Hospital Readmissions Reduction Program

McIlvennan, Colleen K.; Eapen, Zubin J.; Allen, Larry A.

doi:10.1161/circulationaha.114.010270

Cited by 506 publications

(395 citation statements)

References 31 publications

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“…32,33 This practice pattern may have been further reinforced by implementation of Medicare's Hospital Readmission Reduction Program in 2012, which financially penalizes hospitals for high risk-adjusted readmissions, but specifically excludes readmissions from post-acute care facilities. 3,[34][35][36] However, the higher rates of 30-day post-discharge adverse events among those discharged to post-acute care facilities with vital sign instabilities suggests that even with the resources and closer monitoring typically offered in these settings, post-acute care facilities may not be equipped to stabilize and treat patients with vital sign instabilities. Furthermore, an alternate disposition-either prolonged hospitalization or end-of-life care planning, given markedly higher mortality rates-may have been more appropriate for a significant subset of these individuals.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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BACKGROUND: Vital sign instability on discharge could be a clinically objective means of assessing readiness and safety for discharge; however, the association between vital sign instability on discharge and post-hospital outcomes is unclear. OBJECTIVE: To assess the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. DESIGN: Multi-center observational cohort study using electronic health record data. Abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation were assessed within 24 hours of discharge. We used logistic regression adjusted for predictors of 30-day death and readmission. PARTICIPANTS: Adults (≥18 years) with a hospitalization to any medicine service in 2009-2010 at six hospitals (safety-net, community, teaching, and non-teaching) in north Texas. MAIN MEASURES: Death or non-elective readmission within 30 days after discharge. KEY RESULTS: Of 32,835 individuals, 18.7 % were discharged with one or more vital sign instabilities. Overall, 12.8 % of individuals with no instabilities on discharge died or were readmitted, compared to 16.9 % with one instability, 21.2 % with two instabilities, and 26.0 % with three or more instabilities (p < 0.001). The presence of any (≥1) instability was associated with higher risk-adjusted odds of either death or readmission (AOR 1.36, 95 % CI 1.26-1.48), and was more strongly associated with death (AOR 2.31, 95 % CI 1.91-2.79). Individuals with three or more instabilities had nearly fourfold increased odds of death (AOR 3.91, 95 % CI 1.69-9.06) and increased odds of 30-day readmission (AOR 1.36, 95 % 0.81-2.30) compared to individuals with no instabilities. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 % and positive likelihood ratio of 1.8 for 30-day death or readmission. CONCLUSIONS: Vital sign instability on discharge is associated with increased risk-adjusted rates of 30-day mortality and readmission. These simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmissions.

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Section: Discussionmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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“…As a result, these insights fueled both public reporting of 30-day rehospitalization measures and health policy changes that levied payment penalties on hospitals with excessively high rehospitalization rates. 91 These changes, in turn, led to significant decreases in rehospitalization rates. 92 Like all data sources, claims data have limitations.…”

Section: Administrative Claims Datamentioning

confidence: 99%

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Maddox¹,

Albert²,

Borden³

et al. 2017

Circulation

118

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ABSTRACT:The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.H ealth care has never been more complex. Clinicians and patients must make decisions that integrate the continually evolving scientific evidence base with hundreds of individual data points such as patients' vital signs, symptoms, comorbidities, medications, test results, and preferences. Furthermore, once these decisions are made, little information is available about their impact, limiting the ability to learn from and ultimately improve care delivery. This inability of the healthcare system to learn from its operation results in significant inefficiencies, substantial costs, and suboptimal health outcomes.The creation of a learning healthcare system (LHS) can potentially address these issues. The LHS uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery 1,2 (Figure 1). Thus, the LHS enables rapid, iterative learning in which "evidence informs practice, and practice informs evidence." 2 The authors argued that recent advances in information processing and connectivity, healthcare organizational design, and reimbursement policies centered on quality rather than quantity of care provided the necessary tools for the creation of the LHS. Accordingly, they called for systematic redesign of the healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture.

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“…In the USA, there are significant coding, billing and policy level implications because there is a lack of clarity regarding how to categorize T2MI in the International Classification of Diseases and in the Hospital Readmission Reduction Program, 3 where hospitals are financially penalized if they have higher than anticipated risk-standardized 30-day readmission rates for acute MI (AMI).…”

Section: Definitionmentioning

confidence: 99%

Type 2 Myocardial Infarction　― An Evolving Entity ―

McCarthy

Januzzi

Gaggin

2018

Circ J

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Type 2 myocardial infarction (T2MI) refers to myocardial necrosis caused by an imbalance in myocardial oxygen supply and demand and in the absence of acute coronary thrombosis. Despite growing recognition of this entity, there remains little understanding of the pathophysiology and uncertainty over the diagnostic criteria for this subtype of MI. Alarmingly, recent studies suggest that a diagnosis of T2MI pertains a prognosis similar to, if not worse than, type 1 MI. With increasing clinical use of high-sensitivity cardiac troponin assays, the frequency of recognition of T2MI is expected to increase. Yet, there remains a scarcity of prospective studies examining this cohort of patients, let alone randomized clinical trials identifying optimum treatment strategies. Further evaluation of the prevalence, pathophysiology and management of this patient cohort is warranted by the scientific community.

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Hospital Readmissions Reduction Program

Cited by 506 publications

References 31 publications

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Type 2 Myocardial Infarction　― An Evolving Entity ―

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Hospital Readmissions Reduction Program

Cited by 506 publications

References 31 publications

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Type 2 Myocardial Infarction ― An Evolving Entity ―

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Product

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Type 2 Myocardial Infarction　― An Evolving Entity ―