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1.
Am J Med Qual ; 36(2): 84-89, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33830095

RESUMEN

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.


Asunto(s)
/epidemiología , Alta del Paciente/normas , Seguridad del Paciente/normas , Centros Médicos Académicos , Factores de Edad , Protocolos Clínicos , Comorbilidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Medición de Riesgo
2.
BMJ ; 372: n693, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789877

RESUMEN

OBJECTIVE: To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN: Retrospective cohort study. SETTING: NHS hospitals in England. PARTICIPANTS: 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES: Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS: Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS: Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.


Asunto(s)
/complicaciones , Hospitalización/estadística & datos numéricos , Insuficiencia Multiorgánica/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , /mortalidad , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Diabetes Mellitus/epidemiología , Inglaterra/epidemiología , Grupos Étnicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , /aislamiento & purificación
3.
BMC Infect Dis ; 21(1): 315, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794801

RESUMEN

BACKGROUND: The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria. METHOD: A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017-31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models. RESULTS: A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0-84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1-39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16-2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08-1.84), and treatment with diuretics (aSHR 1.51; 1.17-1.94) were independent predictors for readmission. aSHR (1.49, 1.13-1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96-2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors. CONCLUSIONS: More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.


Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Sepsis/patología , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Cohortes , Diuréticos/uso terapéutico , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/patología , Puntuaciones en la Disfunción de Órganos , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
4.
Medicine (Baltimore) ; 100(11): e25222, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726019

RESUMEN

ABSTRACT: The reasons for readmission of children with Hirschsprung disease (HD) are multiple. The study aims to predict the relevant factors for the readmission of children with HD by collecting and analyzing the relevant data of the child's admission to the hospital at the time of surgery.A retrospective review was performed including all patients with surgical treatment of HD at our institution between the years of 2011 to 2020. Univariate and multivariate Logistic regression analysis were performed to obtain the independent risk factor for this study. The receiver operating characteristic curve (ROC) were used to assess the performance of derived models.A total of 162 patients were identified. The average presurgery weights were 6.93 ±â€Š1.78 kg in the readmission group and 8.38 ±â€Š3.17 kg in the non-readmission group. Six children were classified as a low-weight in the readmission group, and 11 children classified as low-weight in the non-readmission group. The length of the intestinal tube after resection was 25.25 ±â€Š15.21 cm in the readmission group, and 16.23 ±â€Š4.10 cm in the non-readmission group. The ROC for the prediction model of readmission after HD surgery (AUC = 0.811).In children undergoing the HD surgery, we showed preoperative low body weight and long intra-operative bowel resection significantly increase the probability of readmission due to complications.


Asunto(s)
Peso Corporal , Enfermedad de Hirschsprung/cirugía , Admisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Área Bajo la Curva , Femenino , Enfermedad de Hirschsprung/fisiopatología , Humanos , Lactante , Modelos Logísticos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Curva ROC , Estudios Retrospectivos , Factores de Riesgo
5.
Medicine (Baltimore) ; 100(10): e25052, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725890

RESUMEN

ABSTRACT: The nurse-led program is associated with a short-term improvement of mental health status (MHS) and quality of life (QOL) in patients with chronic heart failure (CHF). Nonetheless, the long-term effect of this program is undetermined. The aims of the current study were to evaluate the 1-year effects of the nurse-led program on MHS, QOL, and heart failure (HF) rehospitalization among patients with CHF.CHF patients in the control group received standard care, and patients in the treatment group received standard care plus telehealth intervention including inquiring patients' medical condition, providing feedbacks, counseling and providing positive and emotional talk with the patients. At the third, sixth, and twelfth month's follow-up, patients were called by registered nurses to assess the Mental Health Inventory-5 (MHI-5) and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. HF rehospitalization was also assessed.A total of 300 patients were included and 46% (n = 138) of the patients were in the treatment group. There were no significant between-group differences in the MHI-5 and KCCQ scores at baseline. In the control group, the MHI-5 score was gradually decreased with follow-up and the score was significantly lower than that in the treatment group since the third month's follow-up (63.5 ±â€Š10.6 vs 73.6 ±â€Š10.3). Compared with the treatment group, KCCQ score was lower in the control group from the third month's follow-up (64.3 ±â€Š10.6 vs 73.5 ±â€Š12.3) until the end of the twelfth months' follow-up (45.3 ±â€Š11.2 vs 60.8 ±â€Š11.1). During 12 months' follow-up, the proportion of patients who experienced HF rehospitalization was lower in the treatment group (19.6% vs 24.1%). After adjusting for covariates, the utilization of the nurse-led program, and increase of MHI-5 and KCCQ scores were associated with reduced risk of HF rehospitalization.The nurse-led program is beneficial for the improvement of MHS and QOL for CHF patients, which might contribute to the reduction of HF rehospitalization.


