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Background: All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear. Objective: The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors. Methods: A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted. Results: The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors. Conclusions: The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation. [ABSTRACT FROM AUTHOR]

Migration is a major life event that alters the functioning of individuals, often leading to the disruption of families and other social networks. When adaptation and coping fail, psychological distress may result. The purpose of this study is to examine the prevalence of psychological distress and to identify risk factors associated with the development of psychological distress symptoms in Chinese immigrants. A cross-sectional survey was conducted in a Chinese community in Maryland, USA. A total of 247 people completed the survey. Descriptive statistics were used to describe demographic and prevalence data. Differences in means of psychological distress scores by group were examined witht-tests and analysis of variance. Multiple regression analysis was used to test multiple predictors of psychological distress scores. The prevalence of psychological distress among Chinese immigrants in this study was 22.3%, double the expected frequency in the general US population. Being younger, self-reported with poor health and financial strain predicted the development of psychological distress. The relatively high prevalence of psychological distress in adult Chinese immigrants has important implications for healthcare professionals in the area of cross-cultural mental health. Recommendations center on routine screening for psychological distress and building capacity for culturally sensitive interventions. [ABSTRACT FROM AUTHOR]

Background: The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. Objectives: The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. Methods: In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients’ age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. Results: Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R2 = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R2 = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R2 = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. Conclusion: In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To evaluate the contributions of patient and caregiver factors to length of stay (LOS) and 30-day readmission status for recipients of allogeneic hematopoietic stem cell transplantation (HSCT). Design: Secondary data analysis from a phase 2 clinical trial. Setting: National Institutes of Health Clinical Center in Bethesda, Maryland. Sample: 68 dyads (N = 136) comprised of patients receiving HSCT and their caregivers. Methods: Multiple linear regression and logistic regression analyses were used to investigate associations between caregiver and patient factors and outcomes. Main Research Variables: Patients' initial LOS, 30-day readmission, and demographic and disease characteristics; caregiver demographic factors, health problems, psychological distress, burden, and self-efficacy. Findings: Twenty-five patients were readmitted within 30 days after hospital discharge following their initial hospitalization for HSCT. LOS was 34% longer for patients with infection than patients without infection. Patients with grade 2 or greater acute graft-versus-host disease (GVHD) stayed longer compared to patients with no or mild acute GVHD. Patients who had nonspousal caregivers stayed longer than patients with spousal caregivers. Infection was significantly related to readmission. Conclusions: Knowledge regarding factors associated with increased LOS and 30-day readmission can help nurses and transplantation team members anticipate the healthcare needs of patients receiving HSCT, improve outcomes, and decrease the use of expensive health services. Implications for Nursing: Educating patients and caregivers on infection prevention is critically important to reduce LOS and 30-day readmission after HSCT. [ABSTRACT FROM AUTHOR]