Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?

Weeks, William B.; Lee, Richard; Wallace, Amy E.; West, Alan N.; Bagian, James P.

doi:10.1111/j.1748-0361.2009.00200.x

Cited by 38 publications

(57 citation statements)

References 26 publications

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“…Because of these geographic and social PRACTICE AND PUBLIC HEALTH POLICY factors, they have less access to both VHA and non-VHA care [45]. Compared to urban veterans, rural veterans have lower quality of life, higher hospital readmission rates, less access to specialty and mental health services, and are vulnerable to urban healthcare regionalization [46][47][48][49][50][51]. In an integrated healthcare system such as the VHA, understanding geographic differences in disease prevalence as well as access to care guide targeting of liver telemedicine initiatives.…”

Section: Understanding Access To Liver Care Geographymentioning

confidence: 99%

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Rongey

Asch

Knight

2011

Behav. Med. Pract. Policy Res.

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The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.

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Section: Understanding Access To Liver Care Geographymentioning

confidence: 99%

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Rongey

Asch

Knight

2011

Behav. Med. Pract. Policy Res.

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“…34 Although SSIs and VTEs, are considered preventable occurrences, the methodology of prevention is more complex in neurosurgical patients, as this cohort is inherently more prone to these complications. 14,21,27,39 With respect to VTE, tumor biology, 31 operation time, 24 and inability to administer prophylactic anticoagulation during surgery due to risk of intracranial hemorrhage may sometimes supersede adequate prevention of this complication. 8 Furthermore, complications that would routinely be managed on an outpatient basis require readmission in this cohort due to the sensitivity of postoperative craniotomy patients.…”

Section: 40mentioning

confidence: 99%

Unplanned readmissions and survival following brain tumor surgery

Dickinson¹,

Carico²,

Nuño³

et al. 2015

JNS

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OBJect Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. MetHODS The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. reSultS Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9-1.0) and patients discharged home (OR 0.21, 95% CI 0.1-0.6) were less likely to get readmitted. cOncluSiOnS An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.http://thejns.org/doi/abs/10.3171/2014.8.JNS1498Key WOrDS unplanned readmission; glioblastoma; complications; functional status; oncology aBBreviatiOnS DVT = deep venous thrombosis; HR = hazard ratio; KPS = Karnofsky Performance Status; LOS = length of hospital stay; PE = pulmonary embolism; SOI = severity of illness; SSI = surgical site infection; UTI = urinary tract infection; VTE = venous thromboembolism.

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“…In the United States, Weeks et al [1] found a 13.9% 30-day readmission rate for musculoskeletal system among older veterans. Among 432 spinal cord injury patients in a Sydney hospital, MSC were the fourth leading cause of 30-day readmission (8%).…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] MSC accounts for half of all sickness absences longer than two weeks in Norway and is the most expensive disease in Sweden [1] and the United States. [3] The direct cost of health service utilisation from MSC, as a percentage of gross national product, was 0.7% in the Netherlands, 1.0% in Canada and 1.2% in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…[3] The direct cost of health service utilisation from MSC, as a percentage of gross national product, was 0.7% in the Netherlands, 1.0% in Canada and 1.2% in the United States. [1] The purpose of this investigation is to explore the relationship between hospitalisation for musculoskeletal malignant neoplasms (MMN) and community socioeconomic status (SES). It is hypothesised that high SES communities have significantly lower age-adjusted MMN hospitalisation rates.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Musculoskeletal malignant neoplasms hospitalisation in Victoria

Ore¹

2015

JER

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The paper describes factors associated with 2,605 hospital admissions for musculoskeletal malignant neoplasms (MMN) over one year. The rates per 10,000 population increased significantly (t=5.3, p<.01) with age, with men (4.5 per 10,000 population, 95% CI 4.1-5.0) at greater risk than women (3.3 per 10,000 population, 95% CI 2.8-3.7). The 30-day readmission rate was 19%, the third highest of all admission categories. The average length of stay was significantly (t=4.5, p<.01) shorter in the metropolitan area (8.2 days) than in rural communities (10.8 days). The age-standardised rates varied inversely (r=-0.28) with socioeconomic status. Communities with high MMN admission rates had high rates of heart failure admissions (r=0.35), alcohol consumption (r=0.34) and receiving Disability Support Pension (r=0.32). There was a significant (t=13.8, p<.001) monthly variability in MMN hospitalisation rates. As a leading cause of hospital readmission and disability, the condition requires closer analysis.

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Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?

Cited by 38 publications

References 26 publications

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Unplanned readmissions and survival following brain tumor surgery

Musculoskeletal malignant neoplasms hospitalisation in Victoria

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