Document Detail

Use of hospital-based acute care among patients recently discharged from the hospital.
MedLine Citation:
PMID:  23340638     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Current efforts to improve health care focus on hospital readmission rates as a marker of quality and on the effectiveness of transitions in care during the period after acute care is received. Emergency department (ED) visits are also a marker of hospital-based acute care following discharge but little is known about ED use during this period.
OBJECTIVES: To determine the degree to which ED visits and hospital readmissions contribute to overall use of acute care services within 30 days of discharge from acute care hospitals, to describe the reasons patients return for ED visits, and to describe these patterns among Medicare beneficiaries and those not covered by Medicare insurance.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study of patients aged 18 years or older (mean age: 53.4 years) who were discharged between July 1, 2008, and September 31, 2009, from acute care hospitals in 3 large, geographically diverse states (California, Florida, and Nebraska) with data recorded in the Healthcare Cost and Utilization Project state inpatient and ED databases.
MAIN OUTCOME MEASURES: The 3 primary outcomes during the 30-day period after hospital discharge were ED visits not resulting in admission (treat-and-release encounters), hospital readmissions from any source, and a combined measure of ED visits and hospital readmissions termed hospital-based acute care.
RESULTS: The final cohort included 5,032,254 index hospitalizations among 4,028,555 unique patients. In the 30 days following discharge, 17.9% (95% CI, 17.9%-18.0%) of hospitalizations resulted in at least 1 acute care encounter. Of these 1,233,402 postdischarge acute care encounters, ED visits comprised 39.8% (95% CI, 39.7%-39.9%). For every 1000 discharges, there were 97.5 (95% CI, 97.2-97.8) ED treat-and-release visits and 147.6 (95% CI, 147.3-147.9) hospital readmissions in the 30 days following discharge. The number of ED treat-and-release visits ranged from a low of 22.4 (95% CI, 4.6-65.4) encounters per 1000 discharges for breast malignancy to a high of 282.5 (95% CI, 209.7-372.4) encounters per 1000 discharges for uncomplicated benign prostatic hypertrophy. Among the highest volume discharges, the most common reason patients returned to the ED was always related to their index hospitalization.
CONCLUSIONS AND RELEVANCE: After discharge from acute care hospitals in 3 states, ED visits within 30 days were common among adults and accounted for 39.8% of postdischarge hospital-based acute care visits. Improving care transitions should focus not only on decreasing readmissions but also on ED visits.
Anita A Vashi; Justin P Fox; Brendan G Carr; Gail D'Onofrio; Jesse M Pines; Joseph S Ross; Cary P Gross
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-23     Completed Date:  2013-01-24     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  364-71     Citation Subset:  AIM; IM    
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MeSH Terms
Databases, Factual
Diagnosis-Related Groups
Emergency Service, Hospital / utilization*
Medicare / statistics & numerical data
Middle Aged
Outcome Assessment (Health Care)
Patient Discharge / statistics & numerical data*
Patient Readmission / statistics & numerical data*
Prospective Studies
Quality Indicators, Health Care*
Time Factors
United States
Grant Support
K08 AG032886/AG/NIA NIH HHS; K08 AG032886/AG/NIA NIH HHS
Comment In:
JAMA. 2013 Jan 23;309(4):394-6   [PMID:  23340642 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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