Saeed Subha, Patel Rahul, Odeyemi Rachel
Resident Physician, Internal Medicine, Crozer-Keystone Health System, Upland, PA, 19013, USA.
Assistant Professor, Drexel University College of Medicine & Associate Program Director Internal Medicine, Crozer-Keystone Health System, Upland, PA, 19013, USA.
J Community Hosp Intern Med Perspect. 2022 Jul 4;12(4):24-27. doi: 10.55729/2000-9666.1036. eCollection 2022.
The soaring hospital readmission rates are straining the already limited financial resources in the US health system. Meanwhile, timely outpatient follow-up, an efficient and cost-effective intervention following hospital discharge, has been shown to reduce the readmission risk. However, the current and projected shortage of physicians in primary and specialty care poses a unique dilemma in transitional care planning: optimizing the utilization of post-discharge follow-up to reduce readmission rate while limiting the strain on the limited pool of outpatient physicians. The ideal solution would entail a strategy whereby patients at higher risk for readmission are stratified towards earlier outpatient follow-up and vice versa. This article explores the utility of Institution-specific readmission risk prediction algorithms for assessing patient population for diverse administrative, clinical and socioeconomic risk factors and further classifying the hospital's patient population into high- and low-risk strata, so that appropriate risk-concordant timing of follow-up can be assigned at the time of hospital discharge, with earlier follow-up assigned to high readmission risk strata. This stratification shall help ensure judicious and equitable human resource allocation while simultaneously reducing hospital readmission rates.
美国医疗系统中不断飙升的医院再入院率正在使本就有限的财政资源不堪重负。与此同时,及时的门诊随访作为出院后的一种高效且具成本效益的干预措施,已被证明能降低再入院风险。然而,目前及预计的初级和专科护理医生短缺,在过渡性护理规划中构成了一个独特的困境:既要优化出院后随访的利用以降低再入院率,又要限制门诊医生资源有限所带来的压力。理想的解决方案需要一种策略,即对再入院风险较高的患者进行分层,使其接受更早的门诊随访,反之亦然。本文探讨了针对特定机构的再入院风险预测算法的效用,该算法用于评估患者群体的各种行政、临床和社会经济风险因素,并进一步将医院的患者群体分为高风险和低风险层,以便在出院时能分配适当的与风险相匹配的随访时间,将更早的随访分配给高再入院风险层。这种分层有助于确保合理且公平的人力资源分配,同时降低医院再入院率。