Head and neck cancer readmission reduction(HANCARRE)project:Reducing 30-day readmissions  

作　　者：Sara Yang William Adams Carol Bier-Laning 

机构地区：[1]Department of Otolaryngology—Head and Neck Surgery,Loyola University Medical Center,Maywood,Illinois,USA [2]Department of Public Health Sciences,Loyola University Chicago,Maywood,Illinois,USA

出　　处：《World Journal of Otorhinolaryngology-Head and Neck Surgery》2022年第2期158-166,共9页世界耳鼻咽喉头颈外科杂志（英文）

摘　　要：Objective:Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction.The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focused on patient and staff education,use of targeted skilled nursing facilities,and appropriate use of patient observation status.Methods:This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018.In October 2016,the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery.These changes included enhancing patient education,increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses,and appropriate utilization of 23-h observation status for returning patients.The readmission rate from the pre-intervention era(October 2015 through September 2016)was compared to the readmission rate from the post-intervention era(October 2016 through September 2018).Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.Results:In this sample of 449 patients,161(35.9%)were observed before the change-in-practice(before October 2016),and 288(64.1%)were observed following the change-in-practice(after September 2016).On univariable analysis,the risk of readmission declined by approximately 41.4%from the pre-intervention era,though this conclusion was not statistically significant(P=0.06).On multivariable analysis,patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days(P=0.03).Similarly,those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days(P=0.001).No patient cha

关 键 词：30-day readmissions head and neck oncology healthcare utilization 

分 类 号：R739.91[医药卫生—肿瘤]