30-Day-or-Sooner Readmissions of Gastrointestinal Medical Oncology Patients Following Cancer Center Inpatient Service Discharge: Characteristics and Preventability

Epstein, Andrew S.; Crosbie, Christopher; Martin, Steven C.; Egan, Barbara; Goring, Tabitha N.; Koo, Douglas J.; Kumar, C. Bala; Salvit, Cori; Capanu, Marinela; Chou, Joanna; Saltz, Leonard B.

doi:10.3810/hp.2014.12.1157

Cited by 11 publications

(7 citation statements)

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“…In three studies senior residents performed the review supervised by a senior physicians [19, 26, 59]. In five studies no information on expertise was reported [40, 49, 52, 56, 60].…”

Section: Resultsmentioning

confidence: 99%

“…Agreement and consensus regarding the preventability was handled differently: a double review of each readmission was performed meaning that both reviewers assessed the preventability of the readmissions and came to a mutual agreement [14, 16, 18, 19, 22, 23, 29–31, 35, 42, 44, 46, 47, 50, 52, 53, 57]. In some cases a team or panel was consulted when mutual agreement on the preventability was not achieved [5, 48, 55, 60]. Two studies could not be allocated to one of these review categories because the review process was not clearly described or because they used a mix of different methods [39, 56].…”

Section: Resultsmentioning

confidence: 99%

“…Agreement was calculated in different ways: the interrater agreement (i.e. kappa coefficient) [15, 16, 23, 30, 40, 42, 50, 52, 53, 60], intrarater reliability [49] or both [36]; other options were the interclass correlation and a concordance coefficient [39, 41] or the percentage of agreement on preventability [25, 33, 37, 43, 48, 55]. A low level of agreement was associated with the presence of multiple conditions; the more difficult it was to disentangle the reason for readmissions, the higher the chance of disagreement between the reviewers [39].…”

Section: Resultsmentioning

confidence: 99%

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How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

Kneepkens

Brouwers

Singotani

et al. 2019

BMC Med Res Methodol

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Background A large number of articles examined the preventability rate of readmissions, but comparison and interpretability of these preventability rates is complicated due to the large heterogeneity of methods that were used. To compare (the implications of) the different methods used to assess the preventability of readmissions by means of medical record review. Methods A literature search was conducted in PUBMED and EMBASE using “readmission” and “avoidability” or “preventability” as key terms. A consensus-based narrative data synthesis was performed to compare and discuss the different methods. Results Abstracts of 2504 unique citations were screened resulting in 48 full text articles which were included in the final analysis. Synthesis led to the identification of a set of important variables on which the studies differed considerably (type of readmissions, sources of information, definition of preventability, cause classification and reviewer process). In 69% of the studies the cause classification and preventability assessment were integrated; meaning specific causes were predefined as preventable or not preventable. The reviewers were most often medical specialist (67%), and 27% of the studies added interview as a source of information. Conclusion A consensus-based standardised approach to assess preventability of readmission is warranted to reduce the unwanted bias in preventability rates. Patient-related and integrated care related factors are potentially underreported in readmission studies. Electronic supplementary material The online version of this article (10.1186/s12874-019-0766-0) contains supplementary material, which is available to authorized users.

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“…In three studies senior residents performed the review supervised by a senior physicians [19, 26, 59]. In five studies no information on expertise was reported [40, 49, 52, 56, 60].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

Kneepkens

Brouwers

Singotani

et al. 2019

BMC Med Res Methodol

View full text Add to dashboard Cite

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“…The increasing literature on preventability of 30-day readmissions suggests that preventable readmissions are rare events, between 8–20% [ 22 – 24 ], and as low as 1% for the most vulnerable patients facing refractory malignancies [ 25 ]. Preventability also appears to decrease within the 30-day window [ 26 , 27 ], leading experts to propose that 3 or 7-day readmissions may be a more appropriate accountability measure for hospitals [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Preventability of early vs. late readmissions in an academic medical center

et al. 2017

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BackgroundIt is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.ObjectiveCompare preventability of hospital readmissions, between an early period [0–7 days post-discharge] and a late period [8–30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.Design, setting, patients120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010MeasuresSum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.ResultsReadmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1–6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].ConclusionsReadmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.

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“…7 As the validity of the readmission metric continues to be debated among different stakeholders, various cancer viders have investigated their own data to understand the nature of readmissions within their institutions. [8][9][10] Several studies have focused on the postsurgical period, which uses readmission outcomes as a quality measure. [11][12][13][14] Predictors of readmission have been investigated as well (eg, patient characteristics and some regional and hospital effects), although there is a lack of consistency across studies.…”

Section: Introductionmentioning

confidence: 99%

Readmission Patterns After GI Cancer Hospitalizations: The Medical Versus Surgical Patient

Manzano

Yang

Zhao

et al. 2018

JOP

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Unplanned readmissions among elderly patients with GI cancer are more common after medical hospitalizations compared with surgical hospitalizations. There are shared risk factors and unique risk factors for these hospitalizations that can inform policy, health care delivery, and interventions to reduce readmissions. Other findings underscore the importance of care coordination and comorbidity management in this patient population.

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30-Day-or-Sooner Readmissions of Gastrointestinal Medical Oncology Patients Following Cancer Center Inpatient Service Discharge: Characteristics and Preventability

Cited by 11 publications

References 0 publications

How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

Preventability of early vs. late readmissions in an academic medical center

Readmission Patterns After GI Cancer Hospitalizations: The Medical Versus Surgical Patient

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