-
1.
Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial.
Golden, NH, Cheng, J, Kapphahn, CJ, Buckelew, SM, Machen, VI, Kreiter, A, Accurso, EC, Adams, SH, Le Grange, D, Moscicki, AB, et al
Pediatrics. 2021;(4)
-
-
Free full text
-
Abstract
BACKGROUND AND OBJECTIVES We recently reported the short-term results of this trial revealing that higher-calorie refeeding (HCR) restored medical stability earlier, with no increase in safety events and significant savings associated with shorter length of stay, in comparison with lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa. Here, we report the 1-year outcomes, including rates of clinical remission and rehospitalizations. METHODS In this multicenter, randomized controlled trial, eligible patients admitted for medical instability to 2 tertiary care eating disorder programs were randomly assigned to HCR (2000 kcals per day, increasing by 200 kcals per day) or LCR (1400 kcals per day, increasing by 200 kcals every other day) within 24 hours of admission and followed-up at 10 days and 1, 3, 6, and 12 months post discharge. Clinical remission at 12 months post discharge was defined as weight restoration (≥95% median BMI) plus psychological recovery. With generalized linear mixed effect models, we examined differences in clinical remission over time. RESULTS Of 120 enrollees, 111 were included in modified intent-to-treat analyses, 60 received HCR, and 51 received LCR. Clinical remission rates changed over time in both groups, with no evidence of significant group differences (P = .42). Medical rehospitalization rates within 1-year post discharge (32.8% [19 of 58] vs 35.4% [17 of 48], P = .84), number of rehospitalizations (2.4 [SD: 2.2] vs 2.0 [SD: 1.6]; P = .52), and total number of days rehospitalized (6.0 [SD: 14.8] vs 5.1 [SD: 10.3] days; P = .81) did not differ by HCR versus LCR. CONCLUSIONS The finding that clinical remission and medical rehospitalization did not differ over 1-year, in conjunction with the end-of-treatment outcomes, support the superior efficacy of HCR as compared with LCR.
-
2.
Predictor Biomarkers of Nonelective Hospital Readmission and Mortality in Malnourished Hospitalized Older Adults.
Pencina, KM, Bhasin, S, Luo, M, Baggs, GE, Pereira, SL, Davis, GJ, Deutz, NE, Travison, TG
The Journal of frailty & aging. 2020;(4):226-231
Abstract
BACKGROUND 90-day mortality and rehospitalizations are important hospital quality metrics. Biomarkers that predict these outcomes among malnourished hospitalized patients could identify those at risk and help direct care plans. OBJECTIVES To identify biomarkers that predict 90-day (primary) and 30-day (secondary) mortality or nonelective rehospitalization. DESIGN AND PARTICIPANTS An analysis of the ability of biomarkers to predict 90- and 30-day mortality and rehospitalization among malnourished hospitalized patients. SETTING 52 blood biomarkers were measured in 193 participants in NOURISH, a randomized trial that determined the effects of a nutritional supplement on 90-day readmission and death in patients >65 years. Composite outcomes were defined as readmission or death over 90-days or 30-days. Univariate Cox Proportional Hazards models were used to select best predictors of outcomes. Markers with the strongest association were included in multivariate stepwise regression. Final model of hospital readmission or death was derived using stepwise selection. MEASUREMENTS Nutritional, inflammatory, hormonal and muscle biomarkers. RESULTS Mean age was 76 years, 51% were men. In univariate models, 10 biomarkers were significantly associated with 90-day outcomes and 4 biomarkers with 30-day outcomes. In multivariate stepwise selection, glutamate, hydroxyproline, tau-methylhistidine levels, and sex were associated with death and readmission within 90-days. In stepwise selection, age-adjusted model that included sex and these 3 amino-acids demonstrated moderate discriminating ability over 90-days (C-statistic 0.68 (95%CI 0.61, 0.75); age-adjusted model that included sex, hydroxyproline and Charlson Comorbidity Index was predictive of 30-day outcomes (C-statistic 0.76 (95%CI 0.68, 0.85). CONCLUSIONS Baseline glutamate, hydroxyproline, and tau-methylhistidine levels, along with sex and age, predict risk of 90-day mortality and nonelective readmission in malnourished hospitalized older patients. This biomarker set should be further validated in prospective studies and could be useful in prognostication of malnourished hospitalized patients and guiding in-hospital care.
-
3.
Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study.
