Hospital at Home: An Evolving Model for Comprehensive Healthcare.

Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.

Thirty-Day readmissions among COVID-19 patients hospitalized during the early pandemic in the United States: Insights from the Nationwide Readmissions Database.

BACKGROUND: Hospital readmissions are core indicators of the quality of health care provision. OBJECTIVE: To understand factors associated with 30-day, all-cause hospital readmission rate for patients with COVID-19 in the United States during the early pandemic by utilizing the Nationwide Readmissions Database. METHODS: This retrospective study characterized the 30-day, all-cause hospital readmission rate for patients with COVID-19 in the United States during the early pandemic by utilizing the Nationwide Readmissions Database. RESULTS: The 30-day, all-cause hospital readmission rate in this population was 3.2%. We found the most common diagnoses at readmission to be sepsis, acute kidney injury, and pneumonia. Chronic alcoholic liver cirrhosis and congestive heart failure were prominent predictors of readmission among patients with COVID-19. Moreover, we found that younger patients and patients from economically disadvantaged backgrounds were at higher risk of 30-day readmission. Acute complications during index hospitalization, including acute coronary syndrome, congestive heart failure, acute kidney injury, mechanical ventilation, and renal replacement therapy, also increased the risk of 30-day readmission for patients with COVID-19. CONCLUSION: Based on the results of our study, we advise clinicians to promptly recognize patients with COVID-19 who are at high risk of readmission, and to subsequently manage their underlying comorbidities, to institute timely discharge planning, and to allocate resources to underprivileged patients in order to decrease the risk of 30-day hospital readmissions.

A nationwide study of liver disease hospitalizations during the coronavirus pandemic in the United States.

BACKGROUND AND AIM: The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. METHODS: Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related complications including cirrhosis, alcohol-associated liver disease (ALD) and alcoholic hepatitis using regression modeling. We reported relative change (RC) in the study period. RESULTS: Decompensated cirrhosis hospitalizations decreased in 2020 compared with 2019 (RC: -2.7%, P < 0.001) while all-cause mortality increased by 15.5% (P < 0.001). Hospitalizations for ALD increased compared with pre-pandemic years (RC: 9.2%, P < 0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, P = 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID-19 was higher among patients with decompensated cirrhosis (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] [1.53-1.94]), Native Americans (OR 1.76, 95% CI [1.53-2.02]), and patients from lower socioeconomic groups. CONCLUSIONS: Cirrhosis hospitalizations decreased in 2020 compared with pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic. In-hospital COVID-19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.

Evaluation, Description and Magnitude of Readmission Phenomenon in Azienda Ospedaliero Universitaria Pisana (AOUP) for Chronic-Degenerative Diseases in the Period 2018-2021.

BACKGROUND: Readmissions are hospitalizations following a previous hospitalization (called index hospitalization) of the same patient that occurred in the same facility or nursing home. They may be a consequence of the progression of the natural history of a disease, but they may also reveal a previous suboptimal stay, or ineffective management of the underlying clinical condition. Preventing avoidable readmissions has the potential to improve both a patient's quality of life, by avoiding exposure to the risks of re-hospitalization, and the financial well-being of health care systems. METHODS: We investigated the magnitude of 30 day repeat hospitalizations for the same Major Diagnostic Category (MDC) in the Azienda Ospedaliero Universitaria Pisana (AOUP) over the period from 2018 to 2021. Records were divided into only admissions, index admissions and repeated admission. The length of the stay of all groups was compared using analysis of variance and subsequent multi-comparison tests. RESULTS: Results showed a reduction in readmissions over the period examined (from 5.36% in 2018 to 4.46% in 2021), likely due to reduced access to care during the COVID-19 pandemic. We also observed that readmissions predominantly affect the male sex, older age groups, and patients with medical Diagnosis Related Groups (DRGs). The length of stay of readmissions was longer than that of index hospitalization (difference of 1.57 days, 95% CI 1.36-1.78 days, p < 0.001). The length of stay of index hospitalization is longer than that of single hospitalization (difference of 0.62 days, 95% CI 0.52-0.72 days, p < 0.001). CONCLUSIONS: A patient who goes for readmission thus has an overall hospitalization duration of almost two and a half times the length of the stay of a patient with single hospitalization, considering both index hospitalization and readmission. This represents a heavy use of hospital resources, about 10,200 more inpatient days than single hospitalizations, corresponding to a 30-bed ward working with an occupancy rate of 95%. Knowledge of readmissions is an important piece of information in health planning and a useful tool for monitoring the quality of models of patient care.

