scholarly journals Cost-Effectiveness of a New Internet-Based Monitoring Tool for Neonatal Post-Discharge Home Care

2013 ◽  
Vol 15 (2) ◽  
pp. e38 ◽  
Author(s):  
Valentina Isetta ◽  
Carme Lopez-Agustina ◽  
Esther Lopez-Bernal ◽  
Maribel Amat ◽  
Montserrat Vila ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Home Care ◽  
Monitoring Tool ◽  
Post Discharge ◽  
Discharge Home

Abstract 3763: Impact Of Race And Ethnicity On Stroke Risk Factors And Care: Echocardiographic Risk Stratification And Discharge Disposition

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jessica D Lee ◽  
Bhim Upreti ◽  
John C Pezzullo ◽  
Timea Hodics
Keyword(s):  
Risk Factors ◽  
Home Care ◽  
Race And Ethnicity ◽  
Hispanic Americans ◽  
Retrospective Chart Review ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Healthcare Needs ◽  
Discharge Home ◽  
Chi Square Analysis

Background: Hispanic Americans (HA) and African Americans (AA) are known to have greater incidence of stroke and may have more severe deficits than non-Hispanic whites (NHW). AA and HA are known to have higher incidences of hypertension compared to NHW. Little has been published on the use of echocardiography to determine racial and ethnic distribution of risk factors Recently published information indicates that while minorities have equal access to rehabilitative services, minorities with stroke have longer hospital stays and poorer functional outcomes compared to NHW, leading to potential increased healthcare needs post-discharge. Hypothesis: We hypothesize that HA and AA are more likely than NHW to have evidence of hypertensive pathology on echocardiographic evaluation. We further hypothesize that HA, due to social and cultural differences, are more likely to discharge home and less likely than AA and NHW to utilize skilled nursing facilities (SNF) or long term acute care facilities (LTAC). Methods: We conducted a retrospective chart review of patients at a single institution with a diagnosis of TIA, ischemic or hemorrhagic stroke admitted from January 2004 to January 2007 (N=1480). Demographic information, co-morbid conditions, diagnostic test results, and information regarding discharge were collected. We used descriptive statistics to characterize the groups, and association between ethnicity and echocardiogram evaluation and discharge disposition was tested by Chi-square analysis. Results: TTE and TEE were used equally across ethnic groups. AA had more evidence of hypertensive pathology on echocardiographic imaging compared to NHW and HA (95% vs. 43% and 40%, respectively, p<.001). Unexpectedly, HA were more likely to have potential embolic sources found on echocardiographic studies compared to NHW or AA (68% vs. 38% and 44% respectively, p<.001). HA were less likely to discharge to SNF or LTAC compared to NHW or AA (2% vs. 7% for both NHW and AA, p<.001). There was no difference in the likelihood of discharge to SNF or LTAC between AA and NHW. Conclusions: HA have more embolic sources as a potential cause for stroke compared to either NHW or AA. This may have impact on the diagnostic utilization of TTE and TEE. Hypertensive echochardiographic changes are common in AA, emphasizing the need for primary prevention. HA are more likely to discharge home, rather than to a SNF or LTAC facility. This finding may indicate a need for additional home care services and education regarding home care of stroke patients for this population.

Baby Steps: A Post-Discharge Home Visiting Program By Neonatology Fellows

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 489A-489A
Author(s):  
Janice E. Hobbs ◽  
Jacky M. Jennings ◽  
Megan Tschudy ◽  
Brenda Hussey-Gardner ◽  
Renee Boss
Keyword(s):  
Home Visiting ◽  
Post Discharge ◽  
Discharge Home ◽  
Home Visiting Program

scholarly journals Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e211-e217
Author(s):  
Benjamin Miao ◽  
Monique Miller ◽  
Belinda Lovelace ◽  
Anne Beaubrun ◽  
Kelly McNeil-Posey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Home Care ◽  
Hospital Mortality ◽  
Burden Of Illness ◽  
Bleeding Risk ◽  
Post Discharge ◽  
Out Of Home Care ◽  
Multivariable Regression ◽  
Mean Differences

