Emergency Department Visits After Hospital Discharge: A Missing Part of the Equation

Rising, Kristin L.; White, Laura F.; Fernandez, William G.; Boutwell, Amy E.

doi:10.1016/j.annemergmed.2013.01.024

Cited by 66 publications

(71 citation statements)

References 4 publications

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“…1 Including emergency department visits in post-discharge acute care use estimates increases utilization rates by as much as onethird. 2,3 Unfortunately, a significant portion of this utilization may be unneeded. We found that approximately onethird of the hospital utilization events following discharge could be avoided with an intervention that improves clinician, patient, and family preparation for care transitions.…”

Section: Introductionmentioning

confidence: 99%

Patient Activation and 30-Day Post-Discharge Hospital Utilization

et al. 2013

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BACKGROUND: Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined. METHODS: A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hospital. Data from 695 Englishspeaking general medical inpatient subjects were analyzed. We used an adapted, eight-item version of the validated Patient Activation Measure (PAM). Total scores were categorized, according to standardized methods, as one of four PAM levels of activation: Level 1 (lowest activation) through Level 4 (highest activation). The primary outcome measure was total 30-day post-discharge hospital utilization, defined as total emergency department (ED) visits plus hospital readmissions including observation stays. Poisson regression was used to control for confounding. RESULTS: Of the 695 subjects, 67 (9.6 %) were PAM Level 1, 123 (17.7 %) were Level 2, 193 (27.8 %) were Level 3, and 312 (44.9 %) were Level 4. Compared with highly activated patients (PAM Level 4), a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation (PAM Level 1, incident rate ratio [IRR] 1.75, 95 % CI,1.18 to 2.60) and (PAM Level 2, IRR 1.50, 95 % CI 1.06 to 2.13). The rate of returning to the hospital among patients at PAM Level 3 was not statistically different than patients with PAM Level 4 (IRR 1.30, 95 % CI, 0.94 to 1.80). The rate ratio for PAM Level 1 was also higher compared with Level 4 for ED use alone (1.68(1.07 to 2.63)) and for hospital readmissions alone (1.93 [1.22 to 3.06]). CONCLUSION: Hospitalized adult medical patients in an urban academic safety net hospital with lower levels of Patient Activation had a higher rate of post-discharge 30-day hospital utilization.

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Section: Introductionmentioning

confidence: 99%

Patient Activation and 30-Day Post-Discharge Hospital Utilization

et al. 2013

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“…Several studies have examined the relationship between inpatient readmission stays and other types of hospital care. Rising and colleagues found that nearly one-quarter of inpatient discharges were followed within 30 days by a visit to the ED, and argued that including these types of visits in a measure of re-hospitalization would enhance opportunities to improve post-hospitalization care (Rising, White, Fernandez, & Boutwell, 2013). In looking for opportunities to improve post-discharge care, a study published by the Dartmouth Atlas Project found large variation in the percentage of patients that had an ED visit within 30 days of an inpatient hospitalization at both the regional and hospital levels (Goodman, Fisher, & Chang, 2011).…”

Section: Introductionmentioning

confidence: 99%

Evaluating Whether Changes in Utilization of Hospital Outpatient Services Contributed to Lower Medicare Readmission Rate

Gerhardt¹,

Yemane²,

Apostle³

et al. 2014

MMRR

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“…This study found further that the 30-day post-discharge ED visit rate varied from a low of 2.2% for patients with an index admission for breast malignancy to a high of 28.3% for patients with an index admission for uncomplicated benign prostatic hypertrophy. A second study based on inpatients who were discharged from a single urban academic hospital found that 23.8% of them returned to the hospital for a treat-and-release ED visit within 30 days (Rising, White, Fernandez, & Boutwell, 2013). (The study authors concluded that postdischarge ED use is likely to be higher than this percentage, however, since patient visits to EDs at other hospitals were not recorded.…”

Section: Introductionmentioning

confidence: 99%