Effects of a pharmacist-driven intervention program on hospital readmissions.

PURPOSE: Results of a study to determine whether routine use of a multifaceted medication-focused intervention at a safety-net hospital was feasible and could reduce hospital readmissions in a Medicare fee-for-service population are reported. METHODS: A quality-improvement cohort study of 1,059 admissions of 667 patients at an inner-city hospital was conducted. Patients in the intervention groups received some or all components of the multifaceted "Medication REACH" intervention, with direct pharmacist involvement from admission through postdischarge aftercare. A pharmacist reconciled medications, provided patient-centered education, collaborated with healthcare providers to optimize therapy, ensured access to medications, and followed up with patients at home as needed. Rates of unplanned readmissions within 30 days of discharge in the full- and partial-intervention groups and in patients who received standard discharge care were compared. RESULTS: Among patients who received the full Medication REACH intervention, 30 of 305 admissions (9.8%) resulted in unplanned readmissions within 30 days, as compared with a readmission rate of 20.4% (110 of 538 patients) among patients who received standard discharge care (p < 0.001). Linear regression modeling, with adjustments for patient age, sex, ethnicity, and case-mix index, indicated an adjusted risk difference favoring the full-intervention group of 9.4 percentage points (95% confidence interval, 4.3-14.6 percentage points; p < 0.001). CONCLUSION: Rates of 30-day readmission were substantially lower with pharmacist involvement and collaboration with other healthcare team members during patient transitions from the hospital to the home setting.

The use of financial incentives to increase fresh fruit and vegetable purchases in lower-income households: results of a pilot study.

Identifying effective strategies to promote healthier eating in underserved populations is a public health priority. In this pilot study, we examined the use of financial incentives to increase fresh fruit and vegetable purchases in low-income households (N=29). Participants received pre-paid coupons to buy fresh produce at the study store during the intervention period. Purchases were compared among the three study phases (baseline, intervention, and follow-up). A financial incentive provided by study coupons increased the average weekly purchase of fresh fruit but was less successful with fresh vegetables. These findings underscore the need for specific targeting of vegetable selection and preparation to exploit this strategy more fully.

Breastfeeding among inner-city women: from intention before delivery to breastfeeding at hospital discharge.

OBJECTIVE: This study assessed the degree to which women's intention to breastfeed prior to delivery translates to actual breastfeeding at hospital discharge and to investigate predictors of breastfeeding in a minority inner-city population. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of consecutive mother-infant dyads born July-September 2010 and discharged from the nursery at an academic community hospital in Philadelphia. RESULTS: The demographics of the 578 women who participated included a mean age of 25.3 years (SD 6.1), 61% African American and 18% Latina, 85% covered by Medicaid, and a mean postpartum hospital stay of 2.3 days. Overall, 60% expressed an intention to breastfeed prior to delivery (exclusively or with formula), but only 50% were breastfeeding at discharge. Of those who intended to breastfeed (exclusively or with formula), 75% were breastfeeding at discharge. Of those who intended to breastfeed exclusively, 40% were doing so at discharge. Of those who intended to bottle feed, 11% were breastfeeding at discharge. In multivariable analysis, older mothers and those with lower parity were more likely to breastfeed at discharge and also to breastfeed exclusively, controlling for ethnicity, parity, insurance, pregravida body mass index, score on the Edinburgh Postpartum Depression Scale, type of delivery, infant birth weight and gestational age. CONCLUSIONS: In a minority inner-city population, only three in four women who intended to breastfeed prior to delivery were breastfeeding at hospital discharge. However, one in 10 women previously not intending to breastfeed did so. Strategies are needed to promote and strengthen women's intention to breastfeed and to help women's breastfeeding outcomes meet their intentions.

Fresh fruit and vegetable purchases in an urban supermarket by low-income households.

OBJECTIVE: To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful. METHODS: Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted. RESULTS: Controlling for household size, the average number of servings of fresh produce per week was higher in families with more children (P = .008) and in families with a wider age range of children (P = .04). CONCLUSIONS AND IMPLICATIONS: Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families.

Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery.

BACKGROUND: The outcomes of Medicare patients undergoing bariatric surgery have been particularly scrutinized, especially with the Center of Medicare and Medicaid Services' decision to offer bariatric surgery benefits. METHODS: The length-of-stay (LOS) data were analyzed from the National Hospital Discharge Survey from 2002 to 2004. To test the hypothesis that Medicare and Medicaid beneficiaries were more likely to have a prolonged length of stay (PLOS), we used a multivariate logistic regression model controlling for age, gender, hospital size, and year of procedure. RESULTS: An estimated 312,000 bariatric procedures were performed nationally from 2002 to 2004. The average patient age was 41.5 years (range 14-75) and 83.6% were women. The in-hospital mortality rate was reported to be .17%. A PLOS occurred in 3.7% of the population. The Medicare and Medicaid beneficiaries represented 5.7% and 6.2% of the population, respectively. The Medicare beneficiaries were 6.0 times (95% confidence interval 2.5-14; P <.001) as likely to have a PLOS, and Medicaid beneficiaries were 3.2 times (95% confidence interval 1.2-8.9; P = .02) as likely to have a PLOS as others after controlling for age, gender, hospital size, and year of procedure. For every 10-year increase in age, the risk of a PLOS increased by 30% (P <.012). CONCLUSION: Medicare and Medicaid beneficiaries are both at an increased risk of a PLOS. This study was not designed to identify the potential causes of a PLOS. Data from prospectively collected bariatric registries might aid surgeons in assessing the risk/benefit ratio of surgical interventions in groups regarded as high risk.

Family care giving for patients at life's end: report from the cultural variations study (CVAS).

OBJECTIVE: To investigate differences between African American and White family caregivers in self-reported health, use of social support and external resources, and emotional and financial strain in the context of their care of a family member with advanced cancer. METHODS: Sixty-nine patient-designated family caregivers of patients with advanced lung or colon cancer interviewed between December 1999 and July 2001. RESULTS: Most African American and White family caregivers were able to identify someone else who was helping them in the care of their family member. Few caregivers used outside resources (e.g., home-based medical care, meal delivery, pastoral care, outside social support visitor) to assist in the support and care of the patient. At baseline, White caregivers were more likely to agree that caregiving caused work adjustments, (p=.28, p=.02) and emotional difficulties (p=.32, p=.008) and that caregiving had been completely overwhelming (p=.19, p=.12) than were African American caregivers. At follow-up, among family caregivers of patients who had died, 44% reported having to quit work to provide personal care for the patient. Twenty-five percent of family caregivers reported using most or all of the family's saving in caring for the patient. SIGNIFICANCE OF RESULTS: Caregivers of patients at end of life experience substantial emotional and financial difficulties related to caregiving. Family caregiving is a private undertaking with little use of outside resources to mitigate the burden.