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General interest items edited by Janice Flahiff

Single 30-day hospital readmission metric fails to reflect changing risk factors

Single 30-day hospital readmission metric fails to reflect changing risk factors.

wsj-readmissions

From the 3 June 2015 P & T news release

Separate 8-day and 30-day benchmarks would better inform readmission prevention strategies, authors say

A new study from researchers at Beth Israel Deaconess Medical Center suggests that risk factors for readmission change significantly over the course of the 30 days following hospital discharge. Thirty-day hospital readmission rates have become a federal quality metric intended to reflect inpatient quality of care and unnecessary health-care utilization.

Published June 2 in the Annals of Internal Medicine, the research suggests that two distinct 8-day and 30-day readmission rates would serve as better inpatient quality measurements and would better inform readmission prevention strategies.

he authors also noted that other research has shown that hospitals that strictly follow evidence-based care standards do not necessarily have the lowest readmission rates and that readmission rates do not serve as a benchmark for inpatient mortality. Under the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services may reduce payments to acute-care hospitals deemed to have excess readmissions within 30 days of discharge.

The study also found that discharges between 8 a.m. and 12:59 p.m. were associated with lower odds of an early readmission. The authors noted that discharge in the first part of the day likely gave patients and their families more time to access community resources such as pharmacies and social supports, thereby reducing the likelihood of readmission.

The authors also found that social determinants of health are closely tied to readmissions, as they affect how patients access care. They evaluated the effect of barriers to health literacy on readmissions and found that they were associated with both early and late readmissions. A patient’s insurance status was also relevant among those readmitted in the late period; patients with unsupplemented Medicare or Medicaid were more likely to be readmitted 8 or more days after discharge.

“The growing movement toward accountable-care organizations and patient-centered medical homes may prove beneficial in preventing unnecessary hospital readmissions,” Graham said. “Patients discharged from the hospital need support from and teamwork among hospitalists, primary care physicians, nurse practitioners, visiting nurses, pharmacists, and others.”

The authors stressed that both hospital and outpatient settings need systems of care that closely monitor patients as they transition their medical care from the hospital team back to the primary care team. Post-discharge monitoring would better enable a team to make sure patients adhere to the detailed care plan designed by the hospital team, such as taking medications correctly and keeping follow-up appointments.

Source: Beth Israel Deaconess Medical Center; June 2, 2015.

July 21, 2015 Posted by | health care | , , , , , | Leave a comment

[Report] Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010

Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010 

From the January 2015 NCHS Data Brief (US Centers for Disease Control and Prevention)

Key findings Data from the National Hospital Discharge Survey

  • In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges.
  • From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease.
  • The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65–74 (9 per 1,000 population) and 75–84 (23 per 1,000 population).
  • Adults aged 85 and over were less likely than those aged 65–74 and 75–84 to be discharged home and more likely to die in the hospital.

From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65–74 and 75–84.

What percentage of hospital care was provided to adults aged 85 and over?

  • In 2000, adults aged 85 and over accounted for only 2% of the U.S. population but 8% of hospital discharges. In 2010, adults aged 85 and over still accounted for 2% of the U.S. population but accounted for 9% of hospital discharges (Figure 1).

Figure 1. Population, discharges, and days of care, by age: United States, 2000 and 2010

Figure 1 is a horizontal bar chart showing the percentage of the U.S. population, hospital discharges, and days of care by four age groups 2000 and 2010

NOTE: Population is the U.S. civilian noninstitutionalized population.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

  • In 2000 and 2010, adults aged 85 and over accounted for 12% and 14%, respectively, of those aged 65 and over. However, adults aged 85 and over accounted for more than 20% of hospital discharges for those aged 65 and over for both years.
  • Adults aged 85 and over accounted for a disproportionate share of the total days of care, 10% in 2000 and 11% in 2010.

 

Figure 2. Hospitalizations, by age: United States, 2000–2010

Figure 2 is a line graph showing hospitalization rates for five age groups for 2000 through 2010

1Rate of hospitalization exceeds the rate for younger age groups for every year from 2000 through 2010 (p < 0.05).
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

  • From 2000 through 2010, the hospitalization rate for adults aged 85 and over remained significantly higher than the rates for adults under age 65, aged 65–74, and aged 75–84.
  • In 2010, the hospitalization rate for adults aged 85 and over (553 per 1,000 population) was more than five times higher than the rate for adults under 65 (80 per 1,000 population).

 

What were common causes of hospitalization for adults aged 85 and over?

  • In 2010, congestive heart failure (43 per 1,000 population) was the most frequent first-listed diagnosis for adults aged 85 and over, but in 2000 and 2005, pneumonia (51 and 52 per 1,000 population, respectively) was the most common first-listed diagnosis for adults aged 85 and over (Table).
  • Hospitalization rates for congestive heart failure, pneumonia, stroke, and hip fracture decreased from 2000 through 2010 for adults aged 85 and over, and the rates for urinary tract infections and septicemia increased from 2000 through 2010.

 

Table. Common causes of hospitalization for adults aged 85 and over: United States, 2010
First-listed diagnosis 2000 2005 2010 Percent change1 (2000 to 2010)
Rate of hospitalization per 1,000 population
Congestive heart failure 48 47 43 –9.5
Pneumonia 51 52 34 –32.8
Urinary tract infection 19 24 30 +55.9
Septicemia 15 18 28 +84.8
Stroke 37 27 28 –25.0
Hip fracture 28 23 21 –25.4

1Percent change for each diagnosis is significant from 2000 through 2010 (p < 0.05).
NOTE: First-listed diagnosis is considered to be the main cause or reason for the hospitalization. The diagnoses were chosen because they were the top six first-listed diagnoses in 2010.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

How likely were adults aged 85 and over to be hospitalized for injury?

  • The rate of all injuries for adults aged 85 and over (51 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (9 and 23 per 1,000 population, respectively) (Figure 3).
  • The rate of hip fractures for adults aged 85 and over (21 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (2 and 8 per 1,000 population, respectively).
  • The rate of other fractures for adults aged 85 and over (18 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (4 and 10 per 1,000 population, respectively).
  • The rate of other injuries for adults aged 85 and over (12 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (3 and 6 per 1,000 population, respectively).

 

 

More at  http://www.cdc.gov/nchs/data/databriefs/db182.htm

 

January 26, 2015 Posted by | health care, Health Statistics | , , , , , , , , , | Leave a comment

   

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