Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System

Baecker, Aileen; Meyers, Merry; Koyama, Sandra; Taitano, Maria; Watson, Heather; Machado, Mary T; Nguyen, Huong Q.

doi:10.1001/jamanetworkopen.2020.27410

Cited by 26 publications

(47 citation statements)

References 33 publications

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“…Baseline sociodemographic variables including age, sex, race, body mass index, and tobacco use were included, as well as missed appointments and prior hospitalizations within the year prior to index hospitalization. 7,21 The Elixhauser index and specific comorbidities identified as significant in prior studies were extracted using ICD codes. 3,22 The Elixhauser index is a summative capture of the number of Elixhauser comorbidities present with a higher number indicative of more comorbidities.…”

Section: Co-variatesmentioning

confidence: 99%

Disease-Specific Factors Associated with Readmissions or Mortality After Hospital Discharge in COVID-19 Patients: a Retrospective Cohort Study

et al. 2022

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Background Understanding the implications of disease-specific factors beyond baseline patient characteristics for coronavirus disease 2019 (COVID-19) may allow for identification of indicators for safe hospital discharge. Objective Assess whether disease-specific factors are associated with adverse events post-discharge using a data-driven approach. Design Retrospective cohort study. Setting Fifteen medical centers within Kaiser Permanente Southern California. Participants Adult patients ( n =3508) discharged alive following hospitalization for COVID-19 between 05/01/2020 and 09/30/2020. Interventions None. Main Measures Adverse events defined as all-cause readmission or mortality within 14 days of discharge. Least absolute shrinkage and selection operator (LASSO) was used for variable selection and logistic regression was performed to estimate odds ratio (OR) and 95% confidence interval (CI). Key Results Four variables including age, Elixhauser index, treatment with remdesivir, and symptom duration at discharge were selected by LASSO. Treatment with remdesivir was inversely associated with adverse events (OR: 0.46 [95%CI: 0.36–0.61]), while symptom duration ≤ 10 days was associated with adverse events (OR: 2.27 [95%CI: 1.79–2.87]) in addition to age (OR: 1.02 [95%CI: 1.01–1.03]) and Elixhauser index (OR: 1.15 [95%CI: 1.11–1.20]). A significant interaction between remdesivir and symptom duration was further observed ( p =0.01). The association of remdesivir was stronger among those with symptom duration ≤10 days vs >10 days at discharge (OR: 0.30 [95%CI: 0.19–0.47] vs 0.62 [95%CI: 0.44–0.87]), while the association of symptom duration ≤ 10 days at discharge was weaker among those treated with remdesivir vs those not treated (OR: 1.31 [95%CI: 0.79–2.17] vs 2.71 [95%CI 2.05–3.59]). Conclusions Disease-specific factors including treatment with remdesivir, symptom duration, and their interplay may help guide clinical decision making at time of discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07610-5.

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Section: Co-variatesmentioning

confidence: 99%

Disease-Specific Factors Associated with Readmissions or Mortality After Hospital Discharge in COVID-19 Patients: a Retrospective Cohort Study

et al. 2022

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“…Furthermore, this interaction should not be limited to physicians, but also to other healthcare professionals (i.e. pharmacists, nurses, social workers), achieving a greater comprehensive involvement of the interprofessional team, reducing the risk of adverse events [ 41 , 42 ]. This is even more important during the vulnerable period after the acute event, either hospitalization, visit to the emergency department or the outpatient clinic/day hospital [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Escobar

Palacios

Varela

et al. 2022

BMC Health Serv Res

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Aims To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. Results Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9–27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. Conclusions HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

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“…The period of highest educational need for HF patients who want to know how to obtain a more balanced lifestyle is before discharge from hospital [ 29 , 30 ]. Therefore, to ensure that the patient can safely transition from hospital to home, transition nursing education is needed to advise patients on how to control their lifestyle from different points of view [ 31 , 32 , 33 , 34 ]. This study was conducted to obtain consensus opinions from practical and academic experts in HF to develop educational materials on healthy self-care management when patients transition from hospital to home care using a Delphi survey approach.…”

Section: Discussionmentioning

confidence: 99%

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

Lee

Kim

2022

IJERPH

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Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.

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Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System

Cited by 26 publications

References 33 publications

Disease-Specific Factors Associated with Readmissions or Mortality After Hospital Discharge in COVID-19 Patients: a Retrospective Cohort Study

Disease-Specific Factors Associated with Readmissions or Mortality After Hospital Discharge in COVID-19 Patients: a Retrospective Cohort Study

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

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