Gonzales, GB, Ngari, MM, Njunge, JM, Thitiri, J, Mwalekwa, L, Mturi, N, Mwangome, MK, Ogwang, C, Nyaguara, A, Berkley, JA
Maternal & child nutrition. 2020;(2):e12913
-
-
Free full text
-
Abstract
Hospital readmission is common among children with complicated severe acute malnutrition (cSAM) but not well-characterised. Two distinct cSAM phenotypes, marasmus and kwashiorkor, exist, but their pathophysiology and whether the same phenotype persists at relapse are unclear. We aimed to test the association between cSAM phenotype at index admission and readmission following recovery. We performed secondary data analysis from a multicentre randomised trial in Kenya with 1-year active follow-up. The main outcome was cSAM phenotype upon hospital readmission. Among 1,704 HIV-negative children with cSAM discharged in the trial, 177 children contributed a total of 246 readmissions with cSAM. cSAM readmission was associated with age<12 months (p = .005), but not site, sex, season, nor cSAM phenotype. Of these, 42 children contributed 44 readmissions with cSAM that occurred after a monthly visit when SAM was confirmed absent (cSAM relapse). cSAM phenotype was sustained during cSAM relapse. The adjusted odds ratio for presenting with kwashiorkor during readmission after kwashiorkor at index admission was 39.3 [95% confidence interval (95% CI) [2.69, 1,326]; p = .01); and for presenting with marasmus during readmission after kwashiorkor at index admission was 0.02 (95% CI [0.001, 0.037]; p = .01). To validate this finding, we examined readmissions to Kilifi County Hospital, Kenya occurring at least 2 months after an admission with cSAM. Among 2,412 children with cSAM discharged alive, there were 206 readmissions with cSAM. Their phenotype at readmission was significantly influenced by their phenotype at index admission (p < .001). This is the first report describing the phenotype and rate of cSAM recurrence.
-
4.
Effect of single follow-up home visit on readmission in a group of frail elderly patients - a Danish randomized clinical trial.
Lembeck, MA, Thygesen, LC, Sørensen, BD, Rasmussen, LL, Holm, EA
BMC health services research. 2019;(1):751
Abstract
BACKGROUND Unplanned hospital admissions are costly and prevention of these has been a focus for research for decades. With this study we aimed to determine whether discharge planning including a single follow-up home visit reduces readmission rate. The intervention is not representing a new method but contributes to the evidence concerning intensity of the intervention in this patient group. METHODS This study was a centrally randomized single-center controlled trial comparing intervention to usual care with investigator-blinded outcome assessment. Patients above the age of 65 were discharged from a single Danish hospital during 2013-2014 serving a rural and low socioeconomic area. For intervention patients study and department nurses reviewed discharge planning the day before discharge. On the day of discharge, study nurses accompanied the patient to their home, where they met with the municipal nurse. Together with the patient they reviewed cognitive skills, medicine, nutrition, mobility, functional status, and future appointments in the health care sector and intervened if appropriate. Readmission at any hospital in Denmark within 8, 30, and 180 days after discharge is reported. Secondary outcomes were time to first readmission, number of readmissions, length of stay, and readmission with Ambulatory Care Sensitive Conditions, visits to general practitioners, municipal services, and mortality. RESULTS One thousand forty-nine patients aged > 65 years discharged from medical, geriatric, emergency, surgical or orthopedic departments met inclusion criteria characteristic of frailty, e.g. low functional status, need of more personal help and multiple medications. Among 945 eligible patients, 544 were randomized. Seven patients died before discharge. 56% in the intervention group and 54% in the control group were readmitted (p = 0.71) and 23% from the intervention group and 22% from the control group died within 180 days. There were no significant differences between intervention and control groups concerning other secondary outcomes. CONCLUSIONS There was no effect of a single follow-up home visit on readmission in a group of frail elderly patients discharged from hospital. TRIAL REGISTRATION https://clinicaltrials.gov (identifier NCT02318680), retrospectively registered December 11, 2014.
-
5.
A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China.
Cui, X, Zhou, X, Ma, LL, Sun, TW, Bishop, L, Gardiner, FW, Wang, L
Rural and remote health. 2019;(2):5270
Abstract
INTRODUCTION Patient self-management skills are an important part of heart failure (HF) management. However, there is a lack of knowledge about the effectiveness of nurse-led education on patient self-management and the associated clinical outcomes of rural Chinese patients with chronic heart failure (CHF). As such, this study was designed to evaluate the impact of a nurse-led education program on patient self-management and hospital readmissions in rural Chinese patients with CHF. METHODS Ninety-six patients in the eastern Chinese province of Shandong with CHF were randomly divided into intervention and control groups. A structured education program was delivered to the intervention group during hospitalization and after discharge. Control group patients were managed as per clinical guidelines without structured education. Medication adherence, dietary modifications, social support, and symptom control were assessed 12 months after the educational intervention. RESULTS The mean score of medication adherence, dietary modifications, social support and symptom control in the intervention group was higher than in the control group at the end of the study (p<0.01). The readmission rates for HF in the intervention and control group were 10.4% and 27.1%, respectively (p=0.036). CONCLUSIONS This study has demonstrated that a structured education program was associated with a significant improvement in medication adherence, dietary modifications, social support, and symptom control in rural CHF patients. Furthermore, this program was associated with a significant reduction in hospital readmission. This study indicates that implementation of a nurse-led education program improves self-management and clinical outcomes of rural CHF patients, who may not have regular access to cardiac management services as per metropolitan populations.