Hospital readmissions of patients with COVID-19: causes, features, outcomes

Introduction. On average, 10% of patients hospitalized due to new coronavirus infection (COVID-19) will be readmitted. To date, the reasons for readmission and the characteristics of these cases are not fully presented. The aim of the study was to analyze readmissions of COVID-19 patients to identify the causes of readmission, clinical features, examination data and treatment outcomes. Materials and methods. The study was performed retrospectively by using electronic records of the medical cases of the St. Petersburg City Hospital of St. George. Inclusion criteria: 1) the presence of two or more hospitalizations during 2020–2021;2) COVID-19 confirmed by polymerase chain reaction within 14 days before or during the first hospitalization, or the detection of changes in the lungs with a high probability associated with COVID-19 during primary computed tomography. One hundred and two people met the specified criteria. Results. In 85% of cases, the cause of re-admission was symptoms of respiratory infection;in 13% – thrombotic events (pulmonary embolism, acute cerebrovascular accident, deep vein thrombosis of the lower extremities);12% – severe pain syndrome of various localizations;11%-infectious and inflammatory processes;9% – antibiotic-associated diarrhea;5% – atrial fibrillation and less often other pathologies. Patients with respiratory symptoms had a high degree of respiratory failure, an increase in the volume of affected lung tissue and an increase in the content of various markers of inflammation in the blood when compared with the data of the initial examination. Nine percent of patients died during hospitalization. Conclusions. The leading cause of repeated inpatient treatment of COVID-19 patients were symptoms of reactivation of the infection with a number of indicators of a greater severity of this "second wave” of the disease. Further studies are required to reduce the risk of repeated inpatient treatment. © 2022, Remedium Group Ltd. All rights reserved.

Hospital readmissions of patients with COVID-19: causes, features, outcomes

Introduction. On average, 10% of patients hospitalized due to new coronavirus infection (COVID-19) will be readmitted. To date, the reasons for readmission and the characteristics of these cases are not fully presented. The aim of the study was to analyze readmissions of COVID-19 patients to identify the causes of readmission, clinical features, examination data and treatment outcomes. Materials and methods. The study was performed retrospectively by using electronic records of the medical cases of the St. Petersburg City Hospital of St. George. Inclusion criteria: 1) the presence of two or more hospitalizations during 2020–2021;2) COVID-19 confirmed by polymerase chain reaction within 14 days before or during the first hospitalization, or the detection of changes in the lungs with a high probability associated with COVID-19 during primary computed tomography. One hundred and two people met the specified criteria. Results. In 85% of cases, the cause of re-admission was symptoms of respiratory infection;in 13% – thrombotic events (pulmonary embolism, acute cerebrovascular accident, deep vein thrombosis of the lower extremities);12% – severe pain syndrome of various localizations;11%-infectious and inflammatory processes;9% – antibiotic-associated diarrhea;5% – atrial fibrillation and less often other pathologies. Patients with respiratory symptoms had a high degree of respiratory failure, an increase in the volume of affected lung tissue and an increase in the content of various markers of inflammation in the blood when compared with the data of the initial examination. Nine percent of patients died during hospitalization. Conclusions. The leading cause of repeated inpatient treatment of COVID-19 patients were symptoms of reactivation of the infection with a number of indicators of a greater severity of this "second wave” of the disease. Further studies are required to reduce the risk of repeated inpatient treatment. © 2022, Remedium Group Ltd. All rights reserved.

