Thirty‐Day Hospital Readmissions in a Care Transitions Program for High‐Risk Older Adults

2020 ◽  
Vol 68 (6) ◽  
pp. 1307-1312
Author(s):  
Joseph G. Ouslander ◽  
Bernardo Reyes ◽  
Sanya Diaz ◽  
Gabriella Engstrom
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Hospital Readmissions ◽  
Care Transitions ◽  
Day Hospital

Real-Time Risk Tool for Pharmacy Interventions

2020 ◽  
pp. 001857872097388
Author(s):  
Hanh L. Nguyen ◽  
Kristin S. Alvarez ◽  
Boryana Manz ◽  
Arun Nethi ◽  
Varun Sharma ◽  
...  
Keyword(s):  
High Risk ◽  
Prediction Models ◽  
Risk Model ◽  
Hospital Readmissions ◽  
Group Versus ◽  
Safety Net ◽  
Low Risk ◽  
Day Hospital ◽  
Significant Difference ◽  
Safety Net Hospital

Background: Adverse drug events (ADEs) result in excess hospitalizations. Thorough admission medication histories (AMHs) may prevent ADEs; however, the resources required oftentimes outweigh what is available in large hospital settings. Previous risk prediction models embedded into the Electronic Medical Record (EMR) have been used at hospitals to aid in targeting delivery of scarce resources. Objective: To determine if an AMH scoring tool used to allocate resources can decrease 30-day hospital readmissions. Design, Setting, and Participants: Propensity-matched cohort study, Medicine/Surgery patients in large academic safety-net hospital. Intervention or Exposure: Pharmacy-conducted AMHs identified by risk model versus standard of care AMH. Main Outcomes and Measures: A total of 30-day hospital readmissions and inpatient ADE prevention. Results: The model screened 87 240 hospitalizations between June 2017 and June 2019 and 4027 patients per group were included. There were significantly less 30 day readmissions among high-risk identified patients that received a pharmacy-conducted AMH compared to controls (11% vs 15%; P = 0.004) and no significant difference in readmission rates for low-risk patients. While there was significantly higher documentation of major ADE prevention in the pharmacy-led AMH group versus control (1656 vs 12; P < 0.001), there was no difference in electronically-detected inpatient ADEs between groups. Conclusions: A risk tool embedded into the EMR can be used to identify patients whom pharmacy teams can easily target for AMHs. This study showed significant reductions in readmissions for patients identified as high-risk. However, the same benefit in readmissions was not seen in those identified at low-risk, which supports allocating resources to those that will benefit the most.

Implementation of a Care Transitions Model for Low-Income Older Adults: A High-Risk, Vulnerable Population

2013 ◽  
Vol 61 (6) ◽  
pp. 987-992 ◽  
Author(s):  
Ugochi Ohuabunwa ◽  
Queenie Jordan ◽  
Seema Shah ◽  
Michael Fost ◽  
Jonathan Flacker
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Low Income ◽  
Care Transitions ◽  
Vulnerable Population

Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

2018 ◽  
Vol 33 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Nghi (Andy) Bui ◽  
Mobolaji Adeola ◽  
Rejena Azad ◽  
Joshua T. Swan ◽  
Kathryn S. Agarwal ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Day Hospital ◽  
Practice Experience

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient’s ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

2019 ◽  
Vol 67 (12) ◽  
pp. 2634-2642 ◽  
Author(s):  
Peter J. Huckfeldt ◽  
Bernardo Reyes ◽  
Gabriella Engstrom ◽  
Qingnan Yang ◽  
Sanya Diaz ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Care Transitions ◽  
Hospitalized Older Adults

scholarly journals Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment

2019 ◽  
Author(s):  
Bjorg Thorsteinsdottir ◽  
Stephanie M Peterson ◽  
James N Naessens ◽  
Rozalina G McCoy ◽  
Gregory J Hanson ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
High Risk ◽  
Care Transitions ◽  
Frail Older Adults

scholarly journals Care setting and 30-day hospital readmissions among older adults: a population-based cohort study

2018 ◽  
Vol 190 (38) ◽  
pp. E1124-E1133 ◽  
Author(s):  
Andrea Gruneir ◽  
Kinwah Fung ◽  
Hadas D. Fischer ◽  
Susan E. Bronskill ◽  
Dilzayn Panjwani ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Care Setting ◽  
Hospital Readmissions ◽  
Population Based ◽  
Day Hospital
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