Abstract Introduction A paucity of contemporary data examining bleeding-related hospitalization outcomes in atrial fibrillation (AF) patients exists. Methods Adults in the Nationwide Readmissions Database (January 2016–November 2016) with AF and hospitalized for intracranial hemorrhage (ICH), gastrointestinal, genitourinary, or other bleeding were identified. Association between bleed types and outcomes were assessed using multivariable regression (gastrointestinal defined as referent) and reported as crude incidences and adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CIs). Results In total, 196,878 index bleeding-related hospitalizations were identified in this AF cohort (CHA2DS2VASc score ≥2 in 95.1%), with 70.8% classified as gastrointestinal. The overall incidences of in-hospital mortality, need for post-discharge out-of-home care, and 30-day readmission were 4.9, 50.8, and 18.2%, respectively. Multivariable regression suggested traumatic and nontraumatic ICHs were associated with higher odds of in-hospital mortality (OR = 3.99, 95% CI = 3.79, 4.19; OR = 13.09, 95% CI = 12.24, 13.99) and need for post-discharge out-of-home care (OR = 2.92, 95% CI = 2.83, 3.01; OR = 2.74, 95% CI = 2.59, 2.90), and increases in mean index hospitalization length-of-stay (8.31 days, 95% CI = 8.03, 8.60, 6.27 days, 95% CI = 5.97, 6.57) versus gastrointestinal bleeding. Genitourinary and other bleeds were associated with lower mortality (OR = 0.37, 95% CI = 0.25, 0.55; OR = 0.59, 95% CI = 0.53, 0.64) and reduced length-of-stays (−2.84 days, 95% CI =  − 2.91, −2.76; −2.06 days, 95% CI =  − 2.11, −2.01) versus gastrointestinal bleeding. Genitourinary bleeds were also associated with a reduced need for post-discharge out-of-home care (OR = 0.86, 95% CI = 0.77, 0.97). Conclusion The burden of bleeding-related hospitalizations was notably driven by relatively rare but severe and life-threatening ICH, and less morbid but more frequent gastrointestinal bleeding. There is need for continued research on bleeding risk factors and mitigation techniques to avoid bleeding-related patient hospitalizations.

Why Do Hospital-Based Occupational Therapists Carry Out Post-Discharge Home Visits with Elderly People?

1993 ◽  
Vol 56 (9) ◽  
pp. 325-329 ◽  
Author(s):  
Jane Hassall
Keyword(s):  
Qualitative Methods ◽  
Elderly People ◽  
Multidisciplinary Team ◽  
Research Question ◽  
Home Visits ◽  
Occupational Therapists ◽  
Multidisciplinary Teams ◽  
Discharge Time ◽  
Post Discharge ◽  
Discharge Home

This study examined why hospital-based occupational therapists carry out post-discharge home visits with elderly people, due to the varying frequency within local practice, and used qualitative methods to answer the research question. The results showed that activities concerned with the provision of equipment were the most frequent and that little time was spent in monitoring or treating the patient after discharge. Time was mentioned as a major factor in not carrying out visits, but in fact most visits took less than half an hour. The study emphasised a significant gap in the service, covering patients' post-discharge needs and treatment sessions in the community, and showed the importance of improving communication between multidisciplinary teams and effective planning before discharge. There is a need in Salford for an occupational therapist to work with elderly people to fill this gap and liaise with the hospital multidisciplinary team about plans for discharge.

