Patterns of care for readmission after radical cystectomy in New York State and the effect of care fragmentation

Pak, Jamie S.; Lascano, Danny; Kabat, Daniel H.; Finkelstein, Julia B.; RoyChoudhury, Arindam; DeCastro, G. Joel; Gold, William; McKiernan, James M.

doi:10.1016/j.urolonc.2015.06.001

Cited by 21 publications

(9 citation statements)

References 23 publications

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“…Similarly, a hospital-level analysis from New York state also found that although the aggregate 30-day mortality rate was higher at non-index hospitals than index hospitals after radical cystectomy, this elevation was mitigated by adjustment of covariates, including severity of illness and risk of mortality, which both captured all patient refined diagnosis-related group and diagnoses at readmission. 15 Additional examination is warranted to evaluate whether non-index readmissions contribute to higher mortality outside of hospitals independent of reasons for readmission.…”

Section: Discussionmentioning

confidence: 99%

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Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Zheng¹,

Habermann

Shara

et al. 2016

Journal of the American College of Surgeons

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BACKGROUND Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care—readmission to a hospital different from the location of the operation—and evaluates its causes and consequences among patients readmitted after major cancer surgery. STUDY DESIGN We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission. RESULTS Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26–3.06), rural residence (OR = 1.81; 95% CI, 1.61–2.04), and extensive procedures (eg hepatectomy vs proctectomy; OR = 2.77; CI, 2.08–3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03–1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98–1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02–1.32), independent of all covariates. CONCLUSIONS Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.

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Section: Discussionmentioning

confidence: 99%

“…However, the relationship between location and outcomes of readmission remains largely unexplored among cancer patients, with the exception of gastrectomy and radical cystectomy. 15,25 …”

mentioning

confidence: 99%

Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Zheng¹,

Habermann

Shara

et al. 2016

Journal of the American College of Surgeons

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“…For example, while some readmissions can be detected by an office visit (16%), the model showed that detection is increased by an office visit followed by four telephone calls. 29 10 Hu et al, 11 Leow et al, 12 Minnillo et al, 6 Pak et al, 13 Chappidi et al 14 12 Chappidi et al 14,15 Open 6.6 ND Schmid et al 4…”

Section: Cystectomy-specific Readmission Timing Risk Factors and Carmentioning

confidence: 99%

“…Thus, if a readmission is required, reasonable efforts should be made to return the patient to the index hospital if possible, since this may not only decrease care fragmentation, but could also be lifesaving. 8,13 Currently implemented strategies for healthcare improvement and effects on readmissions We must point out that techniques to improve patient care may not directly reduce readmissions yet have a positive influence in other areas of care quality improvement. Both minimally invasive (MI) surgery and enhanced recovery after surgery (ERAS) programs improve patient care in a number of ways, but this does not always translate to a reduction in readmissions.…”

Section: Mis Nd Ndmentioning

confidence: 99%

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Strategies to minimize readmission rates following major urologic surgery

Kukreja

Kamat

2017

Therapeutic Advances in Urology

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Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families. Here, we explore the reasons patients are readmitted, using radical cystectomy as a case study, and means to decrease the incidence of readmissions. Since time to readmission for most major urologic oncology surgeries is within the first 2 weeks after discharge, this time frame is critical for efforts to improve symptom identification and reduce the total number and severity of readmissions. Readmission reduction to zero is unlikely for any major surgery, but with effective coordinated strategies, we must strive to reduce the rates as much as possible, as a means to improve the care continuum for our patients.

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Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review

2019

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INTRODUCTION: Interhospital fragmentation of care occurs when patients are admitted to different, disconnected hospitals. It has been hypothesized that this type of care fragmentation decreases the quality of care received and increases hospital costs and healthcare utilization. This systematic review aims to synthesize the existing literature exploring the association between interhospital fragmentation of care and patient outcomes. METHODS: MEDLINE, the Cochrane Library, EMBASE, and the Science Citation Index were systematically searched for studies published up to April 30, 2018 reporting the association between interhospital fragmentation of care and patient outcomes. We included peerreviewed observational studies conducted in adults that reported measures of association between interhospital care fragmentation and one or more of the following patient outcomes: mortality, hospital length of stay, cost, and subsequent hospital readmission. RESULTS: Seventy-nine full texts were reviewed and 22 met inclusion criteria. Nearly all studies defined fragmentation of care as a readmission to a different hospital than the patient was previously discharged from. The strongest association reported was that between a fragmented readmission and in-hospital or short-term mortality (adjusted odds ratio range 0.95-3.62). Over half of the studies reporting length-of-stay showed longer length of stay in fragmented readmissions. All three studies that investigated healthcare utilization suggested an association between fragmented care and odds of subsequent readmission. The study populations and exposures were too heterogenous to perform a meta-analysis. DISCUSSION: Our review suggests that fragmented hospital readmissions contribute to increased mortality, longer length-of-stay, and increased risk of readmission to the hospital.

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Patterns of care for readmission after radical cystectomy in New York State and the effect of care fragmentation

Cited by 21 publications

References 23 publications

Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Strategies to minimize readmission rates following major urologic surgery

Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review

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