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3.
Nurs Res ; 68(6): 423-432, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31693547

RESUMEN

BACKGROUND: Facebook (FB) has been widely used recently to recruit participants for adult health research. However, little is known about its effectiveness, cost, and the characteristics of participants recruited via FB when compared to other recruitment methods. OBJECTIVES: The purpose of this integrative review was to examine the published evidence concerning the use of FB in participant recruitment for adult health research, as compared to other social media, online, and traditional recruitment methods. METHODS: In this integrative review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, SCOPUS, and Web of Science were the electronic databases used to identify the published articles. In regard to language, the search was limited. RESULTS: The efficacy and cost-effectiveness of using FB for recruitment in healthcare research as compared to more traditional forms of recruitment remain unclear. Reporting of recruitment strategies is inconsistent, and costs are often not included. FB is being used for recruitment frequently with other methods and, although often effective, can be costly. DISCUSSION: FB is used to recruit participants for a variety of studies, with researchers using both free and paid ads to reach potential participants. Reporting of recruitment methods needs to be more rigorous, streamlined, and standardized in scientific papers.


Asunto(s)
Investigación sobre Servicios de Salud , Investigación en Enfermería , Selección de Paciente , Medios de Comunicación Sociales , Adulto , Humanos
4.
Nurs Res ; 68(6): 483-487, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31693554

RESUMEN

BACKGROUND: Limited guidelines to assist nurse researchers who use web-based interventions are available. Nurses must develop the supporting technology enabling participants to complete study activities and collected data while maintaining data security and participant confidentiality. OBJECTIVES: The aim of the study was to describe how the authors used advanced Research Electronic Data Capture (REDCap) functionality to support the data management infrastructure of an interactive, web-based therapeutic intervention. METHODS: The data management infrastructure for the WISER (Writing to Improve Self-in-Relationships) intervention pilot study consisted of two components: a website for presentation of the intervention and participant account management and a REDCap project for data capture and storage. The REDCap application programming interface connected these two components using HTML links and data exchanges. RESULTS: We completed an initial pilot study of WISER with 14 participants using the REDCap-based infrastructure. Minimal technical difficulties were encountered. DISCUSSION: REDCap is cost-effective, is readily available, and, through its advanced functionality, is able to facilitate confidential, secure interactions with participants, robust data management, and seamless participant progression in web-based intervention research.


Asunto(s)
Recolección de Datos , Gestión de la Información en Salud , Investigación sobre Servicios de Salud , Internet , Investigación en Enfermería , Programas Informáticos , Bases de Datos Factuales , Humanos , Proyectos Piloto , Encuestas y Cuestionarios
5.
Nurs Res ; 68(6): 488-493, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31693555

RESUMEN

BACKGROUND: Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES: The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS: We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS: We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION: Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.


Asunto(s)
Investigación sobre Servicios de Salud/organización & administración , Indios Norteamericanos , Investigación en Enfermería/organización & administración , Nativos de Alaska , Humanos
6.
Gesundheitswesen ; 81(10): 850-854, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31683317

RESUMEN

The memorandum outlines core questions that should be addressed by future health services research in order to evaluate the impact of health and medical apps on quality of processes and patient outcomes and to take advantage of their potential as new data sources for scientific research.


Asunto(s)
Prestación de Atención de Salud , Investigación sobre Servicios de Salud , Aplicaciones Móviles , Alemania , Humanos , Almacenamiento y Recuperación de la Información
7.
Gesundheitswesen ; 81(10): e154-e170, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31574556

RESUMEN

There are huge expectations to improve quality and efficiency of prevention and healthcare by using digital health applications. In contrast to the dynamically growing supply and a high affinity of large parts of the population to use health and medical apps, there is a lack of data and methods to assess quality, benefit, and patient safety with health apps, most of them are not yet regulated .This memorandum outlines core questions that should be addressed by future health services research in order to evaluate the impact of health and medical apps on quality of processes and patient outcomes and to take advantage of their potential as new data sources for scientific research.


Asunto(s)
Prestación de Atención de Salud , Investigación sobre Servicios de Salud , Alemania , Humanos , Almacenamiento y Recuperación de la Información , Seguridad del Paciente
8.
Rev Saude Publica ; 53: 87, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31576946

RESUMEN

OBJECTIVE: To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017. METHODS: Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used. RESULTS: A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 - 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 - -0.121), specialized (APC = -0.241, 95%CI -0.74 - -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 - -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 - 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities. CONCLUSIONS: A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.


