Advocate Good Samaritan Hospital

AimsIn the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients with ambulatory pulmonary artery pressure (PAP) monitoring guidance. We investigated the effect of ambulatory haemodynamic monitoring on 90 day readmission rates after HFH.Methods and resultsWe retrospectively analysed patients across the Advocate Aurora Health hospital network who had undergone PAP sensor implantation between 1 October 2015 and 31 October 2019. Patients with a ventricular assist device (VAD) or transplant prior to implantation were excluded. Rates of total HFH and 30 and 90 day all‐cause readmission up to 12 months after implantation were collected, while censoring for an endpoint of heart transplantation, VAD, or death. Event rates were compared using Poisson regression. Of 459 patients included, there were 404 HFHs before and 179 after implantation. Compared with pre‐implantation, 30 day all‐cause readmission [incidence rate ratio (IRR): 0.55 (0.39–0.77), P = 0.0006] and 90 day all cause readmission rates were lower post‐implantation [IRR: 0.45 (0.35–0.58), P < 0.0001]. The effect of PAP sensor implantation on 90 day all‐cause readmission incidence rates was consistent across multiple subgroups.ConclusionsAcross a large hospital network, ambulatory haemodynamic monitoring was associated with lower HFH rates, as well as 30 and 90 day all‐cause readmission rates. This supports the utility of ambulatory PAP monitoring to improve HF management in the era of value‐based medicine.

BackgroundInfectious diseases consult (IDC) and antimicrobial stewardship (AMS) intervention independently demonstrate improved management of Staphylococcus aureus bacteremia (SAB). However, data supporting utilizing both strategies is limited. The objective of the current study is to assess evidence-based bundle adherence for SAB in the presence and absence of mandatory IDC and AMS pharmacist review in a multi-site health system.MethodsThis retrospective study included adult inpatients with SAB from January 2016 to December 2018 at seven hospitals. Outcomes were compared between three groups: pre-mandatory IDC and AMS review (group 1), post-mandatory IDC and pre-AMS review (group 2), and post-mandatory IDC and AMS review (group 3). The primary outcome was bundle adherence defined as: appropriate intravenous antimicrobial therapy, appropriate duration of therapy, 24–48-hour surveillance cultures until documented clearance, echocardiography, and removal of indwelling intravenous catheters, if applicable. Secondary endpoints included individual bundle components, source control, length of stay (LOS), 30-day bacteremia-related readmission, and in-hospital all-cause mortality.ResultsA total of 579 patients met the final inclusion criteria for analysis. Complete bundle adherence was achieved in 65% of patients for group 1 (n = 371), 54% for group 2 (n = 87), and 76% for group 3 (n = 121). Adherence to bundle elements was significantly higher in group 3 when compared with group 1 (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37–0.93), and group 2 (OR 0.37, 95% CI 0.20 – 0.67). No difference in bundle adherence was noted between groups 1 and 2. When comparing groups 1, 2 and 3, significant differences were seen in obtaining echocardiography (91% vs. 83% vs. 100%; P = 0.0378), and hospital LOS (10.5 vs. 8.85 vs. 12.0 days; P = 0.0149), respectively. Increased hospital LOS in group 3 may be due to nonsignificant higher rates of complicated bacteremia compared with groups 2 and 1 (32% vs. 44% vs. 43%, P = 0.09), respectively. No differences were noted for readmission or mortality.ConclusionThe addition of AMS pharmacist review to mandatory IDC significantly improved quality care bundle adherence.DisclosuresAll authors: No reported disclosures.

