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READMISSIONS: Hospital revisits data trends including emergency department visits and observation visits

Although readmissions for target conditions decreased from 2012 to 2015 in the US, total hospital revisits within 30 days of discharge steadily increased over that same period.”

Changes in total 30-day hospital revisits (including emergency department treat-and-discharge visits and observation stays as well as hospital readmissions) were studied for Medicare patients hospitalized with pneumonia, heart failure or acute myocardial infarction from January 2012 to September 2015.  A total of over 3 million original hospitalizations were studied.  Hospital readmissions decreased over the study period, but treat-and-discharge visits and observation stays increased.

Source: Wadhera, R.K., and others. (2019). Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: National retrospective analysis. BMJ. 366.  Click here for free full text:https://www.bmj.com/content/bmj/366/bmj.l4563.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

EMERGENCY: Which patients are likely to benefit the most from emergency care?

…we identified 51 condition groups most sensitive to emergency care, conditions where timely, high-quality emergency care is expected to make an impact on mortality and morbidity.”

A comprehensive list of emergency care sensitive conditions (ECSC) developed by an expert panel to represent adult patient conditions that are most appropriate for emergency care is the focus of this research article.  The conditions were then paired with national ED utilization data.  There were about 16 million (14 percent) of the roughly 114 million total ED visits in 2016 that were considered to be ECSC.  Here are the utilization data for the top 5 most frequent of these ECSC visits:

  • 10.7 percent of all ECSC visits were related to sepsis and SIRS
  •   7.9 percent were related to pneumonia
  •   7.9 percent were related to chronic obstructive pulmonary disease
  •   6.1 percent were related to asthma
  •   5.7 percent were related to heart failure

You can also determine those conditions that are most likely to be admitted after presenting in the ED.  Here are the 5 highest:

  • 94.8 percent of patients with sepsis and SIRS were admitted
  • 88.1 percent with respiratory failure
  • 83.9 percent with femur fractures
  • 80.0 percent with cerebral infarction
  • 79.7 percent with meningitis

Other patient disposition data and median emergency department charges are also included.

Source: Vashi, A.A., and others. (2019, August 7). Identification of emergency care-sensitive conditions and characteristics of emergency department utilization. JAMA Network Open, 2(8).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747479 Posted by AHA Resource Center (312) 422-2003 rc@aha.org

PARKINSON’S: Integrated practice unit (IPU) offers one-stop-shop model of care

The concept of an integrated practice unit (IPU) would offer patients with the same disease – Parkinson’s is explored in this article but the model has broader applicability – a team of specialists with appropriate resources at hand for the care of a complex chronic condition.  Several case examples of providers who are developing this type of care include:

  • ParkinsonNet in The Netherlands
  • Kaiser Permanente
  • Van Andel Research Institute (Grand Rapids, MI) – based on the ParkinsonNet model
  • Cleveland Clinic

The author identifies two components as critical for an IPU: patient-reported outcome measures and focus on value.

Sources: McKee, K. (2019, August 1). Creating “one-stop shop” care for Parkinson’s. NEJM Catalyst. Click here: https://catalyst.nejm.org/one-stop-shop-care-parkinsons/

Kaiser Permanente. Our care model.  Click here:  https://parkinsonscare.kaiserpermanente.org/our-care-model/

Van Andel Institute and ParkinsonNet explore partnership. (2015, June 2). News Release.  Click here: http://www.parkinsonnet.info/news/van-andel-institute-and-parkinsonnet-explore-partnership

Porter, M.E., Teisberg, E.O. (2019, June). Cleveland Clinic: Transformation and growth 2015. HBS Case Collection. Click here:  https://www.hbs.edu/faculty/Pages/item.aspx?num=36929  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

ROBOTICS: What is a social robot for hospitalized kids?

The effect of introducing Huggable, a social robot, to hospitalized children aged 3 to 10 years old at Boston Children’s Hospital was studied.  This cuddly blue interactive bear, small enough to sit on a table top, was studied compared to a tablet-based version of the bear and an old-school plush toy bear.  The pediatric patients who played with Huggable were found to exhibit “greater levels of joyfulness and agreeableness than comparison interventions.”  Huggable is suggested as a promising way to address the emotional needs of hospitalized children.  There is an interesting free 4-minute video interview that accompanies this article.

Source: Logan, D.E., and others. (2019, July). Social robots for hospitalized children. Pediatrics, 144(1).  Click here for video: https://pediatrics.aappublications.org/content/144/1/e20181511?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Click here for abstract: https://pediatrics.aappublications.org/content/144/1/e20181511  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

EMERGENCY: What is an emergency department-based ICU?

In 2015, the University of Michigan Health System created The Joyce and Don Massey Family Foundation Emergency Critical Care Center (EC3), an ICU within the ED of its flagship adult hospital.”

Patient outcomes related to the opening of a new model of intensive care unit that is adjacent to the emergency department of a university hospital (with about 75,000 adult ED visits annually) are described in this scholarly article.  The Joyce and Don Massey Family Foundation Emergency Critical Care Center, known as EC3, at Michigan Medicine (Ann Arbor) is a 7,800-sf unit with nine patient rooms and five resuscitation/trauma bays.  Patients stay in the EC3 for about 9 hours on average.  This new model of care was found to reduce mortality and decrease the rate of admission of ED patients to inpatient intensive care units.

Source: Gunnerson, K.J., and others. (2019, July 24). Association of an emergency department-based intensive care unit with survival and inpatient intensive care unit admissions. JAMA Network Open, 2(7).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738625  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIANS: Cardiovascular surgeons and invasive cardiologists generate the most revenue

The amount of revenue generated by different specialties for the hospitals where they practice is analyzed every three years by Merritt Hawkins, a physician recruiting firm.  New data for 2019 edition show the following specialties to be the highest in revenue generation (these figures are rounded):

  • $3.7 million: Cardiovascular Surgery
  • $3.5 million: Invasive Cardiology
  • $3.4 million: Neurosurgery
  • $3.3 million: Orthopedic surgery
  • $3 million: Gastroenterology

Primary care physicians, as a group, generated about $2.1 million each for their hospitals.  There is also a cost/benefit analysis in this report, which compares the average revenue generated with the average salary for each specialty.

Source: Merritt Hawkins. (2019). 2019 physician inpatient/outpatient revenue survey.  Click here: https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

STROKE: Patients who receive physical therapy (PT) services are less likely to be readmitted

Our findings clearly demonstrate that higher intensity of rehabilitation services in the acute setting has a major impact on downstream outcomes, such as hospital readmission.”

Older patients who have suffered an ischemic stroke are less likely to be readmitted to the hospital within 30 days if they participate in physical therapy while in the hospital for the stroke.  This was a study of nearly 89,000 Medicare fee-for-service patients who were hospitalized nationwide in 2010.  Overall, the 30-day readmission rate was found to be 14 percent.

Source: Kuman, A., Resnik, L., Karmarkar, A., and others. (2019, July). Archives of Physical and Medical Rehabilitation, 100(7), 1218-1225. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599551/pdf/nihms-1013343.pdf   Posted by AHA Resource Center (312) 422-2003, rc@aha.org