Post-Acute Care — The Next Frontier for Controlling Medicare Spending

Mechanic, Robert E.

doi:10.1056/nejmp1315607

Cited by 206 publications

(186 citation statements)

References 3 publications

Supporting

Mentioning

177

Contrasting

Order By: Relevance

“…A better understanding of the role of post-acute care for individuals with vital sign instabilities at discharge is needed, and will become a more pressing issue with anticipated payment reform measures to encourage greater integration and accountability for outcomes across the entire spectrum of care. 33,[37][38][39] Our study had several strengths. First, our cohort was diverse with respect to hospital type and patient population.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Improving care transitions and reducing 30-day hospital readmissions have become a national priority in the United States (11)(12)(13). Post-acute care use, including services and placement at discharge, is costly and increasing (12).…”

mentioning

confidence: 99%

“…Post-acute care use, including services and placement at discharge, is costly and increasing (12). When combined with 30-day readmissions, the costs of post-acute care may rival the cost of the index hospitalization, highlighting the incentive to integrate acute and post-acute care for high-risk conditions (12,13).…”

mentioning

confidence: 99%

Post–Acute Care Use and Hospital Readmission after Sepsis

et al. 2015

View full text Add to dashboard Cite

Rationale: The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.Objectives: To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods:In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.Measurements and Main Results: Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P , 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P , 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P , 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.Conclusions: Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.

show abstract

“…Because most geriatric rehabilitation is provided after acute hospitalisation of older persons, effective collaboration between hospitals and postacute care settings for the development and performance of integrated care is essential [4][5][6]. Poor organisation of care has a negative impact on health care costs, patient outcomes and patient satisfaction with care [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…This programme was introduced at a time when the health care system was transforming from a typical long-term care government-guided reimbursement system without financial incentive for efficient geriatric rehabilitation, towards a more market-guided bundled payment system. Internationally, bundled payment systems appear to be a strong incentive for collaborating geriatric rehabilitation service organisations with the goal to improve quality of care [6,13].…”

Section: Introductionmentioning

confidence: 99%

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Holstege¹,

Caljouw²,

Zekveld³

et al. 2015

Int J Integr Care

View full text Add to dashboard Cite

Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. This article is published in a peer reviewed section of the International Journal of Integrated Care 1 Study setting: Sixteen skilled nursing facilities. Research and TheoryStudy design: Prospective study, comparing three consecutive cohorts.Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71-85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge.Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients' needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery.Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients' and informal caregivers' perceptions of health service delivery.

show abstract

Post-Acute Care — The Next Frontier for Controlling Medicare Spending

Cited by 206 publications

References 3 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

Post–Acute Care Use and Hospital Readmission after Sepsis

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Contact Info

Product

Resources

About