Comparison of 1, 2, and 6-Month Readmission Rates in Patients With Acute Myocardial Infarction Directly Admitted to Hospital Versus Transferred From Another Hospital to an Academic Medical Center.

Patients with acute myocardial infarction (AMI) who are transferred are less likely than directly admitted patients to receive outpatient follow-up within 30 days and are more likely to be readmitted. In 2015, we launched a clinic where post-AMI patients (direct admits and transfers) are seen within 1 week of hospital discharge. We compared short- and long-term clinical outcomes of patients who were transferred to patients who were directly admitted to our institution to determine the impact of transfer status on early outpatient follow-up and clinical outcomes. A total of 280 post-AMI patients, 193 direct admissions (69%), and 87 transfers (31%) were referred to the clinic. Clinic attendance was similar between the transferred and the directly admitted patients (91% vs 92%, p = 0.688, respectively). Transferred patients had similar rates of confusion regarding their medical regimen as the directly admitted patients (11% vs 8%, p = 0.393). Compared with directly admitted patients, transferred patients lived farther from the hospital (median distance of 30 vs 48 miles, p <0.0001), were predominately white (77% vs 91%, p = 0.005), and had higher rates of chronic obstructive pulmonary disease (9% vs 17%, p = 0.014). There was no difference in 30- (16% vs 13%, p = 0.562) or 60-day readmission rates (6% vs 8%, p = 0.543) between transferred patients and directly admitted patients. At 6 months, mortality rates were similar (6% vs 4%, p = 0.556). In conclusion, transferred patients who were evaluated early after hospital discharge for acute MI had similar clinical outcomes (including rates of unplanned readmissions) to their directly admitted counterparts.

The prehospital and hospital costs of emergency care for frequent ED patients.

INTRODUCTION: Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care. METHODS: Data on 2012 ED visits to a rural Level I Trauma Center and public safety net hospital were collected through a deidentified patient database. Transport data and 2012 Medicare Reimbursement Schedules were used to estimate the cost of EMS transport. Health information, outcomes, and costs were compared to find differences between the FP and non-FP group. RESULTS: This study identified 1242 FPs who visited the ED 5 or more times in 2012. Frequent patients comprised 3.25% of ED patients but accounted for 17% of ED visits and 13.7% of hospital costs. Frequent patients had higher rates of chronic disease, severity scores, and mortality. Frequent patients arrived more often via ambulance and accounted for 32% of total transports at an estimated cost of $2.5-$3.2 million. Hospital costs attributable to FPs were $29.1 million, bringing the total cost of emergency care to $31.6-$32.3 million, approximately $25,000 per patient. CONCLUSIONS: This study demonstrates that the inclusion of a prehospital cost estimate adds approximately 10% to the cost of care for the FP population. In addition to improving care for a sick population of patients, programs that reduce frequent EMS and ED use have the potential to produce a favorable cost benefit to communities and health systems.