Electronic dashboard-based remote glycemic management program reduces length of stay and readmission rate among hospitalized adults.
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ABSTRACT: Aims/introduction
Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring.Materials and methods
In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis.Results
A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS).Conclusions
Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.
SUBMITTER: Sheen YJ
PROVIDER: S-EPMC8409866 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo develop a predictive model for real-time predictions of length of stay, mortality, and readmission for hospitalized patients using electronic health records (EHRs).Materials and methodsA Bayesian Network model was built to estimate the probability of a hospitalized patient being "at home," in the hospital, or dead for each of the next 7 days. The network utilizes patient-specific administrative and laboratory data and is updated each time a new pathology test result becomes available. Electronic health records from 32 634 patients admitted to a Sydney metropolitan hospital via the emergency department from July 2008 through December 2011 were used. The model was tested on 2011 data and trained on the data of earlier years.ResultsThe model achieved an average daily accuracy of 80% and area under the receiving operating characteristic curve (AUROC) of 0.82. The model's predictive ability was highest within 24 hours from prediction (AUROC = 0.83) and decreased slightly with time. Death was the most predictable outcome with a daily average accuracy of 93% and AUROC of 0.84.DiscussionWe developed the first non-disease-specific model that simultaneously predicts remaining days of hospitalization, death, and readmission as part of the same outcome. By providing a future daily probability for each outcome class, we enable the visualization of future patient trajectories. Among these, it is possible to identify trajectories indicating expected discharge, expected continuing hospitalization, expected death, and possible readmission.ConclusionsBayesian Networks can model EHRs to provide real-time forecasts for patient outcomes, which provide richer information than traditional independent point predictions of length of stay, death, or readmission, and can thus better support decision making.
| S-EPMC7839923 | biostudies-literature
Project description:BackgroundEvidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14.MethodsThe association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day).ResultsOf 4 667 827 babies, 5.2% were readmitted within 30 days. Aggregated data showed hospitals with longer mean LOS were not associated with lower readmission rates for vaginal (adjusted risk ratio (aRR) 0.87, 95% confidence interval (CI) 0.66, 1.13), or caesarean (aRR 0.89, 95% CI 0.72, 1.12) births. LOS fell by an average 2.0% per year for vaginal births and 3.4% for caesarean births, while readmission rates increased by 4.4 and 5.1% per year respectively. Approaches (iii) and (iv) indicated that longer LOS was associated with a reduced risk of readmission, but only for late preterm, vaginal births (34-36 completed weeks' gestation).ConclusionsLonger newborn LOS may benefit late preterm babies, possibly due to increased medical or psychosocial support for those at greater risk of potentially preventable readmissions after birth. Research based on observational data to evaluate relationships between LOS and readmission should use methods to reduce the impact of unmeasured confounding.
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Project description: Not available
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Project description:ObjectivesAnemia, either chronic or newly developed in the hospital as a result of underlying disease and/or phlebotomy, is seen commonly among general medical inpatients, and its impact on the quality and efficiency of care is unknown.MethodsThis study investigated the relation among hemoglobin level, length of stay, and 30-day unplanned readmission rates in a cohort of 314 general medical inpatients 18 years old and older admitted to a teaching hospital during a period of 4 months in a large urban academic medical center, using retrospective chart review of the electronic health record.ResultsAnemia was common among this cohort of general medical inpatients (44.6%), and there was a statistically significant decrease in hemoglobin levels during their hospitalization. Anemic patients, as compared with nonanemic patients, had significantly longer mean and median length of stay. More important, the admission hemoglobin level and its change during hospitalization were significant predictors of increased length of stay. For every 1-U increase in admission hemoglobin level, the median length of stay was reduced by 0.5 days. For every 1-U increase in the level of hemoglobin change, the median length of stay was extended by 1.5 days. Likewise, the discharge hemoglobin level predicted the rate of 30-day unplanned readmission. For every 1-U decrease in discharge hemoglobin level, the readmission rate increased by nearly 4%. These relations remained after adjusting for common demographic and clinical variables, including age, sex, nutritional status, and number of comorbidities.ConclusionsAnemia is common among general medical inpatients and adversely affects their length of stay and 30-day unplanned readmission rate.
| S-EPMC7047646 | biostudies-literature
Project description:BackgroundThe population of persons seeking medical care is linguistically diverse in the United States. Language barriers can adversely affect a patient's ability to explain their symptoms. Among hospitalized patients, these barriers may lead to higher readmission rates and longer hospitalizations. Trained interpreters help overcome communication barriers; however, interpreter usage among patients is suboptimal.ObjectiveTo investigate differences among patients with limited English proficiency (LEP) in their length of stay (LOS) and 30-day readmission rate associated with their receiving professional interpretation at admission or discharge.DesignWe analyzed the rates of interpretation at admission and discharge of all LEP patients admitted to a tertiary care hospital over a three-year period. We calculated length of stay in days and as log of LOS. We also examined 30-day readmission. Using multivariable regression models, we explored differences among patients who received interpretation at admission, discharge, or both, controlling for patient characteristics, including age, illness severity, language, and gender.ParticipantsAll LEP patients admitted between May 1, 2004 and April 30, 2007.Main measuresLength of hospital stay as related to use of professional interpreters; readmission to the hospital within 30 days.Key resultsOf the 3071 patients included in the study, 39 % received language interpretation on both admission and discharge date. Patients who did not receive professional interpretation at admission or both admission/discharge had an increase in their LOS of between 0.75 and 1.47 days, compared to patients who had an interpreter on both day of admission and discharge (P<0.02). Patients receiving interpretation at admission and/or discharge were less likely than patients receiving no interpretation to be readmitted with 30 days.ConclusionsThe length of a hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or both admission/discharge.
