Patient Care

When Do Patient-Reported Outcome Measures Inform Readmission Risk?


 

Clinical question: Among patients discharged from the hospital, how do patient-reported outcome (PRO) measures change after discharge, and can they predict readmission or ED visit?

Background: Variables to predict 30-day rehospitalizations of discharged general medical patients have been looked into, but not many strategies have incorporated PRO measures in predictive models.

Study design: Longitudinal cohort study.

Setting: Patients discharged from an urban safety-net hospital that serves 128 municipalities in northeastern Illinois, including the city of Chicago.

Synopsis: One hundred ninety-six patients completed the initial survey; completion rates were 98%, 90%, and 88% for the 30-, 90-, and 180-day follow-up surveys, respectively. The Memorial Symptom Assessment Scale (MSAS) and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health short form assessing general self-rated health (GSRH), global physical health (GPH), and global mental health (GMH) were administered. In-hospital assessments of GMH and GSRH predicted 14-day reutilization, whereas post-hospitalization assessments of MSAS and GPH predicted subsequent utilizations. Notable limitations of the study include small sample size with high proportion of uninsured and racial/ethnic minorities and inability to count utilization at hospital(s) other than the hospital studied.

Bottom line: PRO measures are likely to be useful predictors in clinical medicine. More research is needed to improve the generalizability of PRO measures. Perhaps determination of specific measures of high predictive value may be more useful.

Citation: Hinami K, Smith J, Deamant CD, DuBeshter K, Trick WE. When do patient-reported outcome measures inform readmission risk? J Hosp Med. 2015;10(5):294-300.


Short Takes

TREATMENT WITH BETA-LACTAM MONOTHERAPY IS AN OPTION FOR COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS.

Cluster randomized trial showed beta-lactam monotherapy was non-inferior to beta-lactam-macrolide combination or fluoroquinolone monotherapy with regards to 90-day mortality (9%, 11.1%, 8.8% respectively) in non-ICU wards.

Citation: Postma DF, Van Werkhoven CH, Van Elden LJ, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372(14):1312-1323.


BURDEN ON HEALTHCARE SYSTEM CAN BE ALLEVIATED BY REDUCING HOSPITAL-ONSET CLOSTRIDIUM DIFFICILE INFECTIONS (CDIs) AND THEIR READMISSIONS.

CDI discharges have a higher 30-day readmission rate and longer length of stay among readmissions as compared to non-CDI discharges; reduction in the hospital-onset CDIs can improve cost savings to the healthcare system.

Citation: Chopra T, Neelakanta A, Dombecki C, et al. Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program. Am J Infect Control. 2015;43(4):314-317.


PHYSICAL THERAPY (PT) IS AS EFFECTIVE AS SURGERY FOR LUMBAR SPINAL STENOSIS (LSS) TREATMENT

Randomized controlled trial from 2000-2007 found that surgical decompression has the same effect as a PT regime on physical function score at two years in patients with LSS (p>0.50).

Citation: Delitto A, Piva SR, Moore CG, et al. Surgery versus non-surgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465-473.

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