Post-Acute Care Utilization and Quality Among High Risk Medicare Enrollees

2019 ◽  
Vol 20 (3) ◽  
pp. B32
Author(s):  
Shannon Wu ◽  
S. Wu
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Care Utilization ◽  
Acute Care Utilization ◽  
Post Acute Care

Post-Acute Care Utilization and Episode of Care Payments Following Common Elective Operations

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anne P Ehlers ◽  
Ryan Howard ◽  
Yen-ling Lai ◽  
Jennifer F. Waljee ◽  
Lia D. Delaney ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Utilization ◽  
Episode Of Care ◽  
Acute Care Utilization ◽  
Post Acute Care

scholarly journals Racial Differences in Post-Acute Utilization After Hip Fracture in Medicare Beneficiaries With ADRD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 59-59
Author(s):  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Amit Kumar ◽  
Meghan Warren ◽  
Patricia Pohl ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Racial Differences ◽  
Acute Care ◽  
Multinomial Logistic Regression ◽  
Ethnic Disparities ◽  
Inpatient Rehabilitation ◽  
Care Utilization ◽  
Racial Groups ◽  
Acute Care Utilization ◽  
Post Acute Care

Abstract BACKGROUND: The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. OBJECTIVES: To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. METHODS: A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. RESULTS: Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations and improve quality of care and health outcomes.

The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes

2021 ◽  
Author(s):  
Joshua M Liao ◽  
Paula Chatterjee ◽  
Erkuan Wang ◽  
John Connolly ◽  
Jingsan Zhu ◽  
...  
Keyword(s):  
Acute Care ◽  
Low Income ◽  
Safety Net ◽  
Care Utilization ◽  
Difference In Differences ◽  
Bundled Payment ◽  
Hospital Safety ◽  
Percentage Points ◽  
Acute Care Utilization ◽  
Post Acute Care

BACKGROUND: Under Medicare’s Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges. OBJECTIVE: To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes. DESIGN, SETTING, AND PARTICIPANTS: This observational difference-in-differences analysis was conducted in safety net and non–safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011-2016 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. EXPOSURE(S): Hospital BPCI participation and safety net status. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was postdischarge spending. Secondary outcomes included quality and post–acute care utilization measures. RESULTS: Our sample consisted of 803 safety net and 2263 non–safety net hospitals. Safety net hospitals were larger and located in areas with more low-income individuals than non–safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference-in-differences [aDID], $40; 95% CI, –$254 to $335; P = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post–acute care (aDID, 1.06 percentage points; 95% CI, 0.37-1.76; P = .003) and lower discharge home with home health (aDID, –1.15 percentage points; 95% CI, –1.73 to –0.58; P < .001) than BPCI non–safety net hospitals. CONCLUSIONS: Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post–acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.

COPD comorbidity profiles and two-year trajectory of acute and post-acute care utilization

CHEST Journal ◽  
2021 ◽  
Author(s):  
Ernest Shen ◽  
Janet S. Lee ◽  
Richard A. Mularski ◽  
Phillip Crawford ◽  
Alan S. Go ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Utilization ◽  
Acute Care Utilization ◽  
Post Acute Care

Piloting the REDUCE score to decrease acute care utilization.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 252-252
Author(s):  
Valerie Pracilio Csik ◽  
Michael Li ◽  
Lauren Waldman ◽  
Brooke Worster ◽  
Adam F Binder ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Risk Score ◽  
Interdisciplinary Team ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Distress Screening ◽  
Distress Score ◽  
Nurse Navigator ◽  
Acute Care Utilization