| S-EPMC3445680 | biostudies-literature
Project description:ImportanceIn 2012, hospital reimbursement in Switzerland changed from a fee-for-service per diem system to a diagnosis-related group (SwissDRG) system. Whether this change in reimbursement is associated with harmful implications for quality of care and patient outcomes remains unclear.ObjectiveTo examine the association of the SwissDRG implementation with length of hospital stay (LOS), in-hospital mortality, and 30-day readmission rates in the overall adult inpatient population and stratified by 5 individual diagnoses.Design, setting, and participantsThis cohort study used administrative data from the Swiss Federal Statistical Office to investigate medical hospitalizations in Switzerland from January 1, 2009, through December 31, 2015. All hospitalizations for adult medical inpatients were included in the main analysis. Patients who presented with 1 of the 5 common medical diagnoses were included in the subanalyses: community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, acute myocardial infarction, acute heart failure, and pulmonary embolism. An interrupted time series model was used to determine changes in time trends for risk-adjusted LOS, in-hospital mortality, and 30-day readmission after the implementation of SwissDRG in 2012. Analyses were performed from March 1, 2018, to June 30, 2018, and from November 1, 2018, to December 18, 2018.Main outcomes and measuresMonthly patient-level data for LOS, in-hospital mortality, and 30-day readmission rates.ResultsThe sample included a total of 2 426 722 hospitalized adult patients. Of this total, 1 018 404 patients (41.9%; 531 226 [52.2%] male, median [interquartile range (IQR)] age of 69 [55-80] years) composed the before-SwissDRG period; 1 408 318 patients (58.0%; 730 228 [51.9%] male, median [IQR] age of 70 [56-81] years) composed the after-SwissDRG period. The overall LOS gradually decreased from unadjusted mean (SD) 8.0 (12.7) days in 2009 to 7.2 (17.3) days in 2015. This reduction in LOS, however, was not substantially greater with the implementation of SwissDRG in 2012 (risk-adjusted slope, -0.0166 days; 95% CI, -0.0223 to -0.0110 days), with an adjusted difference in slopes of 0.0000 days (95% CI, -0.0072 to 0.0072 days). Risk-adjusted all-cause in-hospital mortality declined from 4.9% in 2009 to 4.6% in 2015, with a substantially greater decline after implementation of SwissDRG (difference between monthly slopes before and after implementation, -0.0115%; 95% CI, -0.0190% to -0.0039%). In the same period, risk-adjusted 30-day readmission rates increased from 14.4% in 2009 to 15.0% in 2015, with a greater increase after SwissDRG implementation (change in monthly slope, 0.0339%; 95% CI, 0.0254%-0.0423%). Patients with acute myocardial infarction were found to have a substantially greater increase after SwissDRG implementation in 30-day readmission rates (adjusted difference in slopes, 0.1144%; 95% CI, 0.0617%-0.1671%).Conclusions and relevanceAmong medical hospitalizations in Switzerland, SwissDRG implementation appeared to be associated with an increase in readmission rates and a decrease in in-hospital mortality but not with the gradual decrease in LOS observed in the historical control period.
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Project description:BackgroundPreoperative immunonutrition (IN) reduces the incidence of postoperative complications in malnourished patients undergoing upper gastrointestinal surgery. However, its effect in norm-nourished patients remains unclear. Furthermore, patients with gastric cancer undergoing laparoscopic total gastrectomy (LTG) are not routinely included in protocols of enhanced recovery after surgery (ERAS).ObjectiveThe aim of this study was to investigate the effects of perioperative IN in patients undergoing laparoscopic total gastrectomy (LTG) within an established ERAS pathway.MethodsA comparative retrospective study of patients undergoing LTG, receiving an immune-enhancing feed plus maltodextrin load the day of surgery (Group A) versus patients who had the same operation but no IN nor fast track management (group B).ResultsThere were no significant differences in patient demographic characteristics between the two groups but the medium age of patients in group A was older. Thirty-days postoperative complications were respectively 8.7% in Group A and 33.3% in Group B (p 0.04). Mean and median LOS for Group A and B were also significantly different: 7.2 ± 4.4 vs 10.3 ± 5.4 and 7 vs 10 days respectively.ConclusionPreoperative IN associated with ERAS protocol in normo-nourished patient undergoing LTG seems to reduce postoperative complications. Reduction in LOS is possibly associated to the ERAS protocol. Clinical trial registration Clinical trials.gov: NCT05259488.