Asunto(s)
Estado de Salud , Insuficiencia Cardíaca/terapia , Salud Mental/estadística & datos numéricos , Pautas de la Práctica en Enfermería/organización & administración , Consulta Remota/organización & administración , Adulto , Anciano , Enfermedad Crónica/terapia , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/psicología , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Estudios Prospectivos , Calidad de Vida , Nivel de Atención/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Resultado del Tratamiento
6.
PLoS One ; 16(3): e0249043, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33755715

RESUMEN

BACKGROUND: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. METHODS: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. RESULTS: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. CONCLUSIONS: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.


Asunto(s)
/patología , Enfermedades Cardiovasculares/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Instituciones de Atención Ambulatoria , Enfermedades Cardiovasculares/mortalidad , Bases de Datos Factuales , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Trasplante de Corazón , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
8.
South Med J ; 114(3): 174-179, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33655312

RESUMEN

OBJECTIVES: This study explores sex differences in ischemic stroke hospitalization incidence, 30-day mortality, and 30-day readmission in a southwestern US medical center. METHODS: Ischemic stroke admissions in a regional medical center in the southwestern United States were obtained for a 6.5-year time frame (N = 1968). Logistic regression models examine the adjusted effects of sex on 30-day mortality and 30-day readmission outcomes among individuals hospitalized for ischemic stroke. RESULTS: Findings confirm that although women experience higher mortality than men (9.1% vs 6.7%), the sex disparity in mortality is explained by the age distribution of strokes. Women experience far more strokes and deaths because of stroke at older ages. No differences in principal procedure or 30-day readmission emerged. CONCLUSIONS: Men experienced higher stroke hospitalization incidence, although women exhibited higher 30-day mortality. Age composition explained sex differences in mortality, but higher male stroke hospitalization incidence represents a larger public health issue that suggests the need for behavioral change at the population level. No meaningful sex differences emerged in treatment, mortality, or readmission.


Asunto(s)
Disparidades en el Estado de Salud , Hospitalización/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Factores Sexuales , Accidente Cerebrovascular/mortalidad , Distribución por Edad , Anciano , Femenino , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Sudoeste de Estados Unidos/epidemiología
9.
Orv Hetil ; 162(11): 413-418, 2021 03 14.
Artículo en Húngaro | MEDLINE | ID: mdl-33714939