Hospital readmissions in the group of users on the Flexible Assertive Community Treatment - experiences from RECOVER E Montenegro samples

Introduction: As a part of Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro in 2018. The initial step involved a thorough situation analysis of the setting and circumstances of treatment of users with severe mental health illnesses, followed by the establishment of the community mental health team (CMHT) within the Special Psychiatric Hospital Kotor. The CMHT became responsible for the treatment of a group of clients with severe mental health illnesses, based on the principles of 'Flexible Assertive Community Treatment (FACT - A Dutch model). Objective(s): The main objective of this research was to establish whether there were substantial differences regarding the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro. Method(s): Within the RECOVER-E project, a sample of 202 patients, users of mental health services, were recruited in Montenegro. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued. To estimate and follow-up the frequency of hospital readmissions, medical documentation was used. Result(s): Patients in the intervention group had less hospital days during the 18 months follow-up period. However, the differences between two groups regarding number of readmissions, and total length of hospital days were not statistically significant measured by independent T test. Conclusion(s): This study showed that CMHT care could reduce the total length of hospital days during the treatment of psychotic disorders even dough during the COVID 19 pandemic and lock down measures.

Discharge to post-acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis.

BACKGROUND: During the initial surge of coronavirus disease 2019 (COVID-19), health-care utilization fluctuated dramatically, straining acute hospital capacity across the USA and potentially contributing to excess mortality. METHODS: This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a 12-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged LOS (PLOS), which we defined as 7 or more days. We performed univariate analyses of patient characteristics, clinical outcomes and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination, wherein all variables with a P-value above 0.05 were eliminated in a stepwise fashion. RESULTS: The cohort included 1366 patients, of whom 13% died and 29% were readmitted within 30 days. The LOS (mean: 12.6) fell over time (P < 0.0001). Predictors of PLOS included discharge to a post-acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6-54.0), uninsured status (OR 3.2, CI 1.1-9.1) and requiring intensive care and intubation (OR 18.4, CI 11.5-29.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) services (38%) as compared to patients discharged home without HHA services (26%) (P < 0.0001). CONCLUSION: Patients hospitalized with COVID-19 during a US COVID-19 surge had a PLOS and high readmission rate. Lack of insurance, an intensive care unit stay and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.

Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design.

Background The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.

Re-Admission of COVID-19 Patients Hospitalized with Omicron Variant-A Retrospective Cohort Study.

In accordance with previous publications, re-admission rates following hospitalization of patients with COVID-19 is 10%. The aim of the current study was to describe the rates and risk factors of hospital re-admissions two months following discharge from hospitalization during the fifth wave due to the dominant Omicron variant. A retrospective cohort study was performed in Rabin Medical Center, Israel, from November 2021 to February 2022. The primary outcome was re-admissions with any diagnosis; the secondary outcome was mortality within two months of discharge. Overall, 660 patients were hospitalized with a diagnosis of COVID-19. Of the 528 patients discharged from a primary hospitalization, 150 (28%) were re-admitted. A total of 164 patients (25%) died throughout the follow-up period. A multi-variable analysis determined that elevated creatinine was associated with a higher risk of re-admissions. Rates of re-admissions after discharge during the Omicron wave were considerably higher compared to previous waves. A discharge plan for surveillance and treatment following hospitalization is of great importance in the management of pandemics.

Patterns of adult and youth inpatient admissions before and after the COVID-19 pandemic in a psychiatric ward: an observational study.

BACKGROUND: The current pandemic situation led to deep changes not only in social relationships, but also on clinical care and access to healthcare facilities. The authors aimed to understand whether this context affected the main characteristics of psychiatric hospitalizations, measured by admissions in a portuguese acute psychiatric ward. METHODS: Retrospective data collection of all patients admitted in Centro Hospitalar Psiquiátrico de Lisboa, in two different time periods: pre-COVID-19 (march 11th, 2019 to march 10th, 2020, n = 1845) and COVID-19 (march 11th, 2020 to march 10th, 2021, n = 1278); comparing the number of total admissions, compulsory ones, age, sex, median days of admission, median days to readmission and diagnosis at discharge. Distribution of disorders in both groups, as well as in compulsory admissions were also evaluated. The same comparisons were evaluated in the 15-25-year-old patient group. RESULTS: Statistical significance was found regarding total number of admissions (reduction of around 30.7%), as well as compulsory ones (reduction of 14%, although the relative frequency had increased), days of admission and distribution between admissions (with lower reductions regarding dementias, schizophrenia and affective disorders, while substance use disorders and intellectual disabilities presented reductions of over 50%), with no differences between gender, median age, previous admissions or readmissions. Distribution between compulsory admissions did not present differences before and during COVID periods. For patients between 15 and 25 years of age, statistical significance was found regarding total number of compulsory ones (94 versus 44, p-value = 0.01), and in all groups of diagnoses (all with p-value = 0.001). CONCLUSIONS: While there was a general reduction in the overall number of patients admitted, in the most severe conditions (compulsory admissions and schizophrenia diagnosis) did not present such a reduction. Difficulties in social, clinical and family networks can explain the reduction of the time to readmission. Future research could show whether there is a rebound increase number of admissions in the other diagnoses. TRIAL REGISTRATION: The current study was approved by the hospital's scientific and ethics committees (CCP number 0060/2021 and CES 09/2021).