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Project description:Objective: How hospital length of stay after delivery for women with preeclampsia is associated with risk for readmission is unknown. The objective of this study was to evaluate risk for 60-day hypertension-related postpartum readmission based on length of stay after delivery.Methods: The 2014 Healthcare Cost and Utilization Project's (HCUP) Nationwide Readmissions Database was used to analyze risk for readmission for a hypertension-related diagnosis within 60 days from cesarean delivery hospitalization for women with preeclampsia who underwent cesarean delivery. Risk for readmission was evaluated based on postoperative length of stay as well as demographic, hospital, and other obstetric factors. Population weights were applied to create national estimates. Multivariable analyses were performed with adjusted risk ratios (aRR) and corresponding 95% confidence intervals as measures of effect. Mean and median hospital charges based upon postoperative length of stay were also evaluated. Time from delivery hospitalization to readmission was calculated.Results: In 2014, 65 401 women with preeclampsia underwent cesarean delivery. Of these, 1016 women (1.6%) were readmitted for a hypertension-related diagnosis. 921 of the 1016 readmissions occurred within 10 days of discharge (90.6%). In adjusted analyses, postoperative LOS 5-7 days and >7 days compared to LOS <3 days were associated with decreased risk of 60-day hypertension-related readmission (aRR 0.59 95% CI 0.45, 0.78; aRR 0.53 95% CI 0.29, 1.00, respectively). When the cohort was restricted to women with severe preeclampsia or eclampsia, LOS 5-7 days was associated with decreased risk of 60-day hypertension-related readmission in both unadjusted and adjusted analyses compared to LOS <3 days (risk ratios (RR) 0.34, 95% CI 0.18, 0.65; aRR 0.29, 95% 0.18, 0.46, respectively). Median delivery hospitalization charges were $26 512. Compared to LOS <3 days, mean and median charges increased significantly for patients with LOS 4, 5-7, and >7 days.Conclusion: Longer postoperative length of stay during cesarean delivery hospitalizations was associated with decreased risk for postpartum hypertension-related readmission. Most readmissions occurred soon after discharge. These findings support that post-delivery management may play a role in likelihood of women requiring subsequent readmission for complications related to preeclampsia after discharge.
| S-EPMC6380960 | biostudies-literature
Project description:Simultaneously evaluate postoperative mortality, length of stay (LOS), and readmission.National Surgical Quality Improvement Program (NSQIP).Retrospective cohort.Data from elective general surgical patients were obtained from the 2012 NSQIP Participant Use File. For each postoperative day, each patient's state was classified as index hospitalization, discharged home, discharged to long-term care (LTC), readmitted, or dead. Transition rates were estimated using exponential regression, assuming constant rates for specified time periods. These estimates were combined into a multistate model, simulated results of which were compared to observed outcomes.Age, comorbidities, more complex procedures, and longer index LOS were associated with lower rates of discharge home and higher rates of death, discharge to LTC, and readmission. The longer patients had been discharged, the less likely they were to die or be readmitted. The model predicted 30-day mortality 0.38 percent (95 percent CI: 0.36-0.41), index LOS 2.85 days (95 percent CI: 2.83-2.86), LTC discharge 2.76 percent (95 percent CI: 2.69-2.82), and readmissions 5.53 percent (95 percent CI: 5.43-5.62); observed values were 0.39 percent, 2.82 days, 2.87 percent, and 5.70 percent, respectively.Multistate models can simultaneously predict postoperative mortality, LOS, discharge destination, and readmissions, which allows multidimensional comparison of surgical outcomes.
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Project description:IMPORTANCE:Hospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning. OBJECTIVE:To examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis. DESIGN:Retrospective cohort study. Data were extracted from the electronic health record. SETTING:Main hospital and satellite facility of a large quaternary care children's hospital from January 10, 2010, through April 30, 2011. PARTICIPANTS:A total of 740 infants aged 2 to 12 months and hospitalized with bronchiolitis. MAIN OUTCOME MEASURE:Hospital LOS. RESULTS:In the multivariable model adjusted for inverse weighting for propensity to receive deep suctioning, increased deep suction as a percentage of suction events was associated with increased LOS with a geometric mean of 1.75 days (95% CI, 1.56-1.95 days) in patients with no deep suction and 2.35 days (2.10-2.62 days) in patients with more than 60% deep suction. An increased number of suctioning lapses was also associated with increased LOS in a dose-dependent manner with a geometric mean of 1.62 days (95% CI, 1.43-1.83 days) in patients with no lapses and 2.64 days (2.30-3.04 days) in patients with 3 or 4 lapses. CONCLUSIONS AND RELEVANCE:For patients admitted with bronchiolitis, the use of deep suctioning in the first 24 hours after admission and lapses greater than 4 hours between suctioning events were associated with longer LOS.
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