent, challenges such as coding inconsistency, data validity, and lack of suitable measures in important domains still hinder the progress.

Objective

The objective of this study was to design a structured way to process records in administrative EMR systems for health services research and assess validity in selected areas.

Methods

On the basis of a local hospital EMR system in Singapore, we developed a structured framework for EMR data processing, including standardization and phenotyping of diagnosis codes, construction of cohort with multilevel views, and generation of variables and proxy measures to supplement primary data. Disease complexity was estimated by Charlson Comorbidity Index (CCI) and Polypharmacy Score (PPS), whereas socioeconomic status (SES) was estimated by housing type. Validity of modified diagnosis codes and derived measures were investigated.

Results

Visit-level (N=7,778,761) and patient-level records (n=549,109) were generated. The International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes were standardized to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) with a mapping rate of 87.1%. In all, 97.4% of the ICD-9-CM codes were phenotyped successfully using Clinical Classification Software by Agency for Healthcare Research and Quality. Diagnosis codes that underwent modification (truncation or zero addition) in standardization and phenotyping procedures had the modification validated by physicians, with validity rates of more than 90%. Disease complexity measures (CCI and PPS) and SES were found to be valid and robust after a correlation analysis and a multivariate regression analysis. CCI and PPS were correlated with each other and positively correlated with health care utilization measures. Larger housing type was associated with lower government subsidies received, suggesting association with higher SES. Profile of constructed cohorts showed differences in disease prevalence, disease complexity, and health care utilization in those aged above 65 years and those aged 65 years or younger.

Conclusions

The framework proposed in this study would be useful for other researchers working with EMR data for health services research. Further analyses would be needed to better understand differences observed in the cohorts.

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Go YY, Sellmair R, Allen JC, Sahlén A, Bulluck H, Sim D, Jaufeerally FR, MacDonald MR, Lim ZY, Chai P, Loh SY, Yap J, Lam CSP. Defining a 'frequent admitter' phenotype among patients with repeat heart failure admissions. Eur J Heart Fail 2018;21:311-318. [PMID: 30549171 DOI: 10.1002/ejhf.1348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open

Abstract

AIMS

We aimed to identify a 'frequent admitter' phenotype among patients admitted for acute decompensated heart failure (HF).

METHODS AND RESULTS

We studied 10 363 patients in a population-based prospective HF registry (2008-2012), segregated into clusters based on their 3-year HF readmission frequency trajectories. Using receiver-operating characteristic analysis, we identified the index year readmission frequency threshold that most accurately predicts HF admission frequency clusters. Two clusters of HF patients were identified: a high frequency cluster (90.9%, mean 2.35 ± 3.68 admissions/year) and a low frequency cluster (9.1%, mean 0.50 ± 0.81 admission/year). An index year threshold of two admissions was optimal for distinguishing between clusters. Based on this threshold, 'frequent admitters', defined as patients with ≥ 2 HF admissions in the index year (n = 2587), were of younger age (68 ± 13 vs 69 ± 13 years), more often male (58% vs. 54%), smokers (38.4% vs. 34.4%) and had lower left ventricular ejection fraction (37 ± 17 vs. 41 ± 17%) compared to 'non-frequent admitters' (< 2 HF admissions in the index year; n = 7776) (all P < 0.001). Despite similar rates of advanced care utilization, frequent admitters had longer length of stay (median 4.3 vs. 4.0 days), higher annual inpatient costs (€ 7015 vs. € 2967) and higher all-cause mortality at 3 years compared to the non-frequent admitters (adjusted odds ratio 2.33, 95% confidence interval 2.11-2.58; P < 0.001).

CONCLUSION

'Frequent admitters' have distinct clinical characteristics and worse outcomes compared to non-frequent admitters. This study may provide a means of anticipating the HF readmission burden and thereby aid in healthcare resource distribution relative to the HF admission frequency phenotype.

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Goodwin A, Henschen BL, O'Dwyer LC, Nichols N, O'Leary KJ. Interventions for Frequently Hospitalized Patients and Their Effect on Outcomes: A Systematic Review. J Hosp Med 2018;13:853-859. [PMID: 30379144 DOI: 10.12788/jhm.3090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]

Champagne PO, Brunette-Clement T, Bojanowski MW, Moumdjian R, Fournier-Gosselin MP, Bouthillier A, Shedid D. Safety of performing craniotomy in the elderly: The utility of co-morbidity indices. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open

Sobotka LA, Modi RM, Vijayaraman A, Hanje AJ, Michaels AJ, Conteh LF, Hinton A, El-Hinnawi A, Mumtaz K. Paracentesis in cirrhotics is associated with increased risk of 30-day readmission. World J Hepatol 2018;10:425-432. [PMID: 29988878 PMCID: PMC6033715 DOI: 10.4254/wjh.v10.i6.425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/13/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open

Identifying Subgroups of Adult Superutilizers in an Urban Safety-Net System Using Latent Class Analysis: Implications for Clinical Practice. Med Care 2017;56:e1-e9. [PMID: 27632768 DOI: 10.1097/mlr.0000000000000628] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Abstract

BACKGROUND

Patients with repeated hospitalizations represent a group with potentially avoidable utilization. Recent publications have begun to highlight the heterogeneity of this group. Latent class analysis provides a novel methodological approach to utilizing administrative data to identify clinically meaningful subgroups of patients to inform tailored intervention efforts.

