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The transition period from hospital to home is a vulnerable time for rehospitalization and adverse events for patients. Follow-up clinic visits within 7-14 days of discharge is an effective strategy for reducing hospital readmissions. Neurocritical care patients have a unique set of needs to safely transition to home. We evaluated the feasibility of a Neuroscience Advanced Practice Provider (APP) Clinic to meet transitional care gaps in neurocritical care patients and prevent rehospitalization. Clinic procedures and documentation templates were customized for the pilot clinic. Six critical care APPs underwent a brief training course for the ambulatory care setting. Eligible patients were tracked throughout the hospitalization and the APP team made follow-up appointments. The pilot clinic took place from October 2022-January 2023. Nine patients were seen in the clinic approximately eight days after discharge. Clinic attendance rate was 90%. Among the clinic attendees, 66% received referrals to a primary care provider or other services, one third received medication changes or refills and all received patient-specific education. There were no rehospitalizations among the clinic patients. Implementation of this pilot clinic was possible with the current departmental resources. This innovative model of care has the potential to reduce hospital readmissions.

Supplemental Digital Content is available in the text, Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk. To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling. This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website. A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = −0.086; 95% Confidence Interval, −0.162 to −0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates. These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial – perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.

Objective: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission. Design: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses. Setting and subjects: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014. Main outcome measure: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload. Results: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p

Objetivo: la rehospitalización de pacientes psiquiátricos hace referencia a la necesidad de internar nuevamente a un paciente que ya había egresado por la misma causa. Es producto de una descompensación recurrente y, cuando se trata de patología mental crónica, las rehospitalizaciones obedecen a factores sociodemográficos, características clínicas y antecedentes personales. El objetivo de esta investigación es explorar los factores asociados con el reingreso de los pacientes psiquiátricos atendidos en la Clínica San Juan de Dios de La Ceja, Antioquia, en 2014. Metodología: estudio analítico transversal. Muestra de 218 pacientes rehospitalizados al menos una vez en agudos, de la Clínica San Juan de Dios, durante el periodo de estudio. Se obtuvieron las características clínicas y demográficas relevantes y se realizó un análisis bivariado entre dichas características y haber sido readmitido al menos dos veces. Resultados: los pacientes tienen como diagnóstico más frecuente el trastorno afectivo bipolar. El 59.2% de los participantes está compuesto por mujeres, la edad media fue de 39 años (rango 15-75), el 73.9% vive en zona urbana. El 24.3% tenía disfunción familiar, el 10.6% disfunción de pareja. El 46.8% egresó con diagnóstico de trastorno afectivo bipolar. Al 43.3% de los pacientes se le remitió a psicología al alta. El mínimo de recaídas fue una y el máximo cuatro. La media de días de estancia hospitalaria fue 9.1 (rango 1-49). No hubo asociación estadística entre las variables estudiadas y el desenlace de interés. Conclusiones: no hay asociación de algún factor sociodemográfico, clínico o personal con el reingreso repetitivo de los pacientes estudiados, por lo que se propone realizar estudios de cohorte en muestras más grandes en las que se analicen más grupos de comparación.

Background The economic impact and ease of measurement of all-cause hospital readmission rates (HRR) have led to the current debate as to whether they are reducible, and whether they should be used as a publicly reported quality indicators of medical care. Objective To assess the efficacy of broad clinical interventions in preventing HRR of patients with chronic diseases Method A meta-review of published systematic reviews of randomized controlled trials (RCTs) of clinical interventions that have included HRR among the patients' outcomes of interest. Main findings Meta-analyses of RCTs have consistently found that, in the community, disease management programs significantly reduced HRR in patients with heart failure, coronary heart disease and bronchial asthma, but not in patients with stroke and in unselected patients with chronic disorders. Inhospital interventions, such as discharge planning, pharmacological consultations and multidisciplinary care, and community interventions in patients with chronic obstructive pulmonary diseases had an inconsistent effect on HRR. Main study limitation Despite their economic impact and ease of measurement, HRR are not the most important outcome of patient care, and efforts aimed at their reduction may compromise patients' health by reducing also justified re-admissions. Conclusions The efficacy of inhospital interventions in reducing HRR is in need of further study. In patients with heart diseases and bronchial asthma, HRR may be considered as a publicly reported quality indicator of community care, provided that future research confirms that efforts to reduce HRR do not adversely affect other patients’ outcomes, such as mortality, functional capacity and quality of life. Future research should also focus on the reasons for the higher efficacy of community interventions in patients with heart diseases and bronchial asthma than in those with other chronic diseases.

