Search results

1 – 10 of 659
Content available
Article
Publication date: 9 April 2021

Tengiz Verulava, Revaz Jorbenadze, Ana Lordkipanidze, Ana Gongadze, Michael Tsverava and Manana Donjashvili

Heart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.

Abstract

Purpose

Heart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.

Design/methodology/approach

The authors explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) from 2015 to 2019. The authors analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6–9 months after the initial hospitalization for HF.

Findings

The major complication of cardiovascular diseases in elderly patients is HF (68.6%). Hospitalization rates due to HF in elderly patients have increased in recent years, which is associated with the population aging process. This trend will be most likely continue. Despite significant improvements in HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). About 6–9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases, including hypertension (43%), myocardial infarction (14%), diabetes (36%) and stroke (8%), affecting the readmission rate.

Originality/value

HF remains an important problem in public health. During HF-associated hospitalizations, both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.

Details

Journal of Health Research, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0857-4421

Keywords

To view the access options for this content please click here
Article
Publication date: 7 July 2020

Hui-chuan Chen, Tommy Cates, Monty Taylor and Christopher Cates

The purpose of this paper is to examine whether patient readmission rates are associated with patient satisfaction and Medicare reimbursement rates in the US hospitals.

Abstract

Purpose

The purpose of this paper is to examine whether patient readmission rates are associated with patient satisfaction and Medicare reimbursement rates in the US hospitals.

Design/methodology/approach

The Hospital Compare database was obtained from the Centers for Medicare and Medicaid Services (CMS) in the US. A total of 2,711 acute care hospitals were analyzed for this present study. The data included patient satisfaction surveys, hospital 30-days readmission ratios for heart failure and pneumonia patients and related payments. Exploratory factor analysis was applied in the first stage to operationalize constructs for scale development. Partial least squares (PLS) modeling analysis via Smart-PLS was utilized for testing the hypotheses.

Findings

Results indicated that data provided from the Hospital Compare database for the acute care hospitals accurately reflect quality outcomes. Nevertheless, the Medicare Hospital Readmissions Reduction Program (HRRP) did not penalize the hospitals when patients reported lower satisfaction via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Originality/value

The findings suggest that a high-readmission rate is not associated with lower payment. Such results appear to conflict with the goals of value-based purchasing programs, which seek to penalize hospitals financially for higher readmission rates.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 4/5
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 1 March 2016

Susan Camilleri and Kathleen Colville

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for…

Abstract

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for patients who receive post-acute care in facilities over which hospitals have little influence to monitor care. Using resource dependence and transaction cost economics to describe the theoretical advantages of hospital ownership of post-acute care facilities (PACs), we empirically test whether hospitals that own PACs experience reduced readmissions. Our findings indicate partial support for the predicted relationship between PAC ownership and readmission rates. We found that hospital ownership of a skilled-nursing facility (SNF) was related to a lower readmissions rate for some patients, while ownership of other types of PACs did not result in significant findings. Our results offer support for the theoretical advantages of ownership, however, the savings realized by ownership may not merit the ownership investment.

Details

International Journal of Organization Theory & Behavior, vol. 19 no. 2
Type: Research Article
ISSN: 1093-4537

To view the access options for this content please click here
Article
Publication date: 1 December 2004

Linda Dobrzanska

The measuring of emergency readmission rates to hospital following discharge is one of fifteen health outcomes the United Kingdom government monitors on an annual basis…

