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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Average Cost of a Hospital Stay, Emergency Room Visit, Physician or Dental Office Visit, or Home Care Service

In 2014, the mean cost for a hospital stay was $13,450, with an average out-of-pocket expense of $351. That’s according to Medical Expenditures Panel Survey [MEPS] Household Component data available from the Agency for Healthcare Research and Quality.

An emergency room visit averaged $1,048 in 2014, with $95 of that in out-of-pocket expenses.

A hospital outpatient visit expense averaged $927 with a $54 out-of-pocket cost, while an office-based physician visit totaled $222 with $29 out-of-pocket. The mean out-of pocket expense for a dental visit was $132 of the total visit cost of $295.

Finally, home health care expenses averaged $1,454 per month for those who had the expense during the year.

MEPS data on household medical expenditures is also available for earlier years.

Source: Expenditures per event by health care service type. Medical Expenditures Panel Survey, Household Component summary tables, Agency for Healthcare Research and Quality, accessed Feb. 15, 2017 at https://meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component=1&subcomponent=0&year=-1&tableSeries=9&searchText=&SearchMethod=1&Action=Search

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

READMISSIONS: How to reduce bounce back from SNFs

After an inpatient stay in the hospital, some patients are discharged to skilled nursing facilities (SNFs) for continued recuperation and therapy.  This article summarizes the findings of a literature search of studies on how to avoid bounce back – readmission of these patients from the SNF to the hospital within 30 days.  Learnings about barriers and strategies from the 10 studies are compared in this article.

Source: Mileski, M., and others. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222. Click here for free full text: https://www.dovepress.com/getfile.php?fileID=34598.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBGYN: Providing prenatal care in group visits

The idea of seeing expectant mothers who are at about the same stage of pregnancy together in a group for prenatal care is not new – it was described in the 1990s.  Generally, it is for low-risk patients.  Mazzoni & Carter discuss findings in the literature as to the effectiveness of this approach.  A popular model is called Centering Pregnancy, which is addressed in the other articles cited below.

Selected Sources:

Mazzoni, S.E., and Carter, E.B. (2017, February 9). Group prenatal care. American Journal of Obstetrics and Gynecology.  Click here for the publisher’s website: http://www.ajog.org/article/S0002-9378(17)30185-0/pdf

Crockett, A.H., and others. (2017, January). The South Carolina centering pregnancy expansion project: Improving racial disparities in preterm birth. American Journal of Obstetrics and Gynecology. 216(1 Supplement), S424-S425. Click here for free full text: http://www.ajog.org/article/S0002-9378(16)31441-7/pdf

Carter, E., and others. (2016, January). Group compared to traditional prenatal care for optimizing perinatal outcomes: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 215(1 Supplement), S382.  Click here for free full text: http://www.ajog.org/article/S0002-9378(15)02081-5/pdf

Garretto, D., and Bernstein, P.S. (2014, January). Centering Pregnancy: An innovative approach to prenatal care delivery. American Journal of Obstetrics & Gynecology, 210(1), 14-15.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01039-9/pdf

Fausett, M., and others. (2014, January). Centering Pregnancy is associated with fewer early, but not overall, preterm deliveries. American Journal of Obsetrics & Gynecology, 210(1, Supplement), S9.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01111-3/pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

STROKE: Cleveland Clinic pioneers deep brain stimulation

On December 19, 2016, Dr. Andre Machado, chair of the Neurological Institute at the Cleveland Clinic, performed the first deep brain stimulation procedure on a stroke patient.  This lengthy surgery, part of an ongoing clinical trial, involved implantation of electrodes in the brain that are connected to a pacemaker-like device.  As the patient recovers from the brain surgery, physical therapy will be combined with stimulation of areas of the brain to overcome damage done by the stroke.  A key objective of this groundbreaking surgery is to help stroke patients recover from stroke-induced paralysis.  An estimated 400,000 Americans a year – or half the number of patients who have a stroke each year – end up disabled.

Sources:

Cleveland Clinic performs nation’s first deep brain stimulation for stroke recovery. (2017, January 4). News release. Click here: https://newsroom.clevelandclinic.org/2017/01/04/cleveland-clinic-performs-nations-first-deep-brain-stimulation-stroke-recovery/; and, Sifferlin, A. (2017, January 4). Doctors perform groundbreaking surgery for stroke. Time. Click here: http://time.com/4620618/doctors-perform-groundbreaking-surgery-for-stroke/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITAL BUDGETS: Hospital spending by category 2015

The following data are based on an analysis of the Centers for Medicare and Medicaid Services (CMS) 2015 inpatient market basket update projections.  A base year of 2010 weights were used.

Hospital Spending (by percent)

  • 59.1  Wages and benefits
  • 14.1  Other products (for example, food, medical instruments)
  •   9.1  Professional fees
  •   6.9  Prescription drugs
  •   3.7  All other: labor intensive
  •   3.7  All other: non-labor intensive
  •   2.1  Utilities
  •   1.2  Professional liability insurance

Source: American Hospital Association. (2017, February). The cost of caring. Click here: http://www.aha.org/content/17/costofcaringfactsheet.pdf  Posted by AHA Resource Center (312) 422.2050 rc@aha.org

ED: How to onboard and train staff at a new freestanding emergency department in a large city

Lenox Health-Greenwich Village, a division of Lenox Hill Hospital, was the first freestanding emergency department in New York City.  The facility, which opened July 17, 2014, was designed with 24 fully-equipped patient rooms and 2 more rooms with minimal furnishings for the safe care of behavioral health patients.  These rooms are all large enough to accommodate two patients each if needed.  The utilization for the first 6 months was 12,700 patients and by the end of the first year, over 30,000 were treated.  This article describes in some detail the simulation process and topics used to train staff prior to the opening of the new facility.  The video describes the construction projects that were underway to add ambulatory surgery space on the fourth floor, imaging upgrades to the fifth floor, and physician offices on the sixth.

Sources:

Kerner, R.L., and others. (2016, October). Simulation for operational readiness in a new freestanding emergency department. Simulation in Healthcare, 11(5), 345-356.  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172849/pdf/sih-11-345.pdf

Here is a video about the facility: https://www.northwell.edu/about/news/video/lenox-health-greenwich-village-what-emergency-care-should-be

Posted by AHA Resource Center (312) 422-2050  rc@aha.org