No abstract

OBJECTIVE:To examine functional status versus medical comorbidities as predictors of acute care readmissions in medically complex patients. DESIGN: Retrospective database study. SETTING: U.S. inpatient rehabilitation facilities. PARTICIPANTS: Subjects included 120,957 patients in the Uniform Data System for Medical Rehabilitation admitted to inpatient rehabilitation facilities under the medically complex impairment group code between 2002 and 2011. INTERVENTIONS: A Basic Model based on gender and functional status was developed using logistic regression to predict the odds of 3-, 7-, and 30-day readmission from inpatient rehabilitation facilities to acute care hospitals. Functional status was measured by the FIM ® motor score. The Basic Model was compared to six other predictive models-three Basic Plus Models that added a comorbidity measure to the Basic Model and three GenderComorbidity Models that included only gender and a comorbidity measure. The three comorbidity measures used were the Elixhauser index, Deyo-Charlson index, and Medicare comorbidity tier system. The c-statistic was the primary measure of model performance. MAIN OUTCOME MEASURES: We investigated 3-, 7-, and 30-day readmission to acute care hospitals from inpatient rehabilitation facilities. RESULTS: Basic Model c-statistics predicting 3-, 7-, and 30-day readmissions were 0.69, 0.64, and 0.65, respectively. The best-performing Basic Plus Model (Basic+Elixhauser) c-statistics were only 0.02 better than the Basic Model, and the best-performing GenderComorbidity Model (Gender+Elixhauser) c-statistics were more than 0.07 worse than the Basic Model. CONCLUSIONS:Readmission models based on functional status consistently outperform models based on medical comorbidities. There is opportunity to improve current national readmission risk models to more accurately predict readmissions by incorporating functional data.

Background. We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Methods. Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs. Results. Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg À1 [0.12]), rocuronium (0.83 mg kg À1 [0.53]) and vecuronium (0.14 mg kg À1 [0.07]). Intraoperative administration of NMBAs was dose-dependently associated with higher risk of 30-day hospital readmission (adjusted odds ratio 1.89 [95% Confidence Interval (CI) 1.26-2.84] for 5th quintile vs 1st quintile; P for trend: P<0.001), prolonged hospital length of stay (adjusted incidence rate ratio [aIRR] 1.20 [95% CI 1.11-1.29]; P for trend: P<0.001) and increased hospital costs (aIRR 1.18 [95% CI 1.13-1.24]; P for trend: P<0.001). Admission type (same-day vs inpatient surgery) significantly modified the risk (interaction term: aOR 1.31 [95% CI 1.05-1.63], P¼0.02), and the adjusted odds of readmission in patients undergoing ambulatory surgical procedures who received high-dose NMBAs vs low-dose NMBAs amounted to 2.61 [95% CI 1.11-6.17], P for trend: P<0.001. Total intraoperative neostigmine dose increased the risk of 30-day readmission (aOR 1.04 [1.0-1.08], P¼0.048). Conclusions. In a retrospective analysis, high doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery.

No abstract

Readmissions are currently used as a marker of hospital performance, with recent financial penalties to hospitals for excessive readmissions. Function-based readmission models outperform models based only on demographics and comorbidities. Readmission risk models would benefit from the inclusion of functional status as a primary predictor.

Sexually transmitted infections (STIs) are a major public health concern that must be addressed with innovative screening methods to supplement traditional approaches. Home-based screening with self-collected urine or vaginal specimens is a highly feasible and acceptable method, and shows promise in improving STI screening rates in both men and women. Home collection kits have been offered in a variety of settings, with results ranging from very modest improvements in screening rates to 100-fold increases beyond the rates observed with clinic-based screening. This article describes and evaluates the effectiveness and limitations of various home screening strategies used for the detection of STIs.

Background Preventing sexually transmitted diseases (STD) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) remains a public health challenge. The U.S. Preventive Services Task Force suggests STD screening among men will likely lead to a decrease in infection rates of women. However, innovative approaches are necessary to increase the traditionally low rates of male screening. The purpose of this study is to compare the acceptability and effectiveness of home-based versus clinic-based urine screening for CT/GC in men. Methods We conducted a randomized clinical trial of 200 men ages 18-45 years who reside in St. Louis, Missouri. Men were enrolled via telephone and randomly assigned to receive a free urine CT/GC screening kit in-person at the research clinic or mailed to a preferred address. Participants completed questionnaires at baseline and 10-12 weeks post-enrollment. The primary outcome was whether a STD screening kit was completed. Results Sixty percent (120/200) completed STD screening. Men assigned to home-based screening were 60% more likely to complete screening compared to clinic-based screening (72% versus 48%, RRadj=1.6, 95% CI, 1.3, 2.00). We identified four cases of CT or GC in the home-based group compared to three cases of CT in the clinic group. Men who completed screening were significantly more likely to be white, younger, and college-educated. Conclusions Home-based screening for CT and GC among men is more acceptable than clinic-based screening and resulted in higher rates of screening completion. Incorporating home-based methods as adjuncts to traditional STD screening options shows promise in improving STD screening rates in men.

Background To provide protection against sexually transmitted infections (STIs) and pregnancy, condoms must be used consistently and correctly. However, a significant proportion of couples in the United States fail to do so. Our objective was to determine the demographic and behavioral correlates of inconsistent and incorrect condom use among sexually active, condom-using women. Methods Analysis of baseline data from a prospective cohort of sexually active, condom-using women in the Contraceptive CHOICE Project (n = 2,087) using self-reported demographic and behavioral characteristics. Poisson regression was used to determine the relative risk of inconsistent and incorrect condom use after adjusting for variables significant in the univariate analysis. Results Inconsistent and incorrect condom use was reported by 41% (n = 847) and 36% (n = 757) of women, respectively. A greater number of unprotected acts was most strongly associated with reporting 10 or more sex acts in the past 30 days, younger age at first intercourse, less perceived partner willingness to use condoms, and lower condom use self-efficacy. Incorrect condom use was associated with reporting 10 or more sex acts in the past 30 days, greater perceived risk for future STIs, and inconsistent condom use. Conclusions Inconsistent and incorrect condom use is common among sexually active women. Targeted educational efforts and prevention strategies should be implemented among women at highest risk for STIs and unintended pregnancies to increase consistent and correct condom use.