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced. Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen

A elevada procura pelo Serviço de Emergência e conseqüente permanência dos pacientes em repetidas admissões torna-se urna situação difícil para os enfermeiros responsáveis pelo gerênciamento desses serviços. Estudo transversal e descritivo realizado no Serviço de Emergência de um hospital de ensino de atenção terciaria a saúde em São Paulo, que teve por objetivos identificar o perfil sócio-demográfiço e morbidade dos pacientes readmitidos e identificar os fatores relacionados as readmissões. A amostra foi composta por maiores de 14 anos internados no Serviço de Emergência, com mais de urna admissão nos seis meses anteriores ão dia da coleta de dados, realizada no mes de Maio de 2004. A incidência de readmissões foi 23,3%, com predominio de homens (61,9%), idade na faixa de 40 a 90 anos (85,9%) e baixa escolaridade (57,8%). A maioria dos pacientes (57,6%) foi readmitida com o mesmo diagnóstiço e 23,9% devido a complicações do diagnóstiço de base. Concluiu-se que a elevada incidência de readmissões pode ser atribuida a evolução da doença cróniço-degenerativa, a avançada idade dos pacientes, as complicações pós-operatórias, a não resolução do problema anterior e ão baixo seguimento das orientações recebidas. Tais achados sugerem a necessidade de investir em melhorias na qualidade do atendimento hospitalar com maior atuação do enfermeiro na assisténcia direta ão paciente nos serviços de emergência e na extensão do cuidado no domicilio. The high demand for attendance in Emergency Department and the resultant length of stay for the patients in repeated admissions have become hard to nurses responsible for the administration of this units deal with the situation. Transversal and descriptive study made at Emergency Department of a teaching hospital in São Paulo city whose objectives were to identify the social-demographic and morbidly profile of the readmitted patients and the factors associated with readmissions. The sample was constituted by patients over fourteen years oíd that became inpatient at the Emergency Department, with over than one admission until six months before the data collection during May 2004. The readmission incidence was 23.3%, the patients were predominantly males (61.9%), had 40 to 90 years oíd (85,9%) and low level education (57.8%). Most of patients (57.6%) were readmitted with the same diagnosis and 23.9% due to complications. It was conclude that the high readmission incidence can be attributed to the evolution of the chronic disease, advanced age, surgical complications, not-resolution of the last health problem and non-adherence to the orientations. The findings suggest the need to invest on improvement of the attendance quality, with more nurse performance on direct assistance to patient on the Emergency Department, and continuity of the care at home. La elevada demanda del Servicio de Emergência y la consecuente permanência de los pacientes en repetidas admisiones se convierte en una situación difícil para los enfermeros responsables de la gestión de esos servicios. Este estudio corresponde a un estudio transversal y descriptivo realizado en el Servicio de Emergência de un hospital de enseñanza de atención terciaria en salud, en la ciudad de São Paulo, cuyo objetivo buscó identificar el perfil socio-demográfiço, la morbilidad de los pacientes readmitidos e identificar los factores relacionados con las readmisiones. La muestra comprendía pacientes mayores de 14 años ingresados en el Servicio de Emergência, con más de una admisión en los seis meses anteriores al día de la recolección de datos realizada en mayo de 2004. La incidência de readmisiones fue del 23,3%, con predominio del sexo masculino (61,9%), edad entre 40 y 90 años (85,9%) ybaja escolaridad (57,8%). La mayoría de los pacientes (57,6%) fue readmitida con el mismo diagnóstiço, debido a complicaciones del diagnóstiço de base (23,9%). Se concluyó que la elevada incidência de readmisiones puede atribuirse a la evolución de la enfermedad cróniço-degenerativa, a la avanzada edad de los pacientes, a las complicaciones post-operatorias, a no haber sido solucionado el problema anterior y al bajo cumplimiento de las orientaciones recibidas. Estos hallazgos sugieren la necesidad de invertir en mejorías en la calidad de la atención hospitalaria con mayor actuación del profesional de enfermería en la asistência directa al paciente en los servicios de emergência y en la extensión del cuidado en el domicilio.