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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
Donnelly JP, Wang XQ, Iwashyna TJ
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
This study describes reasons for readmission, use of intensive care unit (ICU) interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.
Citation: Donnelly JP, Wang XQ, Iwashyna TJ . Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA 2021 Jan 19;325(3):304-06. doi: 10.1001/jama.2020.21465.
Keywords: Respiratory Conditions, COVID-19, Hospital Readmissions, Hospital Discharge, Mortality, Outcomes, Veterans
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
Citation: Paredes AZ, Malik AT, Cluse M . Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis. Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL . Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial. JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE . Return visit admissions may not indicate quality of emergency department care for children. Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes
Holland DE, Brandt C, Targonski PV
Validating performance of a hospital discharge planning decision tool in community hospitals.
The researchers aimed to determine the predictive performance of the Early Screen for Discharge Planning (ESDP) in a rural regional community hospital practice setting. Patients with high ESDP scores reported more problems after discharge, reported lower quality of life, had longer length of stays, and used post-acute care services more than patients with low ESDP scores.
Citation: Holland DE, Brandt C, Targonski PV . Validating performance of a hospital discharge planning decision tool in community hospitals. Prof Case Manag 2017 Sep/Oct;22(5):204-13. doi: 10.1097/ncm.0000000000000233.
Keywords: Decision Making, Hospital Discharge, Outcomes, Rural Health, Tools & Toolkits
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
Wong EG, Parker AM, Leung DG
Association of severity of illness and intensive care unit readmission: a systematic review.
This study sought to determine whether ICU readmission is associated with higher severity of illness scores in adult patients. In most of the 31 studies included in the analysis, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays.
Citation: Wong EG, Parker AM, Leung DG . Association of severity of illness and intensive care unit readmission: a systematic review. Heart Lung 2016 Jan-Feb;45(1):3-9.e2. doi: 10.1016/j.hrtlng.2015.10.040.
Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Hospital Discharge, Outcomes
Gabayan GZ, Derose SF, Chiu VY
Emergency department crowding and outcomes after emergency department discharge.
The researchers assess whether a panel of emergency department (ED) crowding measures, including 2 reported by the Centers for Medicare & Medicaid Services (CMS), is associated with inpatient admission and death within 7 days of ED discharge. Their findings suggest that ED length of stay is a proxy for unmeasured differences in case mix and challenge the validity of the CMS metric as a safety measure for discharged patients.
Citation: Gabayan GZ, Derose SF, Chiu VY . Emergency department crowding and outcomes after emergency department discharge. .
Keywords: Emergency Department, Emergency Medical Services (EMS), Hospital Discharge, Outcomes, Hospitalization
Blecker S, Goldfeld K, Park H
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. The intervention was associated with a reduction in length of stay and an increase in weekend discharges.
Citation: Blecker S, Goldfeld K, Park H . Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study. J Gen Intern Med 2015 Nov;30(11):1657-64. doi: 10.1007/s11606-015-3330-6.
Keywords: Quality Improvement, Quality of Care, Hospitals, Hospital Discharge, Hospital Readmissions, Healthcare Delivery, Outcomes, Patient-Centered Outcomes Research
Gozalo P, Leland NE, Christian TJ
Volume matters: returning home after hip fracture.
This study examined the effect of the relationship between volume (number of hip fracture admissions during the 12 months before participant’s fracture) and other facility characteristics on outcomes. It concluded that in community-dwelling persons with their first hip fracture, successful return to the community varies substantially, according to skilled nursing facility provider volume and staffing characteristics.
Citation: Gozalo P, Leland NE, Christian TJ . Volume matters: returning home after hip fracture. J Am Geriatr Soc 2015 Oct;63(10):2043-51. doi: 10.1111/jgs.13677..
Keywords: Injuries and Wounds, Elderly, Outcomes, Hospital Discharge
Tsilimingras D, Schnipper J, Duke A
Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study.
The researchers aimed to determine the rate of postdischarge adverse events (AEs), classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients. They found that post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable.
Citation: Tsilimingras D, Schnipper J, Duke A . Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study. J Gen Intern Med 2015 Aug;30(8):1164-71. doi: 10.1007/s11606-015-3260-3..
Keywords: Adverse Events, Hospital Discharge, Outcomes, Risk, Rural Health
Hinami K, Smith J, Deamant CD
When do patient-reported outcome measures inform readmission risk?
The study sought was to characterize changes in patient-reported outcome measures from hospital discharge to assess when they best inform risk of utilization as defined by readmissions or emergency department use. It concluded that routine measurement of patient-reported outcomes can help identify patients at higher risk for utilizations. For example, in-hospital assessments revealing high symptom burden and poor health status predicted 14-day reutilization.
Citation: Hinami K, Smith J, Deamant CD . When do patient-reported outcome measures inform readmission risk? J Hosp Med 2015 May;10(5):294-300. doi: 10.1002/jhm.2366..
Keywords: Emergency Department, Healthcare Utilization, Hospital Discharge, Hospital Readmissions, Outcomes
Wagner J, Gabler NB, Ratcliffe SJ
Outcomes among patients discharged from busy intensive care units.
This study of 155 U.S. intensive care units (ICUs) found that when their capacities are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly, and have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected.
Citation: Wagner J, Gabler NB, Ratcliffe SJ . Outcomes among patients discharged from busy intensive care units. Ann Intern Med. 2013 Oct 1;159(7):447-55. doi: 10.7326/0003-4819-159-7-201310010-00004..
Keywords: Intensive Care Unit (ICU), Patient Safety, Outcomes, Hospital Discharge, Mortality