Abstract

The measuring of emergency readmission rates to hospital following discharge is one of fifteen health outcomes the United Kingdom government monitors on an annual basis. There is a wide variation between readmission rates, and it is especially important to older people that there is a reduction in unacceptable variations. A closer understanding of reasons for readmission is therefore necessary to inform future developments, identify patients who may be at high risk of readmission and target resources more appropriately. A review of literature from the United Kingdom and international studies may help in determining the reasons for the unplanned readmission of older people. This could then allow for a re‐allocation of resources in the most cost‐effective and cost‐efficient manner. The literature review was conducted via keywords and combination of keyword searches from 1990‐2003 using various electronic databases. There were several themes that emerged from the literature, and these have been described within the paper. Following the review of the literature it emerged that many international studies into the causes of readmission of older people have an inconsistent approach in defining certain terms. However, in the United Kingdom, there appears a more consistent approach. Most studies agree that the majority of readmissions occur as a result of a relapse or complication of an initial illness. However, some American studies associate the readmission of older people with a specific disease, and the antecedent care process. The findings in the literature have identified several gaps that enable recommendations for future research to be made.

Details

Quality in Ageing and Older Adults, vol. 5 no. 4
Type: Research Article
ISSN: 1471-7794

Keywords

To view the access options for this content please click here
Article
Publication date: 4 May 2021

Nor Hamizah Miswan, Chee Seng Chan and Chong Guan Ng

This paper develops a robust hospital readmission prediction framework by combining the feature selection algorithm and machine learning (ML) classifiers. The improved…

Abstract

Purpose

This paper develops a robust hospital readmission prediction framework by combining the feature selection algorithm and machine learning (ML) classifiers. The improved feature selection is proposed by considering the uncertainty in patient's attributes that leads to the output variable.

Design/methodology/approach

First, data preprocessing is conducted which includes how raw data is managed. Second, the impactful features are selected through feature selection process. It started with calculating the relational grade of each patient towards readmission using grey relational analysis (GRA) and the grade is used as the target values for feature selection. Then, the influenced features are selected using the Least Absolute Shrinkage and Selection Operator (LASSO) method. This proposed method is termed as Grey-LASSO feature selection. The final task is the readmission prediction using ML classifiers.

Findings

The proposed method offered good performances with a minimum feature subset up to 54–65% discarded features. Multi-Layer Perceptron with Grey-LASSO gave the best performance.

Research limitations/implications

The performance of Grey-LASSO is justified in two readmission datasets. Further research is required to examine the generalisability to other datasets.

Originality/value

In designing the feature selection algorithm, the selection on influenced input variables was based on the integration of GRA and LASSO. Specifically, GRA is a part of the grey system theory, which was employed to analyse the relation between systems under uncertain conditions. The LASSO approach was adopted due to its ability for sparse data representation.

Details

Grey Systems: Theory and Application, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2043-9377

Keywords

To view the access options for this content please click here
Article
Publication date: 23 August 2018

Murtaza Nasir, Carole South-Winter, Srini Ragothaman and Ali Dag

The purpose of this paper is to formulate a framework to construct a patient-specific risk score and therefore to classify these patients into various risk groups that can…

Abstract

Purpose

The purpose of this paper is to formulate a framework to construct a patient-specific risk score and therefore to classify these patients into various risk groups that can be used as a decision support mechanism by the medical decision makers to augment their decision-making process, allowing them to optimally use the limited resources available.

Design/methodology/approach

A conventional statistical model (logistic regression) and two machine learning-based (i.e. artificial neural networks (ANNs) and support vector machines) data mining models were employed by also using five-fold cross-validation in the classification phase. In order to overcome the data imbalance problem, random undersampling technique was utilized. After constructing the patient-specific risk score, k-means clustering algorithm was employed to group these patients into risk groups.

Findings

Results showed that the ANN model achieved the best results with an area under the curve score of 0.867, while the sensitivity and specificity were 0.715 and 0.892, respectively. Also, the construction of patient-specific risk scores offer useful insights to the medical experts, by helping them find a trade-off between risks, costs and resources.

Originality/value

The study contributes to the existing body of knowledge by constructing a framework that can be utilized to determine the risk level of the targeted patient, by employing data mining-based predictive approach.