RAPT Scores Predict Inpatient Versus Outpatient Status and Readmission Rates After IPO Changes for Total Joint Arthroplasty: An Analysis of 12,348 Cases.

BACKGROUND: Changes to Medicare's Inpatient Only List (IPO) and factors associated with the COVID pandemic have led to more total joint arthroplasty (TJA) patients to be designated as outpatient (OP). This potentially complicates postoperative care for patients with lower functional status and poor social support. These factors make the decision between OP versus inpatient (IP) designation particularly challenging for healthcare teams. The Risk Assessment and Prediction Tool (RAPT) was designed to indicate patient risk for needing posthospital discharge to facility and considers social and functional factors. The purpose of this study is to 1) evaluate the correlation of RAPT as a clinical tool to aid decision-making regarding OP versus IP for Total Hip and Knee Arthroplasty (THA and TKA), 2) assess the impact of recent changes to the IPO and the COVID pandemic on OP TJA readmission rates, and 3) determine whether 90-day readmissions are correlated with RAPT scores after OP TJA. METHODS: We identified all elective TKA and THA patients from 2015 through 2021 in our electronic health record at our large, urban, academic health system. Fracture patients were excluded. For those patients with available RAPT scores, we determined OP and IP designations, with IP defined as those with length-of-stay 2 midnights or more. We performed subanalysis of OP between same-day and next-day discharge. RAPT scores and readmission rates were compared at time points related to changes in the IPO: before TKA removal in 2018 (period A), from 2018 until THA removal in 2020 (Period B), and after January 1, 2020, inclusive of impact from the COVID pandemic (Period C). RESULTS: Reviewed were 11,819 elective TKAs and 10,212 elective THAs. RAPT scores were available for 6,759 TKA patients and 5,589 THA patients. For both TKA and THA, RAPT scores between IP, same-day, and next-day discharged OP were significantly different across all time periods (P < .001). The percentage of OP designation increased across all time periods for TKA and THA. Over these same time periods, mean RAPT scores decreased significantly for both OP TKA and OP THA (P < .01). Concurrent with these changes were significant increases in OP THA 90-day readmission rates across Periods A and B (P = .010) as well as A and C (P = .006). Readmitted OP TKA had significantly lower RAPT scores than OP TKA without readmission during Period B (P < .001). Readmitted OP THA had significantly lower RAPT scores than those without readmission for all periods (P < .05). To facilitate clinical utility, median RAPT scores were also analyzed, and showed that RAPT scores for OP THA patients with readmission were 1 to 2 points lower for all time periods. CONCLUSION: RAPT scores correlate with IP versus OP status for both TKA and THA and vary significantly with same-day versus next-day discharge. OP TJA RAPT scores may also help predict readmission, and counsel some patients away from OP surgery. Average RAPT scores of 10, 9, and 8 appeared to be separators for same day, next day, and inpatient stay. Changes to the IPO and COVID pandemic correlate with decrease in RAPT scores for both TKA and THA patients within all designations. In addition, a shift toward lower RAPT for OP TJA correlates with increased 90-day readmission rates for OP TJA. Taken together, these results suggest that patients with poorer function and worse social support systems are increasingly being driven toward OP surgery by these changes, which may play a role in increasing readmission rates. Social support and functional factors should be considered for OP elective TKA and THA. Further, any OP TJA value-based payment system must account for these variables.

