• Title, Summary, Keyword: readmission

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Estimation of cost by unnecessary readmission of the tertiary hospitals (불필요한 재입원 비용 추정에 관한 연구)

  • Shin, Min Sun;Lee, Won Jae
    • Journal of the Korea Convergence Society
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    • v.8 no.12
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    • pp.149-157
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    • 2017
  • Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

Effect of Synagis (palivizumab) prophylaxis on readmission due to respiratory syncytial virus in very low birth weight infants (극소 저체중 출생아에서 Synagis (palivizumab) 접종이 respiratory syncytial virus 감염으로 인한 재입원에 미치는 영향)

  • Park, Soo Kyoung;Jung, Yu Jin;Yoo, Hye Soo;Ahn, So Yoon;Seo, Hyun Joo;Choi, Seo Hui;Kim, Myo Jing;Jeon, Ga Won;Koo, Soo Hyun;Lee, Kyung-Hoon;Chang, Yun Sil;Park, Won Soon
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.358-364
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    • 2010
  • Purpose : The aim of this study was to determine the efficacy of $Synagis^{(R)}$ (palivizumab) in reducing the respiratory syncytial virus (RSV) readmission rate in very low birth weight infants (VLBWI ) and the subgroup that showed the most effective vaccination. Methods : We enrolled 350 VLBWI who had been discharged alive from the neonatal intensive care unit of Samsung Medical Center from January 2005 to December 2007 and were followed up for at least one year. A retrospective study based on medical records was performed for a period of one year after discharge. RSV readmission rate was investigated according to BPD (bronchopulmonary dysplasia, requiring oxygen at postnatal day 28) and $Synagis^{(R)}$ prophylaxis. We categorized the subgroups by the severity of BPD gestational age, and birth weight and compared the RSV readmission rates between subgroups. Results : Eleven VLBWI were readmitted. $Synagis^{(R)}$ prophylaxis resulted in a 86% reduction in the rate of readmission due to RSV infection (prophylaxis group, 0.7% and no prophylaxis group, 5.0%; P =0.02). Readmission rate in BPD patients was also reduced in the prophylaxis group (0.7% in the prophylaxis group vs. 5.2% in the no prophylaxis group, P =0.03). The readmission rate in patients without BPD was reduced in the prophylaxis group (0% in the prophylaxis group vs. 4.9% in the no prophylaxis group, P =1.00), but this was not statistically significant.Conclusion : $Synagis^{(R)}$ prophylaxis was effective at reducing RSV readmission in VLBWI. Its efficacy was verified irrespective of BPD, gestational age, or birth weight.

Unplanned Readmission to Intensive Care Unit during the same Hospitalization at a Teaching Hospital (계획에 없던 중환자실 재입실 실태 및 원인)

  • Song, Dong-Hyun;Lee, Sun-Gyo;Kim, Chui-Gyu;Choi, Dong-Ju;Lee, Sang-Il;Park, Su-Kil
    • Quality Improvement in Health Care
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    • v.10 no.1
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    • pp.28-41
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    • 2003
  • Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

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Increased Readmission Risk and Healthcare Cost for Delirium Patients without Immediate Hospitalization in the Emergency Department

  • Ma, I Chun;Chen, Kao Chin;Chen, Wei Tseng;Tsai, Hsin Chun;Su, Chien-Chou;Lu, Ru-Band;Chen, Po See;Chang, Wei Hung;Yang, Yen Kuang
    • Clinical Psychopharmacology and Neuroscience
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    • v.16 no.4
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    • pp.398-406
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    • 2018
  • Objective: Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit. Methods: Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson's comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed. Results: Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities ($CCI{\geq}3$) or older patients (${\geq}65years$). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period. Conclusion: Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty (고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화)

  • Jang, Won-Mo;Eun, Sang-Jun;SaGong, Pil-Young;Lee, Chae-Eun;Oh, Moo-Kyung;Oh, Ju-Hwan;Kim, Yoon
    • Journal of Preventive Medicine and Public Health
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    • v.43 no.6
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    • pp.523-534
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    • 2010
  • Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

Analysis of Readmission Patients after Lumbar Microdiscectomy (요추간판 미세 현미경 수술 후 재입원 환자의 분석)

  • Chi, Yong-Chul;Son, Byung-Gil;Choi, Eun-Seok;Lee, Si-Ou;Shin, Jong-Hyun;Cha, Young-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.29 no.6
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    • pp.772-777
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    • 2000
  • Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

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Outcomes of Home Care Service for Coronary Artery Bypass Graft (관상동맥우회술 환자의 가정간호 효과)