Alternatives to Post-Discharge Home Medication Reviews for High-Risk Patients: Doctors' and Pharmacists' Views

2012 ◽  
Vol 42 (4) ◽  
pp. 273-277 ◽  
Author(s):  
Vaishali Padhye ◽  
Anne P Ponniah ◽  
Lisa K Spurling ◽  
Xin Jou Bong ◽  
Sepehr Shakib ◽  
...  
Keyword(s):  
High Risk ◽  
Post Discharge ◽  
High Risk Patients ◽  
Home Medication ◽  
Discharge Home ◽  
Medication Reviews ◽  
Risk Patients

Cost-effectiveness of Investment in End-of-Life Home Care to Enable Death in Community Settings

Medical Care ◽  
2020 ◽  
Vol 58 (8) ◽  
pp. 665-673
Author(s):  
Sarina R. Isenberg ◽  
Peter Tanuseputro ◽  
Sarah Spruin ◽  
Hsien Seow ◽  
Russell Goldman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Home Care ◽  
End Of Life ◽  
Community Settings

scholarly journals Assess the Performance and Cost-Effectiveness of LACE and HOSPITAL Re-Admission Prediction Models as a Risk Management Tool for Home Care Patients: An Evaluation Study of a Medical Center Affiliated Home Care Unit in Taiwan

2020 ◽  
Vol 17 (3) ◽  
pp. 927
Author(s):  
Mei-Chin Su ◽  
Yi-Jen Wang ◽  
Tzeng-Ji Chen ◽  
Shiao-Hui Chiu ◽  
Hsiao-Ting Chang ◽  
...  
Keyword(s):  
Risk Management ◽  
Cost Effectiveness ◽  
Home Care ◽  
Readmission Rate ◽  
Prediction Models ◽  
Medical Center ◽  
Management Tool ◽  
Receiver Operating Curve ◽  
Limited Information ◽  
Net Reclassification Improvement

The LACE index and HOSPITAL score models are the two most commonly used prediction models identifying patients at high risk of readmission with limited information for home care patients. This study compares the effectiveness of these two models in predicting 30-day readmission following acute hospitalization of such patients in Taiwan. A cohort of 57 home care patients were enrolled and followed-up for one year. We compared calibration, discrimination (area under the receiver operating curve, AUC), and net reclassification improvement (NRI) to identify patients at risk of 30-day readmission for both models. Moreover, the cost-effectiveness of the models was evaluated using microsimulation analysis. A total of 22 readmissions occurred after 87 acute hospitalizations during the study period (readmission rate = 25.2%). While the LACE score had poor discrimination (AUC = 0.598, 95% confidence interval (CI) = 0.488–0.702), the HOSPITAL score achieved helpful discrimination (AUC = 0.691, 95% CI = 0.582–0.785). Moreover, the HOSPITAL score had improved the risk prediction in 38.3% of the patients, compared with the LACE index (NRI = 0.383, 95% CI = 0.068–0.697, p = 0.017). Both prediction models effectively reduced readmission rates compared to an attending physician’s model (readmission rate reduction: LACE, 39.2%; HOSPITAL, 43.4%; physician, 10.1%; p < 0.001). The HOSPITAL score provides a better prediction of readmission and has potential as a risk management tool for home care patients.

scholarly journals Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

2020 ◽  
pp. 070674372098013
Author(s):  
Gonzalo Martínez-Alés ◽  
José B. Cruz Rodríguez ◽  
Pablo Lázaro ◽  
Arce Domingo-Relloso ◽  
María Luisa Barrigón ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Suicide Prevention ◽  
Cost Effective ◽  
Cost Data ◽  
Base Case ◽  
Case Scenario ◽  
Post Discharge ◽  
Base Case Scenario ◽  
Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

Feasibility and Timeliness of Alternatives to Post‐Discharge Home Medicines Reviews for High‐Risk Patients

2011 ◽  
Vol 41 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Manya Angley ◽  
Anne P Ponniah ◽  
Lisa K Spurling ◽  
Louise Sheridan ◽  
Des Colley ◽  
...  
Keyword(s):  
High Risk ◽  
Post Discharge ◽  
High Risk Patients ◽  
Discharge Home ◽  
Risk Patients
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