Background: An Institute of Medicine (IOM) report defines six domains of quality of care: safety, patient-centeredness, timeliness, efficiency, effectiveness, and equity. The effect of emergency department (ED) crowding on these domains of quality has not been comprehensively evaluated.
Agency for Healthcare Research and Quality.
Objective Systemic lupus erythematosus (SLE) has among the highest hospital readmission rates among chronic conditions. We sought to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions in SLE. Methods Using hospital discharge databases from 5 geographically dispersed states, we performed a study of all-cause SLE readmissions between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case-mix. Using multi-level mixed-effects logistic regression, we examined factors associated with 30-day readmissions and calculated risk-standardized hospital-level and state-level readmission rates. Results We examined 55,936 hospitalizations among 31,903 patients with SLE. 9,244 (16.5%) hospitalizations resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. Black and Hispanic patients were more likely to be readmitted compared to white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several lupus clinical characteristics, including lupus nephritis, serositis and thrombocytopenia were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. There was also geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida compared to California. Conclusions We found that about 1 in 6 hospitalized patients with SLE were readmitted within 30 days, with higher rates in historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.
Importance Commercial virtual visits are an increasingly popular model of care for the management of common, acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously—via videoconference, telephone, or webchat—to a physician with whom they have no prior relationship. There has been no assessment of whether the care delivered through those websites is similar, or whether quality varies among the sites. Objective To assess the variation in quality of care among virtual visit companies. Design We performed an audit study using trained standardized patients. Setting The standardized patients presented to commercial virtual visit companies with six common, acute illnesses (ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent urinary tract infection). Participants The eight commercial virtual visit websites with the highest web traffic. Main Outcome Measures The primary outcomes were completeness of histories and physical examinations, naming the correct diagnosis (versus an incorrect diagnosis or not naming any diagnosis), and adherence to guidelines of key management decisions. Results Standardized patients completed 599 commercial virtual visits from May 2013 to July 2014. Histories and physical examinations were complete in 69.6% (95% confidence interval [CI], 67.7%-71.6%) of virtual visits, diagnoses were correctly named in 76.5% (CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 54.3% (CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 34.4% to 66.1% across the eight websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (12.8-82.1%) than for streptococcal pharyngitis and low back pain (74.6-96.5%) or ankle pain and recurrent urinary tract infection (3.4-40.4%). There was no statistically significant variation in guideline adherence by mode of communication (video vs. telephone vs. webchat). Conclusions We found significant variation in quality among companies providing virtual visits for management of common acute illnesses. There was more variation in performance for some conditions than for others, but there was no variation by mode of communication.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.