Details

Industrial Management & Data Systems, vol. 119 no. 1
Type: Research Article
ISSN: 0263-5577

Keywords

To view the access options for this content please click here
Article
Publication date: 3 July 2017

Søren Halkjær and Rainer Lueg

The purpose of this paper is to analyze how specialization in hospitals affects operational performance, measured by the length of stay and readmission rate. The authors…

Abstract

Purpose

The purpose of this paper is to analyze how specialization in hospitals affects operational performance, measured by the length of stay and readmission rate. The authors assess a public policy change in the Danish healthcare sector from 2011 which required that some hospital services had to be centralized leading to specialization within the merged departments.

Design/methodology/approach

Taking an institutional theory perspective, the authors conduct a natural experiment. The data include 24,694 observations of urological patient treatments from 2010 to 2012.

Findings

The econometric difference-in-difference analysis finds that the readmission rate decreases by approximately four percentage points in the departments affected by the policy change. Contrary to expectations, the length of stay increases by 0.38 days. The authors complement the natural experiment with a mixed-methods approach that includes proprietary data from the management control system of the hospital, public documentation on the policy change, as well as interviews with key informants. These data suggest that operational deficiency is related to the fact that specialization was externally enforced through the public policy change. The authors illustrate how the hospital staff struggle for legitimacy after this policy change, and how cost savings obstructed the specialized department in achieving its goals.

Originality/value

The authors conclude that the usual economies-of-scales-based logic of (higher)volume-(better)outcome studies cannot easily be transferred to specialization in hospitals, unless one accounts for the institutional reason of the specialization.

Details

International Journal of Operations & Production Management, vol. 37 no. 7
Type: Research Article
ISSN: 0144-3577

Keywords

To view the access options for this content please click here
Book part
Publication date: 1 January 2006

William E. Encinosa, Didem M. Bernard and Claudia A. Steiner

Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic…

Abstract

Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care.

Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample.

Design. We use the 1998–2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine post-operative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes.

Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery.

Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001–2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures.

Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery.

Details

The Economics of Obesity
Type: Book
ISBN: 978-1-84950-482-9

To view the access options for this content please click here
Book part
Publication date: 4 October 2018

Afsaneh Roshanghalb, Cristina Mazzali, Emanuele Lettieri and Anna Maria Paganoni

This study investigates the stability of the “hospital effect” on performance over time by administrative health data as a source of evidence. Using 78,907 heart failure…

Abstract

This study investigates the stability of the “hospital effect” on performance over time by administrative health data as a source of evidence. Using 78,907 heart failure adult records from 117 hospitals in the Lombardy Region (Northern Italy) over three years (2010–2012), we analyzed hospital performance in terms of 30-day mortality and 30-day unplanned readmissions to gather evidence about the stability of the “hospital effect.” Best/worst performers were identified through multi-level models that combine both patient and hospital covariates. Our results confirm that managerial choices affect hospital performance, and that the “hospital effect” is not, contrary to expectations, stable over the short term. Performance improvement/worsening over the three years has been also analyzed.

Details

Performance Measurement and Management Control: The Relevance of Performance Measurement and Management Control Research
Type: Book
ISBN: 978-1-78756-469-5

Keywords

To view the access options for this content please click here
Article
Publication date: 1 August 2003

Stephen Brewster

How should we judge a readmission to high secure psychiatric services? A case‐by‐case view is insufficient to make sense of potential service deficiencies. People in high…

Abstract

How should we judge a readmission to high secure psychiatric services? A case‐by‐case view is insufficient to make sense of potential service deficiencies. People in high secure psychiatric settings more often than not test our services and cause considerable alarm. The local clinical response is to seek to improve the condition, and they enter the high secure service. The political, legal and clinical imperatives ensure that patients return just as soon as they are ‘fit’. This paper details the career paths of 11 ‘readmissions’ to Ashworth Hospital, now part of Mersey Care NHS Trust, and suggests that it is more a question of tackling gaps in our combined services than of ascribing individual failings.

Details

The British Journal of Forensic Practice, vol. 5 no. 3
Type: Research Article
ISSN: 1463-6646

1 – 10 of 659