252 Background: Emergency department visits and hospitalizations are common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. Efforts to prospectively identify patients at highest risk for this acute care utilization (ACU) are needed. While many risk scoring systems have been developed for this purpose, few have been effectively integrated into clinical practice. We piloted a prospective risk assessment tool using a quality improvement framework. Methods: We utilized our previously published REDUCE score (Reducing ED Utilization in the Cancer Experience) to pilot clinical interventions to reduce ACU using PDSA cycles. Cycle 1 included a chart review and targeted outreach by a nurse navigator to high risk patients identified by REDUCE. Outreach resulted in communication of patient needs to the care team, which may or may not have resulted in additional interventions. Cycle 2 involved initial identification by REDUCE followed by further assessment with a distress screening. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (including supportive medicine physicians, social work, nurses, nurse practitioners) to determine an appropriate intervention. Results: Of the patients in Cycle 1 (N = 138), 26.1% had ACU after outreach by a nurse navigator, while in Cycle 2 (N = 169) 7.1% had ACU after the intervention determined by the interdisciplinary team. The average distress score among all patients in Cycle 2 was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU. We found that combining the risk score with a biopsychosocial screening tool and multidisciplinary team discussion may prove more valuable than the risk score alone, with Cycle 2 findings suggesting that there is a directional correlation between REDUCE score and distress screening results. More work is needed to understand the relative impact of the REDUCE score and the biopsychosocial screening and team discussion on decreasing ACU.

Co-Calibrated Admission Functional Score and Subsequent Post-Acute Care Utilization for Medicare Beneficiaries

2018 ◽  
Vol 99 (10) ◽  
pp. e65
Author(s):  
Chih-Ying (Cynthia) Li ◽  
Amol Karmarkar ◽  
Allen Haas ◽  
Yong-Fang Kuo ◽  
Kenneth Ottenbacher
Keyword(s):  
Acute Care ◽  
Care Utilization ◽  
Functional Score ◽  
Medicare Beneficiaries ◽  
Acute Care Utilization ◽  
Post Acute Care

Can acute care utilization be reduced by a risk score-based intervention alone?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13523-e13523
Author(s):  
Valerie Pracilio Csik ◽  
Adam F Binder ◽  
Nathan Handley ◽  
Michael Li ◽  
Megan Croyle ◽  
...  
Keyword(s):  
High Risk ◽  
Phase I ◽  
Acute Care ◽  
Phase Ii ◽  
Risk Score ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Distress Score ◽  
Risk Patients ◽  
Acute Care Utilization

e13523 Background: Acute care utilization (ACU), encompassing both emergency department visits and hospitalizations, is common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. From a population health perspective, focusing on the highest risk patients is likely to identify the top 5% while the next 30% can be considered rising risk and are likely to need care management support. Many risk scoring systems have been developed, but few have demonstrated effective integration in clinical practice. We sought to evaluate if a risk assessment tool alone was adequate to determine an appropriate patient outreach strategy that results in reduced ACU. Methods: We utilized the REDUCE score (Reducing ED Utilization in the Cancer Experience - see 2020 ASCO Quality Abstract 208) to develop an intervention conducted in two phases. Phase I included a chart review and targeted outreach to high risk patients identified by REDUCE by a nurse navigator. Outreach resulted in communication of patient needs to the care team. Phase II involved initial identification by REDUCE followed by further screening assessment with a distress screen. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (supportive medicine physicians, social work, nurses, nurse practitioners) to determine an intervention. Results: Of the patients in phase I (N = 138), 26.1% had ACU afterward, while in phase II (N = 169) 7.1% had ACU. The average distress score among all patients in the phase II group was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. These findings indicate that there is a directional correlation between REDUCE score and distress screening results. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU, but the significantly less ACU in phase II compared to phase I suggests that the risk score combined with a biopsychosocial screening, such as distress as required by the Commission on Cancer, may prove more valuable than the risk score alone. To identify the most impactful intervention, and to fully understand the implications of a patient’s specific REDUCE score within the high risk category, additional assessment would be beneficial. These preliminary results highlight that directionally correlated measures obtained from a biopsychosocial screening in combination with a risk score gives a more complete picture of patient’s overall risk of ACU.

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