RESUMEN

Összefoglaló. Bevezetés: Az akut pancreatitis az egyik leggyakoribb kórházi felvételt igénylo gastrointestinalis kórkép. A korai visszavételi arány egyrészt az ellátást jellemzo minoségi mutató, másrészt az akut pancreatitis 1 éves mortalitásának legerosebb prognosztikai faktora. Célkituzés: A korai visszavétel arányának, illetve okainak vizsgálata klinikánkon akut pancreatitis diagnózisával kezelt betegek körében. Módszerek: Retrospektív vizsgálatunkat azon 18 év feletti betegek körében végeztük, akiket a 2010. január és 2018. december közötti idoszakban akut pancreatitis diagnózisával kezeltünk klinikánkon, és az elso emissziótól számítva 30 napon belül újból felvételre kerültek. A betegek adatait az Akut Pancreatitis Regiszter és a betegnyilvántartó rendszer (MedSol ) segítségével gyujtöttük össze. A biliaris, illetve nem biliaris akut pancreatitises eseteket hasonlítottuk össze az epidemiológiai adatok, a visszavétel oka, a visszavételig eltelt átlagos idotartam, és a visszavétel idotartama, valamint kimenetele vonatkozásában. Eredmények: Akut pancreatitis diagnózisával 647 beteg került felvételre. Közülük 28 beteg került újrafelvételre. A leggyakoribb okok között 1) peripancreaticus szövodmények, 2) epés panaszok és 3) az akut pancreatitis kiújulása szerepel. A biliaris és a nem biliaris pancreatitises eseteket összehasonlítva, a visszavétel oka epés panasz volt az elobbi csoport 65,5%-ában és az utóbbi 15%-ában. A középsúlyos pancreatitises esetek száma szignifikánsan magasabbnak adódott a nem biliaris csoportban. Következtetés: A középsúlyos/súlyos pancreatitises esetek aránya magasabb volt a nem biliaris pancreatitises csoportban. Biliaris pancreatitis esetén javasolt index-cholecystectomia végzése. Orv Hetil. 2021; 162(11): 413-418. INTRODUCTION: Acute pancreatitis is the leading cause of hospitalization among gastrointestinal diseases. The early readmission rate is a quality marker and the strongest prognostical factor of 1-year mortality of acute pancreatitis. OBJECTIVE: To investigate the rate and cause of early readmission among patients treated with acute pancreatitis at our clinic. METHODS: Our retrospective study was conducted among patients (>18 years) treated with acute pancreatitis between January 2010 and December 2018 at our clinic, by whom unplanned readmission happened <30 days from emission. Personal data were collected from the Hungarian Pancreas Registry. Data of biliary and non-biliary acute pancreatitis cases were compared concerning epidemiological data, cause of readmission, mean time elapsed until readmission, its duration and outcome. RESULTS: 647 patients were diagnosed with acute pancreatitis. Of them, 28 patients had early readmission. The most common causes were 1) local pancreatic complications, 2) biliary and 3) recurrence of acute pancreatitis. By investigating the biliary and non-biliary pancreatitis cases separately, the cause of readmission was biliary in 65.5% and 15%, respectively. The number of moderately severe pancreatitis cases was significantly higher in the non-biliary group. CONCLUSION: The proportion of moderate/severe diseases was higher in the non-biliary pancreatitis group. In the case of biliary pancreatitis, it is suggested to perform index cholecystectomy. Orv Hetil. 2021; 162(11): 413-418.


Asunto(s)
Pancreatitis , Readmisión del Paciente , Indicadores de Calidad de la Atención de Salud , Enfermedad Aguda , Adulto , Humanos , Hungría , Pancreatitis/terapia , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos
10.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663091

RESUMEN

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Asunto(s)
Hospitales/estadística & datos numéricos , Informática Médica/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales , Humanos , Acceso de los Pacientes a los Registros/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Características de la Residencia , Estudios Retrospectivos , Estados Unidos
11.
Medicine (Baltimore) ; 100(7): e24599, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607793

RESUMEN

BACKGROUND: The European Society of Cardiology guidelines recommend the implementation of nurse-led heart failure programs to achieve optimal management of patients with congestive heart failure (CHF). In this analysis, we aimed to systematically show the impact of nurse-led interventions (NLI) on re-admission and mortality in patients with CHF (reduced ejection fraction). METHODS: Publications reporting the impact of NLI on readmission and mortality in patients with CHF were carefully searched from electronic databases. Rehospitalization and mortality were the endpoints. For this analysis, the latest version of the RevMan software was used. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent data following analysis. RESULTS: A total number of 3282 participants with CHF were included in this analysis. A total of 1571 patients were assigned to the nurse-led intervention group whereas 1711 patients were assigned to the usual care group. The patients had a mean age ranging from 50.8 to 80.3 years. Male patients varied from 27.3% to 73.8%. Comorbidities including hypertension (24.6%-80.0%) and diabetes mellitus (16.7%-59.7%) were also reported. Patients had a mean left ventricular ejection fraction varying from 29.0% to 61.0%. Results of this current analysis showed that rehospitalization (RR: 0.81, 95% CI: 0.74-0.88; P = .00001) and mortality (RR: 0.69, 95% CI: 0.56-0.86; P = .0009) were significantly lower among CHF patients who were assigned to the nurse-led intervention. Whether during a shorter (3-6 months) or a longer (1-2 years) follow up time period, rehospitalization for shorter [(RR: 0.73, 95% CI: 0.65-0.82; P = .00001) vs for longer (RR: 0.81, 95% CI: 0.72-0.91; P = .0003) respectively] and mortality for shorter [(RR: 0.55, 95% CI: 0.38-0.80; P = .002) vs longer follow up time period (RR: 0.76, 95% CI: 0.58-0.99; P = .04) respectively] were significantly lower and in favor of the nurse-led interventional compared to the normal care group. CONCLUSIONS: This systematic review and meta-analysis of randomized controlled trials showed that NLI had significant impacts in reducing the risk of rehospitalization and mortality in these patients with CHF (reduced ejection fraction). Hence, we believe that nurse-led clinics and other interventional programs would be beneficial to patients with heart failure and this practice should, in the future be implemented to the health care system.