Asunto(s)
Programas Nacionales de Salud/estadística & datos numéricos , Programas Nacionales de Salud/tendencias , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/tendencias , Investigación sobre Servicios de Salud , Humanos , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/tendencias , Valores de Referencia , Análisis de Regresión , España , Factores de Tiempo
9.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190008, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576984

RESUMEN

OBJECTIVE: To analyze the distribution of health care services for viral hepatitis and reported cases of viral hepatitis according to the health regions of Northern Brazil. METHOD: It is an evaluative, descriptive and quantitative research considering viral hepatitis care services and reported cases in the Northern region of Brazil, using data collected from the National Registry of Health Establishments and the Notifiable Diseases Information System. Descriptive statistics and georeferencing, through software, were used to demonstrate the spatial distribution of services and reported cases. RESULTS: Viral hepatitis health services are distributed in a differentiated way; rapid tests are capillaries in the states; confirmatory tests and treatment are performed in some health regions, with a greater grouping of services in the capitals and their surroundings. Cases were reported across all regions, with areas of higher concentration near services. CONCLUSION: The availability of services can favor access to prevention, diagnosis and monitoring of cases. However, organizational peculiarities of the health system and services highlight fragilities that have repercussions on the access and entirety of viral hepatitis care.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Hepatitis Viral Humana/epidemiología , Brasil/epidemiología , Notificación de Enfermedades/estadística & datos numéricos , Geografía , Investigación sobre Servicios de Salud , Hepatitis Viral Humana/diagnóstico , Humanos , Factores Socioeconómicos , Carga Viral/estadística & datos numéricos
10.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190010, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576986

RESUMEN

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/terapia , Investigación sobre Servicios de Salud/estadística & datos numéricos , Hepatitis C/terapia , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Sífilis Congénita/terapia , Brasil , Infecciones por VIH/epidemiología , Promoción de la Salud/métodos , Promoción de la Salud/estadística & datos numéricos , Hepatitis C/epidemiología , Humanos , Programas Nacionales de Salud , Encuestas y Cuestionarios , Sífilis Congénita/epidemiología
12.
MMWR Morb Mortal Wkly Rep ; 68(39): 851-854, 2019 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-31581162

RESUMEN

Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors.


Asunto(s)
Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Administración de Instituciones de Salud , Fiebre Hemorrágica Ebola/prevención & control , Control de Infecciones/organización & administración , República Democrática del Congo/epidemiología , Investigación sobre Servicios de Salud , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Medición de Riesgo , Uganda
13.
Rev. Ciênc. Plur ; 5(2): 1-15, ago. 2019.
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1021742

RESUMEN

Introdução: O contexto familiar e social influencia nas situações de saúde durante a infância, sendo a orientação familiar um mediador importante entre a família e os profissionais da saúde.Objetivo: avaliar o atributo da orientação familiar sob a ótica dos familiares de crianças inscritas em serviços de puericultura da cidade de Santa Cruz, Rio Grande doNorte. Metodologia: Trata-se de estudo avaliativo, quantitativo, de caráter descritivo, com amostra composta por 186 pais/responsáveis de crianças de 0 à 2 anos dos serviços de puericultura da cidade de Santa Cruz, Rio Grande do Norte, Brasil, no ano de 2016, utilizando um questionário validado no Brasil denominado PCA Tools, versão para crianças. Resultados: Os resultados mostram que os profissionais não conhecem as famílias (48,9%), incluindo os agravos principais (45,7%), entretanto 79,6% afirmaram que sim a respeito dos antecedentes familiares. Para 63,4% eles não sabem sobre os empregos dos familiares, porém estão cientes sobre a dificuldade para obter recursos financeiros para medicação (47,3%). Referente a conhecerem a ideologia sobre o tratamento e autocuidado, 50,5% acreditam que sim.Conclusão: Embora os serviços de saúde da rede da Atenção Primária à Saúde possibilitem maior aproximação com o usuário dos serviços de saúde, bem como em seu contexto familiar e social e tenham sido responsáveis por grandes avanços na saúde pública, ainda se faz necessário implementação de medidas e estratégias para garantir o cumprimento do atributo orientação familiar (AU).