OBJECTIVE

The objective of the study was to identify clinically distinct subgroups of adult superutilizers.

RESEARCH DESIGN

Retrospective cohort analysis.

SUBJECTS

Adult patients who had an admission at an urban safety-net hospital in 2014 and 2 or more admissions within the preceding 12 months.

MEASURES

Patient-level medical, mental health (MH) and substance use diagnoses, social characteristics, demographics, utilization and charges were obtained from administrative data. Latent class analyses were used to determine the number and characteristics of latent subgroups that best represented these data.

RESULTS

In this cohort (N=1515), a 5-class model was preferred based on model fit indices, clinical interpretability and class size: class 1 (16%) characterized by alcohol use disorder and homelessness; class 2 (14%) characterized by medical conditions, MH/substance use disorders and homelessness; class 3 (25%) characterized primarily by medical conditions; class 4 (13%) characterized by more serious MH disorders, drug use disorder and homelessness; and class 5 (32%) characterized by medical conditions with some MH and substance use. Patient demographics, utilization, charges and mortality also varied by class.

CONCLUSIONS

The overall cohort had high rates of multiple chronic medical conditions, MH, substance use disorders, and homelessness. However, the patterns of these conditions were different between subgroups, providing important information for tailoring interventions.

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Hensel JM, Taylor VH, Fung K, de Oliveira C, Vigod SN. Unique Characteristics of High-Cost Users of Medical Care With Comorbid Mental Illness or Addiction in a Population-Based Cohort. PSYCHOSOMATICS 2017;59:135-143. [PMID: 29157683 DOI: 10.1016/j.psym.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]

Evaluation of Phagocytic Component of the Immune System in Patients with Organic Acidemia. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2017. [DOI: 10.5812/pedinfect.61624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Damery S, Combes G. Evaluating the predictive strength of the LACE index in identifying patients at high risk of hospital readmission following an inpatient episode: a retrospective cohort study. BMJ Open 2017;7:e016921. [PMID: 28710226 PMCID: PMC5726103 DOI: 10.1136/bmjopen-2017-016921] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open

Abstract

OBJECTIVE

To assess how well the LACE index and its constituent elements predict 30-day hospital readmission, and to determine whether other combinations of clinical or sociodemographic variables may enhance prognostic capability.

DESIGN

Retrospective cohort study with split sample design for model validation.

SETTING

One large hospital Trust in the West Midlands.

PARTICIPANTS

All alive-discharge adult inpatient episodes between 1 January 2013 and 31 December 2014.

DATA SOURCES

Anonymised data for each inpatient episode were obtained from the hospital information system. These included age at index admission, gender, ethnicity, admission/discharge date, length of stay, treatment specialty, admission type and source, discharge destination, comorbidities, number of accident and emergency (A&E) visits in the 6 months before the index admission and whether a patient was readmitted within 30 days of index discharge.

OUTCOME MEASURES

Clinical and patient characteristics of readmission versus non-readmission episodes, proportion of readmission episodes at each LACE score, regression modelling of variables associated with readmission to assess the effectiveness of LACE and other variable combinations to predict 30-day readmission.

RESULTS

The training cohort included data on 91 922 patient episodes. Increasing LACE score and each of its individual components were independent predictors of readmission (area under the receiver operating characteristic curve (AUC) 0.773; 95% CI 0.768 to 0.779 for LACE; AUC 0.806; 95% CI 0.801 to 0.812 for the four LACE components). A LACE score of 11 was most effective at distinguishing between higher and lower risk patients. However, only 25% of readmission episodes occurred in the higher scoring group. A model combining A&E visits and hospital episodes per patient in the previous year was more effective at predicting readmission (AUC 0.815; 95% CI 0.810 to 0.819).

CONCLUSIONS

Although LACE shows good discriminatory power in statistical terms, it may have little added value over and above clinical judgement in predicting a patient's risk of hospital readmission.

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Maragh-Bass AC, Fields JC, McWilliams J, Knowlton AR. Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. Prehosp Disaster Med 2017;32:148-155. [PMID: 28122657 DOI: 10.1017/s1049023x16001424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]

Abstract

Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment.

METHODS

Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison.

RESULTS

Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building.

CONCLUSIONS

Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to engaging Emergency Medical Service providers in substance use research: a qualitative study. Prehosp Disaster Med. 2017;32(2):148-155.

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Doctoroff L, Hsu DJ, Mukamal KJ. Trends in Prolonged Hospitalizations in the United States from 2001 to 2012: A Longitudinal Cohort Study. Am J Med 2017;130:483.e1-483.e7. [PMID: 27986525 PMCID: PMC5362287 DOI: 10.1016/j.amjmed.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]

Brennan JJ, Chan TC, Killeen JP, Castillo EM. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission. West J Emerg Med 2015;16:1025-9. [PMID: 26759647 PMCID: PMC4703150 DOI: 10.5811/westjem.2015.8.26157] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/22/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022] Open