Disease Chronicity and Quality of Care in Hospital Readmissions

McKay,; Mm, Rowe; Fm, Bernt

doi:10.1111/j.1945-1474.1997.tb01177.x

Cited by 9 publications

(8 citation statements)

References 13 publications

(8 reference statements)

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“…The literature demonstrates that hospital readmission because of chronic disease occurs naturally, is not avoidable, but can be decreased or delayed resulting in fewer readmissions within a specified time period (Gautam, Macduff, Brown, & Squair, 1996;McKay, Rowe, & Bernt, 1997). There is no research in Taiwan that examines variables related to COPD readmission, although other studies in Western countries support COPD readmission as an escalating problem (Connors et al, 1996;Kessler, Faller, Fourgaut, Mennecier, & Weitzenblum, 1999;Miravitlles et al, 2000).…”

Section: Readmission Risk Factors In Copdmentioning

confidence: 94%

Factors Related to Chronic Obstructive Pulmonary Disease Readmission in Taiwan

Chen

Narsavage

2006

West J Nurs Res

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This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.

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Section: Readmission Risk Factors In Copdmentioning

confidence: 94%

Factors Related to Chronic Obstructive Pulmonary Disease Readmission in Taiwan

Chen

Narsavage

2006

West J Nurs Res

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“…Clarke 10 Gautam 14 Halfon 23 Kirk 31 Shalchi 38 Williams 9 Ruiz 34 Oddone 16 Phelan 37 Halfon 30 Kelly 13 Kwok 19 MacDowell 7 Maurer 29 Vinson 11 Graham 5 Haines-Wood 15 Jimenez-Puente 28 McInness 8 Stanley 35 Madigan 22 Balla 32 Courtney 26 Frankl 12 Levy 21 McKay 17 Miles 20 Munshi 24 Popplewell 6 Sutton 25 Witherington 36 Experton 18 Friedman 27 Goldfield (Table 4). Error bars = 95% confidence intervals.…”

Section: % Readmissions Deemed Avoidablementioning

confidence: 99%

“…Four studies did not specify the criteria used to classify readmissions, stating that reviewers judged which readmissions were avoidable. 12,17,25,26 Eleven studies described criteria that were subjective, citing few or no qualifiers or guides for reviewers. 6,13,14,16,21,22,24,31,35,37,38 Three studies used criteria that focused exclusively on adverse drug reactions.…”

Section: −38mentioning

confidence: 99%

Proportion of hospital readmissions deemed avoidable: a systematic review

Walraven¹,

Bennett²,

Jennings³

et al. 2011

Canadian Medical Association Journal

604

493

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In most instances, unplanned readmissions to hospital indicate bad health outcomes for patients. Sometimes they are due to a medical error or the provision of suboptimal patient care. Other times, they are unavoidable because they are due to the development of new conditions or the deterioration of refractory, severe chronic conditions.Hospital readmissions are frequently used to gauge patient care. Many organizations use them as a metric for institutional or regional quality of care.1 The widespread public reporting of hospital readmissions and their use in considerations for funding implicitly suggest a belief that readmissions indicate the quality of care provided by particular physicians and institutions.The validity of hospital readmissions as an indicator of quality of care depends on the extent that readmissions are avoidable. As the proportion of readmissions deemed to be avoidable decreases, the effort and expense required to avoid one readmission will increase. This de crease in avoidable admissions will also dilute the relation between the overall readmission rate and quality of care. Therefore, it is important to know the proportion of hospital readmissions that are avoidable.We conducted a systematic review of studies that measured the proportion of readmissions that were avoidable. We examined how such readmissions were measured and estimated their prevalence. Methods Literature searchWe consulted a local information scientist to develop a search strategy to identify studies that measured the proportion of readmissions deemed avoidable (Appendix 1, available at www .cmaj .ca /cgi /content /full /cmaj .101860 /DC1). We applied this strategy to search the MEDLINE and EMBASE databases for English-language papers published from 1966 to July 2010. Fulltext versions of citations were re trieved for complete review if they specified that hospital readmissions were counted; and the title or abstract used any term(s) indicating that re admissions were classified as avoidable (or "preventable,"

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“…No obstante, en parte relacionado con la diferente terminología empleada, también se ha dudado de su utilidad como índi-ce general (6,10), aunque en determinados procesos clínicos (p. ej., insuficiencia cardiaca, asma bronquial) la tasa de reingreso puede identificar problemas en la calidad asistencial (5,7,(11)(12)(13).…”