Introduction: The family and social context influences health situations during childhood, with family orientation being an important mediator between family and health professionals.Objective: to evaluate the presence and extension of the family orientation attribute from the perspective of the relatives of children enrolled in childcare services in the city of Santa Cruz, Rio Grande do Norte. Methodology: This is an evaluative, quantitative, descriptive study with a sample composed of 186 parents / guardians of children aged 0 to 2 years of childcare services in the city of Santa Cruz, Rio Grande do Norte, Brazil, in 2016, using a questionnaire validated in Brazil called PCA Tools, version for children.Results: The results show that the professionalsdo not know the families (48.9%), including the main diseases (45.7%); however, 79.6% said yes about the family history. For 63.4%, they do not know about family jobs, but are aware of the difficulty in obtaining financial resources for medication (47.3%). Concerning the ideology about treatment and self-care, 50.5% believe that it is. Conclusion: Although the health services of the Primary Health Care Network make it possible to bring health services closer to the user, as well as to their family and social context and have been responsible for great advances in public health, it is still necessary to implement measures and strategies to ensure compliance with the family orientation attribute (AU).


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Atención Primaria de Salud , Familia , Niño , Salud del Niño , Investigación sobre Servicios de Salud , Padres , Brasil , Epidemiología Descriptiva , Encuestas y Cuestionarios , Interpretación Estadística de Datos
14.
Hautarzt ; 70(11): 875-882, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31560083

RESUMEN

BACKGROUND: Psoriasis, atopic eczema and urticaria are chronic inflammatory skin diseases that are often associated with an impairment of affected individuals and their families. Despite constant progress in therapy of these diseases, affected people often do not consult an office-based dermatologist. OBJECTIVES: The aim of this study was to estimate which proportion of affected individuals with severe forms of these diseases receive treatment by an office-based dermatologist in Bavaria. MATERIALS AND METHODS: All dermatologists listed in the database of the Bavarian Association of Panel Doctors (KVB; Kassenärztliche Vereinigung Bayern; n = 499) were invited to participate in a paper-based cross-sectional study. The stated number of patients by each dermatologist were set in relation with the literature-based 1­year prevalence, as well as data on population and data of the KVB. Estimations were based on three approaches (conservative, medium, and progressive estimation method). RESULTS: Overall, 137 dermatologists participated (38.7% women; mean age: 53.2 ± 8.5 years). Conservative estimation indicated that 56.5% of individuals with moderate to severe psoriasis, 57.3% of individuals with moderate to severe atopic eczema and 71.9% of those suffering from chronic spontaneous urticaria are not seen by an office-based dermatologist. CONCLUSION: Many affected individuals seem not to seek an office-based dermatologist when affected by a severe skin condition. Thus, further and more precise studies to identify, address and minimize barriers to optimal patient care are needed.


Asunto(s)
Dermatitis Atópica , Dermatólogos , Atención Dirigida al Paciente , Enfermedades de la Piel , Urticaria , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Dermatitis Atópica/terapia , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Piel/terapia , Urticaria/terapia
16.
Nervenarzt ; 90(11): 1093-1102, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31482184

RESUMEN

BACKGROUND: Healthcare research in the living environment is focused on the scientific investigation of care, which is delivered in the personal environment of those affected by diseases. OBJECTIVE: Presentation of the healthcare policy starting position, content and evidence of forms of care by which treatment focuses on the living environment of affected persons. Presentation of the RECOVER model, by which these forms of care are integrated and coordinated in a care model. MATERIAL AND METHODS: Literature search on "care or treatment models" and "psychiatric disease" over the last 10 years. RESULTS: Many experts are calling for the introduction of integrated and coordinated care as well as the digitalization of the healthcare system as essential future solutions. Evidence-based forms of care, which have a main focus on the living environment of those concerned, play an important role here. These include, for example early diagnosis and treatment of psychoses (early psychosis services, EPS), crisis resolution team (CRT), assertive community treatment (ACT), supported employment (SE) and e­mental health. With the exception of CRT, which can be financed as a hospital ward equivalent treatment according to §§ 39 and 115d (German Social Code V, SGB V), many of these treatment models are not yet part of standard care in Germany. In an integrated and coordinated care system these components work together in a meaningful and coordinated manner in defined care processes. This approach is currently being tested using the so-called RECOVER model, a severity level, evidence-based and cross-sectoral coordinated care model, where implementation, testing and transfer from 2017-2020 will be promoted by the Innovation Fund of the Joint Federal Committee (G-BA).