Background: Patients with cancer are experiencing rapidly rising out-of-pocket costs. The term financial toxicity has emerged to describe the negative impact of these costs on patients with cancer, such as impact on quality of life, treatment adherence, and greater risk of mortality. As patient out-of-pocket expenses have increased, hospitals have increasingly incurred bad debt resulting from unpaid financial obligations. Cancer programs have implemented financial navigation programs to ease the negative impact of financial toxicity on patients and the negative impact of lost revenue on healthcare organizations. The manual nature of financial navigation, however, has limited the ability for navigators to assist patients at risk for financial toxicity and demonstrate value for both patients and healthcare organizations. Though efforts are made to identify financially at-risk patients, most patients self-select into these types of programs. As a result, those with the greatest financial need or collection risk may not receive available assistance.Objective: The objective of the pilot study was to analyze the effect of automating financial navigation programs using the TailorMed Financial Navigation Platform (tailormed.co).Methods: The TailorMed Platform analyzed 4,616 patients at the Cowell Family Cancer Center, Traverse City, Mich. The software identified 244 “high-priority” patients based on high out-of-pocket responsibility, risk for financial toxicity, and qualification for available navigation opportunities. Financial navigators pursued assistance opportunities for these patients using the TailorMed Platform and accounted for the different forms of awarded assistance in patient benefits and organizational financial performance.Results: The study ran for 8 months, during which 244 patients were reviewed by Cowell Family Cancer Center financial navigators. Of the 244 patients, 181 (74 percent) received one or more forms of assistance based on financial opportunities identified by the software. Financial navigators secured a combined total of $3,553,453 in “approved savings” (defined as the total value of aid secured through the financial navigation process); $1,524,562 of this savings accounted for community benefit (defined as direct patient benefits such as aid to offset living expenses, transportation costs, provide free or replacement drugs, or aid for services that are not billed by the hospital, such as oral drugs); and $259,593 contributed to revenue increase (a direct benefit to the cancer center). The financial navigation team also reported improvements in productivity, workflow, and internal organization alignment.Conclusion: Technology can play a major role in advancing financial navigation programs by freeing financial navigators to focus on proactive financial counseling, decreasing out-of-pocket costs for patients, increasing revenue for healthcare organizations, and automatically tracking that value creation for management.

Metastatic tumors with an uncertain primary site can be a difficult clinical problem. In tens of thousands of patients every year, no confident diagnosis is ever issued, making standard-of-care treatment impossible. Gene expression profiling (GEP) tests currently available to analyze these difficult-to-diagnose tumors have never been directly compared with the diagnostic standard of care, immunochemistry (IHC). This prospectively conducted, blinded, multicenter study compares the diagnostic accuracy of GEP with IHC in identifying the primary site of 157 formalin-fixed paraffin-embedded specimens from metastatic tumors with known primaries, representing the 15 tissues on the GEP test panel. Four pathologists rendered diagnoses by selecting from 84 stains in 2 rounds. GEP was performed using the Pathwork Tissue of Origin Test. Overall, GEP accurately identified 89% of specimens, compared with 83% accuracy using IHC (P=0.013). In the subset of 33 poorly differentiated and undifferentiated carcinomas, GEP accuracy exceeded that of IHC (91% to 71%, P=0.023). In specimens for which pathologists rendered their final diagnosis with a single round of stains, both IHC and GEP exceeded 90% accuracy. However, when the diagnosis required a second round, IHC significantly underperformed GEP (67% to 83%, P<0.001). GEP has been validated as accurate in diagnosing the primary site in metastatic tumors. The Pathwork Tissue of Origin Test used in this study was significantly more accurate than IHC when used to identify the primary site, with the most pronounced superiority observed in specimens that required a second round of stains and in poorly differentiated and undifferentiated metastatic carcinomas.

Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

This descriptive study compared the outcomes of the patients who did and did not attend a hospital-based preoperative education class. The sample consisted of 150 patients undergoing total hip or total knee replacement. Patients completed a survey about their preparation and expectations for surgery and their experiences after surgery. Charts were reviewed for length of stay, complications, ambulation distance, and pain score. Postoperative complications were assessed during a follow-up phone call about 30 days after discharge. Patients who attended the preoperative education class reported feeling better prepared for surgery and better able to control their pain after surgery. There were no significant differences between groups in length of stay, ambulation distance, pain level, or complication rate. Knowledge gained from the hospital's preoperative education class did affect patient experiences. Further comparisons of face-to-face versus online structured education are warranted.