An electronic medical record-derived real-time assessment scale for hospital readmission in the elderly.

OBJECTIVE: "Readmission risk score", a 20-point, 4-dimensional tool, is generated from the electronic medical record. This study was performed to evaluate the ability of the readmission risk score to predict 30-day readmissions among older hospitalized patients. METHODS: A retrospective study was conducted utilizing data from the electronic medical record. Using a cutoff value of 7, the readmission score sensitivity was 61%, specificity was 22%, positive predictive value 12%, negative predictive value 77%. The positive and negative likelihood ratios were 0.8 and 1.8, respectively. CONCLUSION: The readmission risk score was associated with 30-day readmissions (median score of readmitted vs not readmitted patients was 8 vs. 5; P = 0.001), and it may be better at identifying those who are not at risk for readmission.

Partners in safety: implementing a community-based patient safety advisory council.

CONTEXT: A recommended strategy for improving patient safety is patient-centered care, with the patient and provider functioning as partners to achieve health care goals. OBJECTIVE: To implement a community-based advisory council where patients and providers can collaboratively develop interventions for safe medication use in the outpatient setting. DESIGN, SETTING, PARTICIPANTS: A descriptive study of the process used to implement a patient-provider advisory council in Walworth County, Wisconsin in 2005-2006. Participants included patients and health care professionals from Aurora Health Care and the community. Using formative research and community-based participatory programs, the Council developed medication safety interventions. MAIN OUTCOME MEASURE(S): Establishment of a community-based patient-provider council; development of interventions to improve medication safety in the outpatient setting. RESULTS: The Walworth County Patient Safety Council was established in November 2005, with 11 patient and 12 provider representatives. The Council identified and developed multiple interventions for patients and health care providers. CONCLUSIONS: A community-based advisory council is an effective partnership model where patients, providers, and their community can collaboratively develop strategies for improving medication safety. As interventions are disseminated in Walworth County, their effectiveness on medication safety outcomes will be evaluated.

AcuteCare for Elders (ACE) tracker and e-Geriatrician: methods to disseminate ACE concepts to hospitals with no geriatricians on staff.

This article describes an innovative method to disseminate the Acute Care for Elders (ACE) model of care for hospitalized older patients implemented at 11 community hospitals in Wisconsin. The ACE Tracker is a computer-generated checklist of all older patients in a facility that takes information from multiple areas of the electronic medical record to identify the older patients' risk factors for functional decline and poor outcomes. The ACE Tracker report was validated against in-person observation of the older patients and found to be accurate. Interdisciplinary teams on medical-surgical units use this summary report to review each patient's plan of care and to efficiently assess the patients who are vulnerable to poor hospital outcomes. The ACE Tracker is also used during regular consultation provided through teleconferencing between an off-site geriatrician (e-Geriatrician) and the local ACE team. The effect of the ACE Tracker and e-Geriatrician models was assessed by measuring use of urinary catheters, physical restraints, high-risk medications, and social service evaluation at a single hospital for the 6 months before and after implementation of the models. There were significant improvements in urinary catheter and physical therapy referrals but no significant changes in the other outcomes. There was no change in the length of stay or in the rate of hospital readmission within 30 days.