Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure

Phillips, Christopher; Wright, Scott M.; Kern, David E.; Singa, Ramesh M.; Shepperd, Sasha; Rubin, Haya R.

doi:10.1001/jama.291.11.1358

Cited by 763 publications

(571 citation statements)

References 38 publications

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“…Data regarding the effectiveness of pre-and postdischarge interventions have been mixed, but targeting these lower acuity admissions may be more cost-effective than interventions addressing long-term outpatient disease management. [38][39][40][41][42][43][44][45] Primary care access and ED utilization patterns have been examined in multiple studies looking at risk for admission, with varying results. 4,6,12,13,[46][47][48] In our study, self-reported ambulatory care did not differ between the patients with strongly acuity-driven and moderately/weakly acuity-driven admissions.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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BACKGROUND:Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE: To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN: Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS: Non-critically ill adult patients admitted to the hospital (n=297) and the admitting emergency medicine physicians (n=34). MAIN MEASURES: A patient survey assessed nonmedical factors, including primary care access and utilization. A physician survey assessed clinical and nonmedical factors influencing the decision to admit. Based on physician responses, admissions were characterized as Bstrongly acuity-driven,^Bmoderately acuity-driven,ô r Bweakly acuity-driven.^Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS: Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS: Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.KEY WORDS: non-medical factors; hospital admission decision; access to care; care transitions; decision making; emergency medicine; health care delivery; medical decision making; severity of illness; socioeconomic factors; utilization.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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“…Whether a DMP is a cost-effective way to manage these patients is not well established. The studies suggest a DMP may be cost effective or the extra cost associated with a DMP is acceptable (131,(139)(140)(141)(142). In a recent analysis by Whellan et al (143), an interesting concept based on the American system of reimbursement is presented.…”

Section: Acute Decompensated Hf During Pregnancymentioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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“…There were three meta-analyses of randomized trials and one review assessing DMP approaches to HF care (9,(14)(15)(16). Studies included older and younger patients, patients following hospitalization, and the full spectrum of HF, including patients with severe HF.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, DMPs are associated with improved use of evidence-based therapies, including those that use angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and spironolactone. Two meta-analyses (14,15) have demonstrated a mortality benefit with DMPs for patients at high risk for admission and those recently discharged from hospital. A more recent meta-analysis (16) confirmed a reduction in mortality and hospitalizations in HF patients managed through a DMP.…”

mentioning

confidence: 99%

Treating the right patient at the right time: Access to heart failure care

Ross¹,

Howlett²,

Arnold³

et al. 2006

Canadian Journal of Cardiology

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Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure

Cited by 763 publications

References 38 publications

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Treating the right patient at the right time: Access to heart failure care

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