-
6.
Administration of an Oral Hydration Solution Prevents Electrolyte and Fluid Disturbances and Reduces Readmissions in Patients With a Diverting Ileostomy After Colorectal Surgery: A Prospective, Randomized, Controlled Trial.
Migdanis, A, Koukoulis, G, Mamaloudis, I, Baloyiannis, I, Migdanis, I, Kanaki, M, Malissiova, E, Tzovaras, G
Diseases of the colon and rectum. 2018;(7):840-846
Abstract
BACKGROUND Patients with a newly formed ileostomy often develop electrolyte abnormalities and dehydration. OBJECTIVE The study assessed the prophylactic effect of an isotonic hydration solution on dehydration and electrolyte abnormalities in patients with a newly formed ileostomy. DESIGN This was a prospective, randomized, controlled trial (NCT02036346). SETTINGS The study was conducted at a single surgical unit of a public university hospital. PATIENTS Patients scheduled for elective rectosigmoid resection were considered for study inclusion. INTERVENTION Patients in whom a diverting ileostomy was created were randomly assigned to the intervention group (n = 39), which received an oral isotonic glucose-sodium hydration solution for 40 days postdischarge and the control group (n = 41) which did not receive an intervention. The 2 groups were compared with a group of patients who underwent rectosigmoid resection without diverting ileostomy (n = 37). MAIN OUTCOME MEASURES Serum electrolyte and renal function markers were assessed preoperatively and at 20 and 40 days postdischarge. RESULTS At 20 days postdischarge, the serum sodium of the control group appeared lower than the serum sodium of the intervention group and the nonileostomy group (p = 0.007). At the same time point, urea and creatinine levels of the control group were higher than the urea and creatinine levels of the other 2 groups (p = 0.01 and p = 0.02). At 40 days postdischarge, mean sodium and renal function markers improved in the control group, but sodium and creatinine continued to differ in comparison with the intervention and nonileostomy groups (p = 0.01 and p = 0.04). The readmission rate for fluid and electrolyte abnormalities was higher in the control group (24%) than in the other 2 groups, where no rehospitalization for such a reason was required (p = 0.001). LIMITATIONS The study was limited by its single-center design. CONCLUSION An oral isotonic drink postdischarge can have a prophylactic effect on patients with a newly formed ileostomy, preventing readmission for fluid and electrolyte abnormalities. See Video Abstract at http://links.lww.com/DCR/A603.
-
7.
Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure.
Chen, YW, Wang, CY, Lai, YH, Liao, YC, Wen, YK, Chang, ST, Huang, JL, Wu, TJ
Medicine. 2018;(4):e9629
-
-
Free full text
-
Abstract
BACKGROUND Exercise tolerance and cardiac output have a major impact on the quality of life (QOL) of patients experiencing heart failure (HF). Home-based cardiac rehabilitation can significantly improve not only exercise tolerance but also peak oxygen uptake ((Equation is included in full-text article.)peak), and the QOL in patients with HF. The aim of this prospective study was to evaluate the beneficial effects of home-based cardiac rehabilitation on the quality of medical care in patients with chronic HF. METHODS This study was a randomized prospective trial. HF patients with a left ventricular ejection fraction (LVEF) of less than 50% were included in this study. We randomly assigned patients to the control group (n = 18) and the interventional group (n = 19). Within the interventional group, we arranged individualized rehabilitation programs, including home-based cardiac rehabilitation, diet education, and management of daily activity over a 3-month period. Information such as general data, laboratory data, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) results, and the scores for the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before and after the intervention, was collected from all patients in this study. RESULTS Patients enrolled in the home-based cardiac rehabilitation programs displayed statistically significant improvement in (Equation is included in full-text article.)peak (18.2 ± 4.1 vs 20.9 ± 6.6 mL/kg/min, P = .02), maximal 6-Minute Walking Distance (6MWD) (421 ± 90 vs 462 ± 74 m, P = .03), anaerobic threshold (12.4 ± 2.5 vs 13.4 ± 2.6 mL/kg/min, P = .005), and QOL. In summary, patients receiving home-based cardiac rehabilitation experienced a 14.2% increase in (Equation is included in full-text article.)peak, a 37% increase in QOL score, and an improvement of 41 m on the 6MWD test. The 90-day readmission rate for patients reduced to 5% from 14% after receiving cardiac rehabilitation. CONCLUSION Home-based cardiac rehabilitation offered the most improved results in functional capacity, QOL, and a reduced the rate of readmission within 90 days.
-
8.