Predicting 30-day return hospital admissions in patients with COVID-19 discharged from the emergency department: A national retrospective cohort study.

OBJECTIVES: Identification of patients with coronavirus disease 2019 (COVID-19) at risk for deterioration after discharge from the emergency department (ED) remains a clinical challenge. Our objective was to develop a prediction model that identifies patients with COVID-19 at risk for return and hospital admission within 30 days of ED discharge. METHODS: We performed a retrospective cohort study of discharged adult ED patients (n = 7529) with SARS-CoV-2 infection from 116 unique hospitals contributing to the National Registry of Suspected COVID-19 in Emergency Care. The primary outcome was return hospital admission within 30 days. Models were developed using classification and regression tree (CART), gradient boosted machine (GBM), random forest (RF), and least absolute shrinkage and selection (LASSO) approaches. RESULTS: Among patients with COVID-19 discharged from the ED on their index encounter, 571 (7.6%) returned for hospital admission within 30 days. The machine-learning (ML) models (GBM, RF, and LASSO) performed similarly. The RF model yielded a test area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.71-0.78), with a sensitivity of 0.46 (95% CI, 0.39-0.54) and a specificity of 0.84 (95% CI, 0.82-0.85). Predictive variables, including lowest oxygen saturation, temperature, or history of hypertension, diabetes, hyperlipidemia, or obesity, were common to all ML models. CONCLUSIONS: A predictive model identifying adult ED patients with COVID-19 at risk for return for return hospital admission within 30 days is feasible. Ensemble/boot-strapped classification methods (eg, GBM, RF, and LASSO) outperform the single-tree CART method. Future efforts may focus on the application of ML models in the hospital setting to optimize the allocation of follow-up resources.

Higher admission and rapid readmission rates among medically hospitalized youth with anorexia nervosa/atypical anorexia nervosa during COVID-19.

The COVID-19 pandemic has had sweeping and deleterious effects on the well-being of individuals worldwide. Eating disorders (EDs) are no exception, with incidence and prevalence of EDs rising since COVID-19 onset. The current study examined inpatient census and readmission rates among youth (aged 8-18) hospitalized for medical complications of anorexia nervosa (AN) or atypical anorexia nervosa (AAN) throughout distinct periods of the COVID-19 pandemic, including pre-COVID-19 (n = 136), COVID-19 lockdown (n = 3), and post COVID-19 lockdown (n = 24). Data from the COVID-19 lockdown period was excluded from analyses due to low sample size. Youth hospitalized during post COVID-19 lockdown were over 8-times more likely to be readmitted within 30-days of discharge compared to patients hospitalized before the pandemic (p = .002). Further, the inpatient census of youth with AN/AAN was significantly higher during post COVID-19 lockdown compared to pre-COVID-19 (p = .04). One-third of patients hospitalized since the pandemic identified COVID-19 consequences as a primary correlate of their ED. Our findings, although not causal, suggest an association between COVID-19 and AN/AAN development and exacerbation in youth, thus prompting more medical admissions and rapid readmissions among this demographic. This study has important implications for understanding how AN/AAN onset and exacerbation in youth has been affected by the COVID-19 pandemic and can inform new efforts to support individuals navigating treatment during a global crisis.

A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis.

BACKGROUND: Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. OBJECTIVE: The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. METHODS: We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. RESULTS: We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient. CONCLUSIONS: The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

Short-Stay Hospitalizations for Patients with COVID-19: A Retrospective Cohort Study.

OBJECTIVE: Patients requiring hospital care for COVID-19 may be stable for discharge soon after admission. This study sought to describe patient characteristics associated with short-stay hospitalization for COVID-19. METHODS: We performed a retrospective cohort study of patients with COVID-19 admitted to five United States hospitals from March to December 2020. We used multivariable logistic regression to identify patient characteristics associated with short hospital length-of-stay. RESULTS: Of 3103 patients, 648 (20.9%) were hospitalized for less than 48 h. These patients were significantly less likely to have an age greater than 60, diabetes, chronic kidney disease; emergency department vital sign abnormalities, or abnormal initial diagnostic testing. For patients with no significant risk factors, the adjusted probability of short-stay hospitalization was 62.4% (95% CI 58.9-69.6). CONCLUSION: Identification of candidates for early hospital discharge may allow hospitals to streamline throughput using protocols that optimize the efficiency of hospital care and coordinate post-discharge monitoring.