Asunto(s)
Servicios Comunitarios de Salud Mental , Investigación sobre Servicios de Salud , Prestación de Atención de Salud , Alemania , Humanos , Trastornos Psicóticos
17.
Psychiatr Danub ; 31(Suppl 3): 371-375, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31488754

RESUMEN

BACKGROUND: In this paper we focus on adolescents in transition towards young adulthood (ATYA). We know from international studies that the transition process makes adolescents vulnerable to mental illness. However, little is known about Belgian ATYA mental-health status. Nor are risk factors associated with their mental illness understood, in particular with regard to depressive and anxiety disorder. The aim of this study is (1) to discuss evolution in time of prevalence of depressive disorder (DD) and anxiety disorder (AD) among Belgian ATYA and (2), to identify risk factors associated with these disorders among ATYA. SUBJECTS AND METHODS: Data was extracted from the Belgian Health Interview Survey (BHIS), which is a cross-sectional population survey, carried out in 2001, 2004, 2008, and 2013. Information about the population's background characteristics, health services utilization, health behaviours and mental health status were extracted and statistically analyzed. RESULTS: ATYA prevalence of DD and AD was higher in 2013 in comparison with previous years. These changes were significant only for DD (F=4.466, p=0.004). In contrast with younger adolescents, among ATYA odds of DD were 28.2% higher (OR 1.282, 95% CI 0.967-1.698, p=0.084) and, odds of AD were 55.2% higher (OR 1.552, 95% CI 1.137-2.119, p=0.006). For ATYA, a poor quality of social support was the most predictive factor of DD (OR 11.187, 95% CI 5.530-22.629, p<0.0001) and AD (OR 6.238, 95% CI 2.845-13.676, p<0.0001); whereas, having a paid job was the most protective factor with regard to DD (OR 0.282, 95% CI 0.169-0.470, p<0.0001) and AD (OR 0.552, 95% CI 0.330-0.924, p<0.024). CONCLUSION: Prevalence of mental illness among Belgian ATYA appears to worsen in time. In comparison with younger adolescents, ATYA are more vulnerable to anxiety disorders. Adverse and protective risk factors were identified and discussed in a way to improve access, continuity and mental healthcare pathways for Belgian ATYA.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Estado de Salud , Salud Mental/estadística & datos numéricos , Adolescente , Bélgica/epidemiología , Estudios Transversales , Empleo/estadística & datos numéricos , Conductas Relacionadas con la Salud , Investigación sobre Servicios de Salud , Humanos , Prevalencia , Factores de Riesgo , Adulto Joven
18.
J Nurs Adm ; 49(10): 496-502, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31517757

RESUMEN

OBJECTIVE: The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND: Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS: This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS: The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION: This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.


Asunto(s)
Recolección de Datos/normas , Investigación sobre Servicios de Salud/organización & administración , Proyectos de Investigación/normas , Terminología como Asunto , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Liderazgo , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
19.
BMJ ; 366: l4563, 2019 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-31405902

RESUMEN

OBJECTIVE: To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP). DESIGN: Retrospective cohort study. SETTING: Hospital stays among Medicare patients for heart failure, acute myocardial infarction, or pneumonia between 1 January 2012 and 1 October 2015. PARTICIPANTS: Medicare fee-for-service patients aged 65 or over. MAIN OUTCOMES: Total hospital revisits within 30 days of discharge after hospital stays for medical conditions targeted by the HRRP, and by type of revisit: treat-and-discharge visit to an emergency department, observation stay (not leading to inpatient readmission), and inpatient readmission. Patient subgroups (age, sex, race) were also evaluated for each type of revisit. RESULTS: Our study cohort included 3 038 740 total index hospital stays from January 2012 to September 2015: 1 357 620 for heart failure, 634 795 for acute myocardial infarction, and 1 046 325 for pneumonia. Counting all revisits after discharge, the total number of hospital revisits per 100 patient discharges for target conditions increased across the study period (monthly increase 0.023 visits per 100 patient discharges (95% confidence interval 0.010 to 0.035)). This change was due to monthly increases in treat-and-discharge visits to an emergency department (0.023 (0.015 to 0.032) and observation stays (0.022 (0.020 to 0.025)), which were only partly offset by declines in readmissions (-0.023 (-0.035 to -0.012)). Increases in observation stay use were more pronounced among non-white patients than white patients. No significant change was seen in mortality within 30 days of discharge for target conditions (-0.0034 (-0.012 to 0.0054)). CONCLUSIONS: In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions. Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.


Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Unidades de Observación Clínica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Investigación sobre Servicios de Salud/métodos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Medicare/estadística & datos numéricos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Alta del Paciente , Readmisión del Paciente/tendencias , Neumonía/epidemiología , Neumonía/terapia , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo , Estados Unidos/epidemiología
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