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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 13 of 13 Research Studies Displayed
Pritchard KT, Hong I, Goodwin JS
Association of social behaviors with community discharge in patients with total hip and knee replacement.
The objective of this retrospective cohort study was to understand the association between social determinants of health and community discharge after elective total joint arthroplasty. Social determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. The investigators concluded that their findings demonstrated the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities.
Citation: Pritchard KT, Hong I, Goodwin JS . Association of social behaviors with community discharge in patients with total hip and knee replacement. J Am Med Dir Assoc 2021 Aug;22(8):1735-43.e3. doi: 10.1016/j.jamda.2020.08.021..
Keywords: Orthopedics, Surgery, Hospital Discharge
Schlick CJR, Liu JY, Yang AD
Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection.
Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. The objectives of this study were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator.
AHRQ-funded; HS024516; HS026385.
Citation: Schlick CJR, Liu JY, Yang AD . Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection. J Gastrointest Surg 2020 Jan;24(1):144-54. doi: 10.1007/s11605-019-04354-2..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Blood Clots, Adverse Events, Risk, Hospital Discharge
Hu QL, Livhits MJ, Ko CY MJ, Ko CY
Same-day discharge is not associated with increased readmissions or complications after thyroid operations.
The purpose of this study was to determine whether same-day discharge following thyroid surgery resulted in increased rehospitalization. Data from the American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database was used to identify patients who underwent thyroid resections. Results showed that, in a national cohort of patients undergoing thyroid surgery, same-day discharge was not associated with greater rates of readmission or complications when compared with discharge 1 or 2 days after thyroid surgery.
Citation: Hu QL, Livhits MJ, Ko CY MJ, Ko CY . Same-day discharge is not associated with increased readmissions or complications after thyroid operations. Surgery 2020 Jan;167(1):117-23. doi: 10.1016/j.surg.2019.06.054..
Keywords: Surgery, Ambulatory Care and Surgery, Hospital Readmissions, Hospital Discharge, Adverse Events, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care
Balentine CJ, Kenzik K, Chu DI
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Investigators compared short-term recovery for patients discharged to inpatient rehabilitation versus skilled nursing facilities after gastrointestinal surgery. They found that there was no difference in 30-day readmission rates, but post-discharge mortality was higher for patients discharged to skilled nursing facilities compared to inpatient rehabilitation.
Citation: Balentine CJ, Kenzik K, Chu DI . Planning post-discharge destination for gastrointestinal surgery patients: room for improvement? Am J Surg 2018 Nov;216(5):912-18. doi: 10.1016/j.amjsurg.2018.05.004..
Keywords: Hospital Discharge, Surgery, Digestive Disease and Health, Rehabilitation, Nursing Homes, Quality Improvement, Quality of Care, Transitions of Care
Krishnan N, Li B, Jacobs BL
The fate of radical cystectomy patients after hospital discharge: understanding the black box of the pre-readmission interval.
This study looked at reasons why bladder cancer patients who had undergone radical cystectomy surgery were readmitted to the hospital within 30 days. A retrospective cohort study was conducted for patients from 2005 to 2012. Researchers found that fever or difficulty with eating or maintaining their weight had the highest chance of being readmitted. Patients who had a higher pain tolerance or had noninfectious wounds or urinary concerns were less likely to be readmitted.
Citation: Krishnan N, Li B, Jacobs BL . The fate of radical cystectomy patients after hospital discharge: understanding the black box of the pre-readmission interval. Eur Urol Focus 2018 Sep;4(5):711-17. doi: 10.1016/j.euf.2016.07.004..
Keywords: Adverse Events, Cancer, Hospital Discharge, Hospital Readmissions, Surgery
Chen LM, Acharya Y, Norton EC
Readmission rates and skilled nursing facility utilization after major inpatient surgery.
The purpose of this observational study was to describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. The investigators looked at fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. They concluded that changes in use of postacute care after THR and CABG were not associated with changes in readmission rates in their study.
AHRQ-funded; HS024698; HS020671.
Citation: Chen LM, Acharya Y, Norton EC . Readmission rates and skilled nursing facility utilization after major inpatient surgery. Med Care 2018 Aug;56(8):679-85. doi: 10.1097/mlr.0000000000000941..