Characteristics of patients discharged and readmitted after COVID-19 hospitalisation within a large integrated health system in the United States.

BACKGROUND: Limited studies have explored post-discharge outcomes following Coronavirus Disease 2019 (COVID-19) hospitalisation. We sought to characterise patients discharged following a COVID-19 hospitalisation within a large integrated health system in the United States. METHODS: We performed a retrospective study of 2180 COVID-19 patients discharged between 1 April 2020 and 31 July 2020. The primary endpoint was all-cause observation stay or inpatient readmission within 30 days from discharge. Bivariate and multivariable logistic regression analyses were performed to estimate the association between key socio-demographic and clinical characteristics with risk of 30-day readmission. RESULTS: The 30-day readmission rate was 7.6% (n = 166); 30-day mortality rate was 1% (n = 19). Most readmissions were respiratory-related (58%) and occurred at a median time of 5 days post discharge. Adjusted models showed that prior hospitalisations (Odds Ratio = 2.36, [95% Confidence Interval: 1.59-3.50]), chronic pulmonary disease (1.57 [1.09-2.28]), and discharge to home health (1.46 [1.01-2.11]) were significantly associated with 30-day readmission. Longer duration from diagnosis to index admission was borderline associated with lower odds of readmission (0.95 [0.91-1.00]). CONCLUSION: Readmission and mortality rates for COVID-19 following discharge are low. Most readmissions occur early and are due to respiratory causes and may reflect the prolonged acute disease course.

The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly.

BACKGROUND: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient centered medical home is a promising model, which improves care coordination and may reduce hospital readmissions. METHODS: This is a quality improvement report, the geriatric patient-aligned care team (GeriPACT) at Tennessee Valley Healthcare System (TVHS) participated in ongoing quality improvement (Plan, Do, Study, Act (PDSA)) cycles during teamlet meetings. Post home discharge follow-up for GeriPACT patients was provided by proactive telehealth communication by the Registered Nurse (RN) care manager and nurse practitioner. Periodic operations data obtained from the Data and Statistical Services (DSS) coordinator informed the PDSA cycles and teamlet meetings. RESULTS: at baseline (July 2018-June 2019) the 30-day all-cause readmission for GeriPACT was 21%. From July to December 2019, 30-day all-cause readmissions were 13%. From January to June 2020, 30-day all-cause readmissions were 15%. CONCLUSION: PDSA cycles with sharing of operations data during GeriPACT teamlet meetings and fostering a shared responsibility for managing high-risk patients contributes to improved outcomes in 30-day all-cause readmissions.

Short durations of corticosteroids for hospitalised COVID-19 patients are associated with a high readmission rate.

OBJECTIVE: Our objective was to describe the characteristics of patients admitted, discharged and readmitted, due to COVID-19, to a central London acute-care hospital during the second peak, in particular in relation to corticosteroids use. METHODS: We reviewed patients admitted from the community to University College Hospital (UCH) with COVID-19 as their primary diagnosis between 1st-31st December 2020. Re-attendance and readmission data were collected for patients who re-presented within 10 days following discharge. Data were retrospectively collected. RESULTS: 196 patients were admitted from the community with a diagnosis of COVID-19 and discharged alive in December 2020. Corticosteroids were prescribed in hospital for a median of 5 days (IQR 3-8). 20 patients (10.2%) were readmitted within 10 days. 11/20 received corticosteroids in the first admission of which 10 had received 1-3 days of corticosteroids. Readmission rate in those receiving 1-3 days of corticosteroids was 25%. CONCLUSIONS: Most international guidelines have recommended providing up to 10 days of corticosteroids for severe COVID-19 but stopping on discharge. Our findings show shorter courses of corticosteroids during admission are associated with an increased risk of being readmitted and support continuing the course of corticosteroids after hospital discharge monitored in the virtual ward setting.