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A root cause analysis of preventable 30-day readmissions in patients with heart failure

Osnard, Michael (2016) A root cause analysis of preventable 30-day readmissions in patients with heart failure. Master Essay, University of Pittsburgh.

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Abstract

Background Preventable 30-day readmissions are very costly to the healthcare system. Efforts to reduce their occurrence are thus necessary. Yet, without a clear understanding of the main drivers of this phenomenon, it becomes difficult to efficiently and strategically solve this problem. Methods We studied a subset of the Primary Care Resource Center project, including data collected from April 2015 thru April 2016 at 4 hospital centers. We reviewed information from a cohort of patients with heart failure divided into 2 groups: one composed of patients with HF who experienced an episode of readmission within 30 days of discharge, and another composed of patients with HF who experienced a new unrelated admission or an admission beyond 30-day of discharge. A root cause analysis characterized each admission according to 6 categories: patient preparedness/readiness, follow-up support, evidence-base care, planned admission, unrelated acute illness or injury, or undetermined cause. Subcategories of root causes were also studied. Chi-square test of independence and two-way contingency tables yielding relative frequencies and odds ratios were used to examine differences between groups. Fishbone analysis identified critical readmission drivers in the categories selected. Results A total of 1920 root cause entries for patients with heart failure, with a mean age of 75.8 years old were studied. Relative frequencies and odds ratios of 30-day readmissions by root cause were 15.02% (OR = 0.39, 95% CI 0.31-0.49) for patient readiness factors, 40.3% (OR = 2.26, 95% CI 1.57-3.27) for discharge process/follow-up factors, 26.2% for evidence-base care factors (OR = 1.13, 95% CI 0.74-1.71), 25.0% (OR = 1.05, 95% CI 0.45-2.43) for planned admission, 30.3% (OR = 1.55, 95% CI 1.23-1.27) for unrelated acute illness or injury, and 31.3% for undetermined cause (OR = 1.54, 95% CI 1.17-2.02). Conclusion Flaws in follow-up support and gaps in discharge process constituted the largest proportion of readmissions, and more than doubled the risk of a 30-day readmission for patients with HF. Additionally, home care, transportation and PCP follow-up related factors were key readmission characteristics identified. From a Public Health standpoint, characterizing these relationships can help guide decision-makers in allocating resources where outcomes can be most greatly optimized.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Osnard, Michaelmio18@pitt.eduMIO18
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFinegold, David Ndnf@pitt.eduDNFUNSPECIFIED
Committee MemberCastle, Nicholascastlen@pitt.eduCASTLENUNSPECIFIED
Date: July 2016
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 11 Aug 2016 18:32
Last Modified: 02 May 2019 14:57
URI: http://d-scholarship.pitt.edu/id/eprint/28639

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