Keywords: Hospital Discharge, Hospital Readmissions, Nursing Homes, Surgery
Regenbogen SE, Cain-Nielsen AH, Norton EC
Costs and consequences of early hospital discharge after major inpatient surgery in older adults.
This study evaluated the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. It concluded that early routine postoperative discharge after major inpatient surgery is associated with lower total surgical episode payments. There is no evidence that savings from shorter postsurgical hospitalization are offset by higher postdischarge care spending.
Citation: Regenbogen SE, Cain-Nielsen AH, Norton EC . Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg 2017 May 17;152(5):e170123. doi: 10.1001/jamasurg.2017.0123.
Keywords: Elderly, Surgery, Hospital Discharge, Healthcare Costs, Outcomes
Wiseman JT, Fernandes-Taylor S, Barnes ML
Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery.
This study explored the factors that lead to postdischarge surgical site infections (SSI), investigated the differences between risk factors for in-hospital vs postdischarge SSI, and developed a scoring system to identify patients who might benefit from postdischarge monitoring of their wounds. In a comparative analysis, it found that comorbidities were the primary driver of postdischarge SSI, whereas in-hospital factors (operative time, emergency case status) and complications predicted in-hospital SSI.
Citation: Wiseman JT, Fernandes-Taylor S, Barnes ML . Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg 2015 Oct;62(4):1023-31.e5. doi: 10.1016/j.jvs.2015.04.453..
Keywords: Surgery, Hospital Discharge, Healthcare-Associated Infections (HAIs), Patient Safety, Injuries and Wounds, Adverse Events
Acher AW, LeCaire TJ, Hundt AS
Using human factors and systems engineering to evaluate readmission after complex surgery.
The study objective was to use a human factors and systems engineering approach to understand contributors to surgical readmissions from a patient and provider perspective. Patients and clinician providers identified a number of factors during the transition of care that may have contributed to readmission, including poor patient and caregiver understanding; inadequate discharge preparation for home care; insufficient educational process and materials.
Citation: Acher AW, LeCaire TJ, Hundt AS . Using human factors and systems engineering to evaluate readmission after complex surgery. J Am Coll Surg 2015 Oct;221(4):810-20. doi: 10.1016/j.jamcollsurg.2015.06.014..
Keywords: Surgery, Hospital Readmissions, Hospital Discharge, Transitions of Care, Electronic Health Records (EHRs)
Williams TP, Dimou FM, Adhikari D
Hospital readmission after emergency room visit for cholelithiasis.
This study evaluated the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. It found that the failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy.
Citation: Williams TP, Dimou FM, Adhikari D . Hospital readmission after emergency room visit for cholelithiasis. J Surg Res 2015 Aug;197(2):318-23. doi: 10.1016/j.jss.2015.04.032..
Keywords: Hospital Readmissions, Patient-Centered Outcomes Research, Emergency Department, Hospital Discharge, Surgery
Sanger PC, Hartzler A, Han SM
Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.
This study explored patient experience of surgical site infections (SSI) and openness to a mobile health (mHealth) wound monitoring ‘‘app’’ as a novel solution to address the problem of patient perceptions about barriers experienced while seeking care for post-discharge SSI. It found that patients are dissatisfied with the current standard post-hospitalization care practice and were accepting of the concept of a patient-centered wound monitoring application.
Citation: Sanger PC, Hartzler A, Han SM . Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One 2014 Dec;9(12):e114016. doi: 10.1371/journal.pone.0114016..
Keywords: Surgery, Health Information Technology (HIT), Adverse Events, Patient Experience, Hospital Discharge
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
Citation: Sanger P, Hartzler A, Lober WB . Design considerations for post-acute care mHealth: patient perspectives. AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Gadzinski AJ, Dimick JB, Ye Z
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
This study evaluated discharge practice patterns and use of post-acute care after surgical admissions at critical access hospitals (CAHs). It found that for each of six common surgical procedures, a greater proportion of patients was transferred to another hospital. However, the proportion of patients at CAHs using post-acute care is equal to or less than that of patients treated in non-CAHs.
Citation: Gadzinski AJ, Dimick JB, Ye Z . Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals. JAMA Surg. 2014 Jul;149(7):671-7. doi: 10.1001/jamasurg.2013.5694..
Keywords: Surgery, Critical Care, Hospital Discharge, Quality of Care