Section: Discussionunclassified

“…Otros autores sí consideran que el reingreso hospitalario puede ser indicativo de mala calidad de los cuidados hospitalarios, particularmente en algunas enfermedades con alta tasa de recurrencia y cronicidad (11)(12)(13), aumentando el riesgo de reingreso hasta en 55% cuando los cuidados ofrecidos no han sido de suficiente calidad (14,15), siendo la variabilidad clíni-ca en el manejo de un mismo proceso clínico un factor que se asocia con un incremento en la tasa de reingreso (16,17).…”

Section: Introductionunclassified

Reingreso hospitalario en Medicina Interna

Martínez

Díez

Agara

et al. 2001

An. Med. Interna (Madrid)

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RESUMENFundamento: La tasa de reingreso puede ser un índice de calidad asistencial, estando influenciada por múltiples factores(clínicos, derivados del hospital y del propio paciente). Analizamos el reingreso en un área clínica de medicina interna de un hospital de tercer nivel.Material y métodos: Durante 11 meses de 1998 registramos, según un cuestionario estructurado, los reingresos (R) (ingreso en los últimos 5 años) de todos los pacientes ingresados en un área clínica de 8 camas, contabilizando número de ingresos, tiempo hasta el reingreso, área de procedencia (rural, urbana), médico de atención primaria (médico general, especialista en medicina de familia), modo de vida (sólo, familia, residencia, sin techo). Observamos la causa desencadenante del R y la enfermedad causante. Se clasifican como reingreso relacionado (RR) (reingreso por la misma enfermedad o complicación de la misma), multingreso (MR) (reingreso de una misma patología atendida en diferentes servicios del hospital), reingreso evitable (RE) (aquel reingreso que no cumple criterios AEP), y reingreso temprano (RT)(reingreso antes de los 30 dÍas tras el a l t a ) .Resultados: De un total de 312 pacientes (edad media 67,93±15,5, 64% varones, estancia media 7,75±4,35 días, ingresos urgente 93%, tasa de mortalidad 3,52%). Fueron R 111 (35,5%), RR 83 (26% del total y 75% de R), MR 68 (61,2 de R y 82% de RR), RT 33 (39,7% de RR) y 16 RE (19% de RR). No hubo diferencias en edades, sexo ni estancia media.Las enfermedades más frecuentes fueron la insuficiencia cardiaca y las enfermedades respiratorias crónicas. Las causas del R fueron empeoramiento de trastorno crónico 41 (37%), manejo inadecuado ambulatorio 24 (22%), mal diagnóstico previo 8 (7%), efecto tóxico-iatrogenia 7 (6%), nueva enfermedad 29 (36%), otros 2 (2%). El número de ingresos previos era de 3,22±2,25 y el tiempo hasta el reingreso de 8,99±11,96 meses. La tasa de mortalidad intrahospitalaria de los R fue de 7,2% (p<0,05) (intervalo de confianza al 95% de 2 a 9%). Vivir en zona urbana (p<0,05) y tener un médico de familia como médico de atención primaria (p<0,01) fueron factores aceleradores del R.Los pacientes RR presentaban mayor número de ingresos previos (3,53±2,23) (p<0,001) y reingresaron antes (8,03±11,85) (p<0,01) con una tendencia mayor al reingreso en las mujeres (p=0,052). No consultaron con atención primaria 57% de los pacientes (p<0,05)(intervalo de confianza a 95% 3 a 39%). la consulta con atención primaria supuso un retardo en el reingreso de 5 meses (p<0,01) y el manejo ambulatorio inadecuado se asoció a aceleración en el reingreso (p<0,05).Los pacientes MR tenían mayor número de ingresos previos (p<0,001) y eran factores favorecedores la toxicidad-iatrogenia (p<0,05), manejo ambulatorio inadecuado p<0,001) y empeoramiento del trastorno crónico (p<0,001).Los pacientes con RT presentaron mayor mortalidad intrahospitalaria (p<0,05). ABSTRACT Background: The readmission rate could be a valuable tool as measurement of hospital quality. Readmissions are due to several factors: c...

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Disease Chronicity and Quality of Care in Hospital Readmissions

Cited by 9 publications

References 13 publications

Factors Related to Chronic Obstructive Pulmonary Disease Readmission in Taiwan

Factors Related to Chronic Obstructive Pulmonary Disease Readmission in Taiwan

Proportion of hospital readmissions deemed avoidable: a systematic review

Reingreso hospitalario en Medicina Interna

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