  • Baek, Hee-Chong
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.10 no.2
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    • pp.123-131
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    • 2003
  • This study was to compare the functional status. complication and readmission rates. and client satisfaction with nursing care of home-based care and hospital-based care for clients with Coronary Artery Bypass Graft. Raw data were collected by interviewing and reviewing charts of 41 clients with Coronary Artery Bypass Graft between June 2001 and July 2002 at an university hospital located in Seoul. Korea. Out of 41 clients. 15 were in home care group and 26 were in hospitalization group. The baseline characteristics of the groups were almost identical. Mean age was 61.7 and 75.6% of clients being male. For home care group. the data collection was made at discharge and at termination of home care. and for hospitalization group. at discharge and at the first visit of outpatient department. Complication and readmission rates were investigated at one month after operation. Collected data were then analysed by conducting Chi-square test. Wilcoxon rank sum test. and Wilcoxon signed ranks test with SPSS program. The level of significance was .05. The results of the study are summarized as follows: 1. Postoperative length of stay of the home care group was shorter than that of hospitalization group by 1. 14 days(8.45 days vs. 9.59 days). On average. 1.8 home visits per client were observed. 2. The functional status (Barthel Index) at the termination of home care was significantly increased from that at discharge. For hospitalization group. a significant increase was observed between the functional status at the discharge and that at the first visit of outpatient department. The differencies in incremental of the scores. between the groups. were however not significant. 3. Complication and readmission rates; no statistically significant difference between the groups was observed. 4. The client satisfaction with nursing care (CSS) at termination of home care was significantly higher than that at hospital discharge. In conclusion. the outcomes of the analysis suggest that the home care benefits clients with Coronary Artery Bypass Graft. Client satisfaction with nursing care rises at termination of home care as compare to that measured at hospital discharge. Meanwhile. there was no significant differences in functional status. and complication and readmission rates. Further. home care reduced the length of stay in hospital.

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A study of the Characteristics of Readmitted Patients in an University Hospital in Korea (재입원 환자의 특성연구)

  • Hong, Joon-Hyun
    • Quality Improvement in Health Care
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    • v.2 no.2
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    • pp.56-71
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    • 1996
  • Background : Review of readmissions in health care facilities is necessary from the viewpoint of both economic concerns and quality considerations. To identify the characteristics, factors, and causes of multiple admissions in comparison with single admissions is essential for both providers and payers in order to assure quality care and efficient use of medical resources. Methods: All discharges from an university hospital in 1993 were analyzed, and the characteristics of multiple admissions were identified and were compared with those of single admissions by using the data bases of the discharge abstract and billing for reimbursement. Medical records of patients readmitted within 6 days after the previous discharge were reviewed to identify the reasons for such prompt readmission. Statistical analysis between groups of patients were performed by using SPSS. Result : The mean age was higher in multiple admissions than those of single admissions, and the average length of stay was longer in multiple admissions than in single admissions. The hospital cost per day is higher in single admissions while the cost per case is higher in multiple admissions. More than half of readmissions occurred within one month after the preceding discharges. Above 15% of the readmission within 6 days after the preceding discharges seemed to have close relationship with quality of care provided during the preceding hospitalization. The death rate of the patients readmitted within 6 days was the highest in comparison with multiple admissions and single admissions. Conclusion : Potential preventable readmissions should be reduced by identifying characteristics of multiple admissions, especially unplanned readmission, and by applying some interventions such as standard predischarge assessment or careful follow-up care after discharge for high risk readmission groups. As the results of these efforts, health care facilities could achieve quality improvement in medical care, and effective use of hospital resources.

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Comparison in nursing needs of heart disease patients depending on whether or not readmitted (재입원 여부에 따른 심질환자의 간호요구 비교)

  • Choi, Young-Sil
    • Journal of Digital Convergence
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    • v.12 no.6
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    • pp.519-526
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    • 2014
  • The purpose of this study was investigate nursing needs of heart disease patients depending on whether or not readmitted. Who had diagnosed heart disease and admitted on a general hospital was collected as a self-administered questionnaire method from March to June 2012. Collected data were analyzed through the SPSS 18.0 program. The average of total nursing needs is $4.12{\pm}.49$ point in patient who were not in readmission, and $3.89{\pm}.63$ point in patient joined readmission, there were significant differenced(p=.046). Therapeutic nursing needs are higher than others in nursing needs, in the both groups. Each rank and sub-regions is also different nursing needs according to readmission in two group. Physical, Social-emotional, educational and therapeutic nursing needs was correlated each other in depth. Therefore, focusing on patient's nursing needs according to patient's characteristics are required to perform nursing.

Convergence Analysis of Risk factors for Readmission in Cardiovascular Disease: A Machine Learning Approach (의사결정나무분석을 이용한 심혈관질환자의 재입원 위험 요인에 대한 융합적 분석)

  • Kim, Hyun-Su
    • Journal of Convergence for Information Technology
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    • v.9 no.12
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    • pp.115-123
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    • 2019
  • This is descriptive study to 2nd analysis data KNHANES IV-VI about risk factors of readmission among patients with cardiovascular disease. Among the total 65,973 adults, 1,037 with angina or myocardial infarction were analyzed. The analysis was conducted using SPSS window 21 Program and CHAID decision tree was used in the classification analysis. Root nodes are economic activity(χ2=12.063, p=.001), children's nodes are personal income(χ2=6.575, p=.031), weight change(χ2=12.758, p=.001), residential area(χ2=4.025, p=.045), direct smoking(χ2=3.884, p=.031). p=.049), level of education(χ2=9.630, p=.024). Terminal nodes are hypertension(χ2=3.854, p=.050), diabetes mellitus(χ2=6.056, p=.014), occupation type(χ2=7.799, p=.037). We suggest that the development and operation of programs considering the integrated approach of various factors is necessary for the readmission management of cardiovascular patients.