Serious Adverse Events Associated with Readmission Through One Year After Vertebral Augmentation with Either a Polyetheretherketone Implant or Balloon Kyphoplasty.
Beall, DP, Coe, JD, McIlduff, M, Bloch, D, Hornberger, J, Warner, C, Tutton, S
Pain physician. 2017;(6):521-528
Abstract
BACKGROUND The KAST (Kiva Safety and Efficacy) investigation device exempt (IDE) study indicated that the majority of patients responded equally well to vertebral augmentation using either an implant-based approach or balloon kyphoplasty (BK). Additional investigation has suggested that a subset of patients may benefit further by avoiding repeated readmissions due to serious adverse events (SAEs) if they receive one vertebral augmentation approach over another. OBJECTIVES The primary aim was to assess the effect of 2 different augmentation procedures on readmission rates for SAEs. STUDY DESIGN The KAST trial is a pivotal, multicenter, randomized, controlled trial conducted to evaluate an implant-based vertebral augmentation approach (implant) against BK. Post-hoc analysis was performed to evaluate SAEs and readmission rates. SETTING Twenty-one sites in North America and Europe. METHODS The treatment effect of vertebral implant versus BK on SAEs requiring unplanned readmission was evaluated by estimating the risk of SAEs associated with readmissions in KAST while controlling for key baseline covariates using multivariate Poisson regression modeling. RESULTS Forty (27.8%) patients with implants had 69 SAEs associated with readmission compared to 44 (31.2%) patients with BK having 103 events. The risk for all SAEs leading to readmission was 34.4% lower with the implant than for BK (95% confidence interval = 11.1%, 51.7%; P < 0.01). Multivariate analysis showed that the risk of SAEs associated with readmission was decreased in subjects treated with the implant compared to BK, and increased in patients with prior histories of vertebral compression fractures (VCFs) or significant osteoporosis. LIMITATIONS The power of the KIVA study was based on clinical efficacy criteria to meet FDA requirements and recommendations for equivalency or noninferiority. The primary endpoint in this post-hoc analysis is SAEs associated with readmissions; as a result, the sample size is underpowered, although the results remain significant. CONCLUSION The augmentation approaches compared here have similar pain relief and quality of life effects; the implant showed a lower risk of readmissions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01123512. Key words: Vertebral compression fracture, kiva implant, balloon kyphoplasty, vertebroplasty, health economics, osteoporosis.
-
9.
Medication Intervention for Chronic Kidney Disease Patients Transitioning from Hospital to Home: Study Design and Baseline Characteristics.
Alicic, RZ, Short, RA, Corbett, CL, Neumiller, JJ, Gates, BJ, Daratha, KB, Barbosa-Leiker, C, McPherson, S, Chaytor, NS, Dieter, BP, et al
American journal of nephrology. 2016;(2):122-9
-
-
Free full text
-
Abstract
BACKGROUND The hospital readmission rate in the population with chronic kidney disease (CKD) is high and strategies to reduce this risk are urgently needed. METHODS The CKD-Medication Intervention Trial (CKD-MIT; www.clinicaltrials.gov; NCTO1459770) is a single-blind (investigators), randomized, clinical trial conducted at Providence Health Care in Spokane, Washington. Study participants are hospitalized patients with CKD stages 3-5 (not treated with kidney replacement therapy) and acute illness. The study intervention is a pharmacist-led, home-based, medication management intervention delivered within 7 days after hospital discharge. The primary outcome is a composite of hospital readmissions and visits to emergency departments and urgent care centers for 90 days following hospital discharge. Secondary outcomes are achievements of guideline-based targets for CKD risk factors and complications. RESULTS Enrollment began in February 2012 and ended in May 2015. At baseline, the age of participants was 69 ± 11 years (mean ± SD), 50% (77 of 155) were women, 83% (117 of 141) had hypertension and 56% (79 of 141) had diabetes. At baseline, the estimated glomerular filtration rate was 41 ± 14 ml/min/1.73 m2 and urine albumin-to-creatinine ratio was 43 mg/g (interquartile range 8-528 mg/g). The most frequent diagnosis category for the index hospital admission was cardiovascular diseases at 34% (53 of 155), but the most common single diagnosis for admission was community-acquired acute kidney injury at 10% (16 of 155). CONCLUSION Participants in CKD-MIT are typical of acutely ill hospitalized patients with CKD. A medication management intervention after hospital discharge is under study to reduce post-hospitalization acute care utilization and to improve CKD management.
-
10.
Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization.
Desai, AS, Claggett, BL, Packer, M, Zile, MR, Rouleau, JL, Swedberg, K, Shi, V, Lefkowitz, M, Starling, R, Teerlink, J, et al
Journal of the American College of Cardiology. 2016;(3):241-248
Abstract
BACKGROUND Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization. OBJECTIVES This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril. METHODS We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril. RESULTS Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations. CONCLUSIONS Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization.