Impact of a Novel Post-Discharge Transitions of Care Clinic on Hospital Readmissions.
Medicaid; Medicare; 30 day readmission; 90 day mortality; African-American; Commercial health insurance; Post-discharge; Transitions of care
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) has targeted hospital readmissions, which cost $17 billion per year, as one potential solution to reduce rising health care costs. Studies have documented the ability of Transitions of care (TOC) services to reduce readmissions in high risk patients. However, the vast majority of studies have not explored TOC services for all-cause admissions nor TOC clinics led by hospitalists. The goal of this study is to provide preliminary data regarding the potential effectiveness of a hospitalist-led TOC clinic servicing all patients on hospital readmission rates. METHODS: This cross-sectional feasibility study analyzed patients on a tertiary hospital teaching service. All discharged patients from January 2016 to September 2018 were given an appointment at the TOC clinic within 14 days of discharge. The control group consisted of patients assigned to the teaching service from January 2018 to November 2018 that were not offered a TOC appointment. RESULTS: Overall, 1373 patients (n = 1373) were included in this study between January 2016 and September 2018. The control group consisted of 1000 patients who were not offered follow up in the TOC clinic while the TOC group consisted of 373 patients who did attend a follow up appointment in the TOC clinic. The study participants (n = 1373) included patients admitted to the hospital for any diagnosis and were analyzed for all cause readmission rates. The TOC group consisted of 52% African Americans, 52% Medicare patients and 8% Medicaid patients. Demographic information for the control group was not available. The TOC group had a statistically significant 42% decreased risk of being readmitted within 30 days of discharge (RR = 0.58, 95% CI: 0.40-0.83). These data showed a statistically significant difference between the TOC group and control group in relation to the incidence of 30-day readmissions (p-value = 0.002). CONCLUSION: Among Medicare and Medicaid beneficiaries and commercial health insurance patients, this hospitalist-led TOC intervention was associated with a statistically significant reduction in 30-day readmissions following discharge for all-cause hospital admissions.
Baldino M; Bonaguro AM; Burgwardt S; Lombardi A; Cristancho C; Mann C; Wright D; Jackson C; Seth A
Journal of the National Medical Association
2020
2020-09-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jnma.2020.07.018" target="_blank" rel="noreferrer noopener">10.1016/j.jnma.2020.07.018</a>
Evaluation Of Embolic Protection Devices For Fat Emboli Prevention
Cardiovascular System & Cardiology; Surgery
Background: Patients with acutely treated femoral shaft fractures with reamed intramedullary nailing are at risk for acute respiratory distress syndrome due to liberation of bone marrow fat particles that travel to the lung and cause damage to the parenchyma. The purpose of this study was to demonstrate: (1) the ability of clinically applicable embolic protection devices to capture such particles; (2) how such a device affects cardiopulmonary function after reamed intramedullary nailing; and (3) evaluation of lung pathology to determine whether filtration affects pulmonary embolic load. Methods: A total of 12 canines were anesthetized, and hemodynamic monitoring was established. Carotid embolic protection devices were introduced into the iliac vein, and ipsilateral intramedullary reaming and nailing was performed. Cardiopulmonary parameters were recorded at timed intervals up to 60 minutes after the procedure. The control group (n = 4) was compared with groups treated with Accunet (n = 4) and Spider (n = 4) filters. A blinded histopathological review was performed on lung specimens to determine the average number of emboli per section and to measure the area (mm(2)) of embolic load by digital image analysis. Results: Gross inspection of the embolic protection devices showed the presence of bone marrow debris. A significant change was observed in pH levels (control = -0.052, filters = +0.005; P < .05) within the 60 minutes after intramedullary nailing. Serum bicarbonate (meq/dL) values were noted to have similar changes of -2.7 and -1.8 at 10 and 60 minutes, whereas the experimental group was +0.6 and +0.8 at the same time intervals (P = .01 and .0004, respectively). Pulmonary measurements for pO(2) and oxygen saturation were analogous to the serum parameters with decreases in the control group in comparison with the filter groups. The mean numbers of emboli and area measurements of embolic load were significantly reduced in the filter group (all P < .01). Conclusions: Embolic protection devices were effective in capturing embolic debris from reamed intramedullary nailing of lower extremity long bones and demonstrated a protective effect on pulmonary function and significantly decreased the number and size of emboli in the lung. Based on these findings, patients with long bone fractures at risk for pulmonary complications and acute respiratory distress syndrome could benefit from the placement of embolic protection devices prior to intramedullary fixation. While this study utilized filtration devices designed for carotid embolic protection, further study is warranted to determine optimal filter design in this setting.
Lanzinger W; Caldwell J; Schoenfeld A; Horne W; Sloan P; Stakleff K S; Zink J; Netzley R; Wright D
Journal of Vascular Surgery-Venous and Lymphatic Disorders
2013
2013-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jvsv.2012.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.jvsv.2012.07.012</a>
Hickman catheter dislodgement due to pendulous breasts.
*Catheterization; Adult; Aged; Breast/*anatomy & histology; Central Venous; Female; Gynecomastia/complications; Humans; Male; Middle Aged
Dislodgement of Hickman, Broviac, and Mediport catheters is a rare but recognized complication. To date, no specific etiology for this has been cited. We present five cases of dislodgement due to positional changes in large-breasted women and one man with gynecomastia. Apparently, motion in the subcutaneous tissue secondary to gravitational forces on large breasts causes downward and outward traction on the subcutaneous portion of the catheter. Variations in placement technique to help avoid this complication are described.
Moorman D W; Horattas M C; Wright D; Kaufman K; Ruf W
JPEN. Journal of parenteral and enteral nutrition
1987
1987-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0148607187011005502" target="_blank" rel="noreferrer noopener">10.1177/0148607187011005502</a>
Migration, Fracture, and Rupture as Complications of Endovascular Grafts in the Treatment of Arteriovenous Fistula
Cardiovascular System & Cardiology; Surgery
Wright D; Zink J; Chaudry M; Netzley R; Erzurum V
Journal of Vascular Surgery
2011
2011-06
Journal Article
<a href="http://doi.org/10.1016/j.jvs.2011.03.144" target="_blank" rel="noreferrer noopener">10.1016/j.jvs.2011.03.144</a>