Understanding the Relationship Between Readmission and Quality of Hospital Care in Heart Failure

Gilstrap, Lauren; Joynt, Karen E.

doi:10.1007/s11897-014-0209-5

Cited by 14 publications

(12 citation statements)

References 35 publications

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“…Moreover, readmission rates for HF are increasingly regarded as a quality metric and are being used to define reimbursement rates and penalize underperforming facilities (i.e. readmissionbased financial incentive/disincentive programs) [40] . In the field of UF, some of the studies have evaluated HF-related rehospitalization as a secondary endpoint.…”

Section: Rehospitalizationmentioning

confidence: 99%

Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

Koratala

Kazory²

2016

Blood Purif

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The negative prognostic impact of congestion and worsening renal function in patients with decompensated heart failure (HF) has been widely recognized. As diuretics are thought to provide suboptimal results and are associated with a number of adverse effects, a number of diuretic-sparing therapeutic strategies have been explored. Extracorporeal ultrafiltration (UF) represents an intriguing option that presumably lacks many of the untoward effects of diuretic-based regimens while portending several advantages. However, conflicting data have recently emerged in relation to some of its previously proposed beneficial effects possibly due to counterbalance of the underexplored mechanisms. Herein, the existing literature on the role of UF therapy for management of acute decompensated HF is briefly reviewed with special emphasis on its impact on surrogates of efficacy and safety such as excess fluid removal and renal function. A number of topics relevant to cardiorenal syndrome such as congestion and sodium removal are also discussed.

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Section: Rehospitalizationmentioning

confidence: 99%

Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

Koratala

Kazory²

2016

Blood Purif

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“…However, controversies exist regarding the exact interpretations of the use of acute care services and the correlation with quality of care (7,(11)(12)(13). Health care delivered through the ED can be associated with lower quality of care, higher costs, and lack of coordinated care (14,15).…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Visits after Kidney Transplantation

Schold¹,

Elfadawy

Buccini

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives In 2011, there were approximately 131 million visits to an emergency department in the United States. Emergency department visits have increased over time, far outpacing growth of the general population. There is a paucity of data evaluating emergency department visits among kidney transplant recipients. We sought to evaluate the incidence and risk factors for emergency department visits after initial hospital discharge after transplantation in the United States.Design, setting, participants, & measurements We identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012 using the State Inpatient and Emergency Department Databases included in the Healthcare Cost and Utilization Project. We used multivariable Poisson and Cox proportional hazard models to evaluate adjusted incidence rates and time to emergency department visits after transplantation.Results There were 17,575 emergency department visits over 13,845 follow-up years (overall rate =126.9/100 patient-years; 95% confidence interval, 125.1 to 128.8). The cumulative incidences of emergency department visits at 1, 12, and 24 months were 12%, 40%, and 57%, respectively, with median time =19 months; 48% of emergency department visits led to hospital admission. Risk factors for higher emergency department rates included younger age, women, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and emergency department use before transplant. There was wide variation in emergency department visits by individual transplant center (10th percentile =70.0/100 patient-years; median =124.6/100 patient-years; and 90th percentile =187.4/100 patient-years).Conclusions The majority of kidney transplant recipients will visit an emergency department in the first 2 years post-transplantation, with significant variation by patient characteristics and individual centers. As such, coordination of care through the emergency department is a critical component of post-transplant management, and specific acumen of transplant-related care is needed among emergency department providers. Additional research assessing best processes of care for post-transplant management and health care expenditures and outcomes associated with emergency department visits for transplant recipients are warranted.

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“…It needs to be assessed whether using already existing nephrology resources (e.g., nursing support and disposable supplies) would be financially advantageous by lowering the upfront cost, while still providing the persistent benefits of UF on HFrelated events (47). Finally, financial analyses are further confounded by the fact that readmission rates for HF are increasingly regarded as a quality metric and being used to define reimbursement rates and penalize underperforming facilities (i.e., readmission-based financial incentive/ disincentive programs) (48).…”

Section: Costmentioning

confidence: 99%

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Kazory

2016

CJASN

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Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. In this article, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field. I will discuss the clinical relevance of renal dysfunction and decongestion as two commonly used end points of safety and efficacy in the ultrafiltration trials, with emphasis on the emerging pertinent notions that could challenge our conventional thinking. Finally, a number of practical recommendations (e.g., customization of ultrafiltration rates) are provided for ultrafiltration therapy in the setting of acute decompensated heart failure. Because of a paucity of evidence, universally accepted consensus guidelines cannot yet be generated. As such, when considering ultrafiltration therapy for acute decompensated heart failure, the likely benefits should be carefully balanced against the potential risks for an individual patient. A conceivable implication of the ultrafiltration trials is that collaborative heart failure programs benefiting from nephrology expertise and resources could improve the outcomes and reduce the cost.

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Understanding the Relationship Between Readmission and Quality of Hospital Care in Heart Failure

Cited by 14 publications

References 35 publications

Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

Emergency Department Visits after Kidney Transplantation

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

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