Asunto(s)
Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/enfermería , Readmisión del Paciente/estadística & datos numéricos , Humanos
13.
AJR Am J Roentgenol ; 216(4): 975-980, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33534624

RESUMEN

OBJECTIVE. The purpose of this study was to assess feasibility and rate of patients returning to the hospital when a same-day discharge protocol is used for patients undergoing transradial uterine artery embolization (UAE) for symptomatic fibroids. MATERIALS AND METHODS. A total of 374 patients who underwent transradial UAE with a same-day discharge protocol between April 2013 and June 2019, with documented follow-up, were included in this single-health-system retrospective study. Angiographic images and procedural reports were reviewed for technical success (defined as bilateral embolization). Electronic medical records were reviewed for patient and fibroid characteristics, adverse events, clinical success (defined as documented improvement in symptoms or patient satisfaction), and unplanned clinic visits, emergency department visits, and readmissions within 30 days of UAE. Univariate and multivariate analyses were used to identify risk factors for unplanned visits. RESULTS. Eight (2.1%) patients required conversion to inpatient stay (mean length of stay, 1.4 days; range, 1-3 days). The median postprocedure observation time was 3.7 hours (range, 1.1-12.5 hours). Technical success was achieved in 94.7% of patients, with 2.4% requiring crossover to the femoral artery for access. Clinical success was achieved in 86.0% of patients, with 6-month reductions in uterus and dominant leiomyoma volume of 30.4% and 42.9%, respectively. Rates of unplanned clinic visits, emergency department visits, and readmissions were 3.2%, 5.1%, and 0.5%, respectively. Patients with submucosal fibroids or pain as an indication for UAE were significantly more likely to have unplanned visits. CONCLUSION. Transradial UAE for symptomatic fibroids can be performed using a same-day discharge protocol with low rates of patients returning to the hospital. Submucosal location and pain as an indication for UAE were predictors of early return.


Asunto(s)
Atención Ambulatoria/métodos , Embolización de la Arteria Uterina/métodos , Adulto , Atención Ambulatoria/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Embolización de la Arteria Uterina/efectos adversos , Embolización de la Arteria Uterina/estadística & datos numéricos
14.
JAMA Netw Open ; 4(2): e2037320, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33595661

RESUMEN

Importance: The Hospital Readmissions Reduction Program publicly reports and financially penalizes hospitals according to 30-day risk-standardized readmission rates (RSRRs) exclusively among traditional Medicare (TM) beneficiaries but not persons with Medicare Advantage (MA) coverage. Exclusively reporting readmission rates for the TM population may not accurately reflect hospitals' readmission rates for older adults. Objective: To examine how inclusion of MA patients in hospitals' performance is associated with readmission measures and eligibility for financial penalties. Design, Setting, and Participants: This is a retrospective cohort study linking the Medicare Provider Analysis and Review file with the Healthcare Effectiveness Data and Information Set at 4070 US acute care hospitals admitting both TM and MA patients. Participants included patients admitted and discharged alive with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia between 2011 and 2015. Data analyses were conducted between April 1, 2018, and November 20, 2020. Exposures: Admission to an acute care hospital. Main Outcomes and Measures: The outcome was readmission for any reason occurring within 30 days after discharge. Each hospital's 30-day RSRR was computed on the basis of TM, MA, and all patients and estimated changes in hospitals' performance and eligibility for financial penalties after including MA beneficiaries for calculating 30-day RSRRs. Results: There were 748 033 TM patients (mean [SD] age, 76.8 [83] years; 360 692 [48.2%] women) and 295 928 MA patients (mean [SD] age, 77.5 [7.9] years; 137 422 [46.4%] women) hospitalized and discharged alive for AMI; 1 327 551 TM patients (mean [SD] age, 81 [8.3] years; 735 855 [55.4%] women) and 457 341 MA patients (mean [SD] age, 79.8 [8.1] years; 243 503 [53.2%] women) for CHF; and 2 017 020 TM patients (mean [SD] age, 80.7 [8.5] years; 1 097 151 [54.4%] women) and 610 790 MA patients (mean [SD] age, 79.6 [8.2] years; 321 350 [52.6%] women) for pneumonia. The 30-day RSRRs for TM and MA patients were correlated (correlation coefficients, 0.31 for AMI, 0.40 for CHF, and 0.41 for pneumonia) and the TM-based RSRR systematically underestimated the RSRR for all Medicare patients for each condition. Of the 2820 hospitals with 25 or more admissions for at least 1 of the outcomes of AMI, CHF, and pneumonia, 635 (23%) had a change in their penalty status for at least 1 of these conditions after including MA data. Changes in hospital performance and penalty status with the inclusion of MA patients were greater for hospitals in the highest quartile of MA admissions. Conclusions and Relevance: In this cohort study, the inclusion of data from MA patients changed the penalty status of a substantial fraction of US hospitals for at least 1 of 3 reported conditions. This suggests that policy makers should consider including all hospital patients, regardless of insurance status, when assessing hospital quality measures.


Asunto(s)
Hospitales/normas , Readmisión del Paciente/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Centers for Medicare and Medicaid Services, U.S. , Femenino , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Seguro de Salud , Masculino , Medicare , Medicare Part C , Infarto del Miocardio/terapia , Neumonía/terapia , Formulación de Políticas , Ajuste de Riesgo , Estados Unidos
15.
Int J Gynaecol Obstet ; 153(2): 315-321, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33523481

RESUMEN

OBJECTIVE: To evaluate the consequences of COVID-19 pandemic restrictions on the postpartum course. METHODS: A retrospective cross-sectional study compared women who gave birth between March and April 2020 (first wave), between July to September 2020 (second wave), and a matched historical cohort throughout 2017-2019 (groups A, B, and C, respectively). Primary outcomes were postpartum length of stay (LOS), presentations to the emergency department (ED), and readmissions 30 days or longer after discharge. Following Bonferroni correction, p < 0.016 was considered statistically significant. RESULTS: In total, 3377 women were included: 640, 914, and 1823 in groups A, B, and C, respectively. LOS after birth (both vaginal and cesarean) was shorter in groups A and B compared to the control group (2.28 ± 1.01 and 2.25 ± 0.93 vs 2.55 ± 1.10 days, p < 0.001). Rates of ED presentations 30 days after discharge were higher in groups C and B compared to group A (6.63% and 6.45% vs 3.12%, p = 0.006). Rates of readmissions 30 days after discharge were 0.78%, 1.42%, and 1.09% (groups A, B, and C, respectively), demonstrating no statistical difference (p = 0.408). CONCLUSION: During the COVID-19 pandemic, there was a reduction or no change in rates of ED presentations and readmissions, despite the shortened LOS after delivery. A shift in policy regarding the postpartum LOS could be considered.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Israel/epidemiología , Periodo Posparto , Embarazo , Estudios Retrospectivos
16.
Value Health ; 24(2): 147-157, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518021

RESUMEN

OBJECTIVES: Opioid-related medication errors (MEs) can have a significant impact on patient health and contribute to opioid misuse. The objective of this study was to estimate the incidence of and variables associated with the receipt of an opioid prescription and opioid-related MEs (omissions, duplications, or dose changes) at hospital discharge. We also determined rates of adverse drug events and risks of emergency department visits, readmissions, or death 30 days and 90 days post discharge associated with MEs. METHODS: A cohort of hospitalized patients discharged from the McGill University Health Centre between 2014 and 2016 was assembled. The impact of opioid-related MEs was assessed in a propensity score-adjusted logistic regression models. Multivariable logistic regression was used to determine characteristics associated with MEs and discharge opioid prescription. RESULTS: A total of 1530 (43.9%) of 3486 patients were prescribed opioids, of which 13.4% (n = 205) of patients had at least 1 opioid-related ME. Rates of MEs were higher in handwritten prescriptions compared to the electronic reconciliation discharge prescription group (20.6% vs 1.2%). Computer-based prescriptions were associated with a 69% lower risk of opioid-related MEs (adjusted odds ratio: 0.31, 95% confidence interval: 0.14-0.65) as well as 63% lower risk of receiving an opioid prescription. Opioid-related MEs were associated with a 2.3 times increased risk of healthcare utilization in the 30 days postdischarge period (adjusted odds ratio: 2.32, 95% confidence interval: 1.24-4.32). CONCLUSIONS: Opioid-related MEs are common in handwritten discharge prescriptions. Our findings highlight the need for computer-based prescribing platforms and careful review of medications during critical periods of care such as hospital transitions.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Prescripción Electrónica/normas , Errores de Medicación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Continuidad de la Atención al Paciente , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Conciliación de Medicamentos/normas , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Prospectivos
17.
Ann R Coll Surg Engl ; 103(3): 173-179, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33557703

RESUMEN

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.


Asunto(s)
Procedimientos Quirúrgicos Electivos/métodos , Neoplasias/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Tiempo de Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/métodos , Derivación Arteriovenosa Quirúrgica , Cateterismo Cardíaco , Prestación de Atención de Salud/organización & administración , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Histerectomía , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Reino Unido/epidemiología , Procedimientos Quirúrgicos Urológicos , Adulto Joven
18.
Medicine (Baltimore) ; 100(3): e23987, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545989

RESUMEN

ABSTRACT: The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55-0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51-1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51-1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64-1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262-0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Prevención Secundaria/estadística & datos numéricos , Anciano , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Portugal , Estudios Prospectivos , Sistema de Registros , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/prevención & control , Resultado del Tratamiento
19.
Med J Aust ; 214(5): 212-217, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33580553

RESUMEN

OBJECTIVE: To investigate whether integrating pharmacists into general practices reduces the number of unplanned re-admissions of patients recently discharged from hospital. DESIGN, SETTING: Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. PARTICIPANTS: Adults discharged from one of seven study hospitals during the seven days preceding recruitment (22 May 2017 - 14 March 2018) and prescribed five or more long term medicines, or having a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease. INTERVENTION: Comprehensive face-to-face medicine management consultation with an integrated practice pharmacist within seven days of discharge, followed by a consultation with their general practitioner and further pharmacist consultations as needed. MAJOR OUTCOMES: Rates of unplanned, all-cause hospital re-admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. RESULTS: By 12 months, there had been 282 re-admissions among 177 control patients (incidence rate [IR], 1.65 per person-year) and 136 among 129 intervention patients (IR, 1.09 per person-year; fully adjusted IR ratio [IRR], 0.79; 95% CI, 0.52-1.18). ED presentation incidence (fully adjusted IRR, 0.46; 95% CI, 0.22-0.94) and combined re-admission and ED presentation incidence (fully adjusted IRR, 0.69; 95% CI, 0.48-0.99) were significantly lower for intervention patients. The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit-cost ratio of 31:1. CONCLUSION: A collaborative pharmacist-GP model of post-hospital discharge medicines management can reduce the incidence of hospital re-admissions and ED presentations, achieving substantial cost savings to the health system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).


Asunto(s)
Médicos Generales , Modelos Organizacionales , Readmisión del Paciente/estadística & datos numéricos , Farmacéuticos , Corporaciones Profesionales/organización & administración , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Conciliación de Medicamentos , Persona de Mediana Edad , Atención Primaria de Salud/normas , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Calidad de Vida , Queensland
20.
J Gen Intern Med ; 36(3): 722-729, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33443699

RESUMEN

BACKGROUND: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. OBJECTIVE: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. DESIGN: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73). LIMITATIONS: Single-center study; assignment to remote monitoring was not randomized. CONCLUSIONS: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
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