This section describes literature review conducted in the field of MDSS in order to understand current state-of-the-art MDSS in the field of HIS. Throughout the process of literature review, it was observed there exists already huge amount of literature on how MDSS was built in the field of HIS. After carefully studying the entire literature, it was found that the existing MDSS were broadly classified into 3 systems. • Forecasting binary outcomes • Forecasting classification outcomes and • Forecasting outbreaks. In the next paragraphs, this thesis paper discussed various factors of 3 mentioned MDSS like main motivation for the implementation of new MDSS, different data mining (DM) algorithms used, techniques used to improve the …show more content…
(Adeyemi, Demir, & Chaussalet, 2013); (Demir, 2014) argued that readmission rates should not be accounted for 30 days after surgery, moreover depending upon the disease type it varied from 30-90 days or other minor diseases had a short time frame of 14 days to longer time frame up to 1 year or up to 45-days from diagnosis. To overcome this serious readmission rate problem, Center for Medicare and Medicaid services (CMS) imposed huge penalties on the hospitals, which had serious readmission rates (Amarasingham et al., 2010). Furthermore, most of the developed country governments devoted high importance to identify the patients who are at high risk of readmitting so that hospitals can plan the patient pathways. According to (Demir, 2014) they are: a. Prevention and wellness promotion for relatively low risk patients b. Supporting self-care interventions for moderate risk patients c. Early intervention care management for patients with emergent risk and d. Intensive case management for very high risk patients Most of the researchers created many predictive models that predict the patient’s readmission with a simple “yes” or “no”. Few studies described in table 2, outline who conducted the study, data setting, data mining algorithm used and their accuracies. Source Population setting Data Mining Algorithm ROC statistic Anderson and Steinberg,1985 Medicare patients in the USA from 1974-1977 Logistic
The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.
Hospital readmissions carry huge costs for hospitals and add greatly to the cost of healthcare. Remote patient monitoring has the potential to prevent many such readmissions.” 2
Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.
Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting
In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to
This article reviews the history of Medicare’s Hospital Readmission Reduction Program (HRRP) which began in October 2012. It examines why Medicare and Medicaid initiated the program, clarifies what conditions were originally included in HRRP and analyzes the reasoning behind adding Chronic Obstructive Pulmonary Disease (COPD) to the list of high priority conditions. It also, clarifies what information U.S Centers for Medicare and Medicaid (CMS) take into consideration when calculating readmission rates and points to the fact that high readmission rates could be due to non-hospital factors. The authors review new data that focuses on the potential harm of adding COPD to the list of conditions due to the increased level of patients from lower
This paper deals with the legislative, regulatory components of Medicare Readmission Reduction Program along with recommendation to reduce their readmission rates for a health care facility like Valley hospital in Spokane which has been penalized a higher percentage of 2% as compared to other hospitals in the state of Washington under the third round of penalties.
This memorandum describes Central Health’s Readmission Reduction Program set to commence in May 2017. The Centers for Medicare and Medicaid Services (CMS) has raised concern over the increasing readmission rate and poor quality of care. To address this issue, Congress has created Hospital Readmission Reduction Program (HRRP) statute under the Affordable Care Act, 2010, which was recently updated under 21st Century Cures Act of 2016. Under the constant pressure of a penalty, Central Health has considered to establish its own Hospital Readmission Reduction Program to address specific imperatives, such as care-coordination, treatment adherence program, and streamlined patient discharge process.
Hospitals nationwide have been striving to reduce the rate of patient readmissions. Both the federal government and private insurers are tired of picking up the tab. In a 2009 study in the New England Journal of Medicine, researchers estimated that a year's worth of unplanned re-hospitalizations cost Medicare alone $17.4 billion. Congestive heart failure is a particularly big target, as one in four patients end up back in the hospital within 30 days of discharge. Starting in the fall of 2012, the government will cut Medicare reimbursements for hospitals with higher-than-expected 30-day readmission rates for heart failure and two other conditions: heart attack and pneumonia (Avril, 2011).
Early rehospitalizations of patients in various disease states have been well studied in recent years. Research in this area has increased since the Centers for Medicare & Medicaid Services (CMS) made readmissions within thirty (30) days a major quality indicator for health care organizations. These admits consume a considerable amount of health care costs and interventions are needed that are aimed at reducing risks associated with rehospitalization (Hain, Tappen, Diaz, & Ouslander, 2012). Early readmissions in those with decompensated cirrhosis are costly, partially preventable, and linked to worse patient outcomes (Volk, Tocco, Bazick, Rakowski, & Lok, 2012). Developing specific disease oriented interventions can help decrease morbidity
Quantitatively this issue can be documented in readmission rate statistics alongside the morbidity and mortality rate among the readmission cohort. By identifying the number of patients with preventable readmissions, and then categorizing the increased incidence of infection and/or injury in this cohort compared to like populations without avoidable readmissions one could show the burden of readmission.
Policy makers created the Medicare Hospital Readmissions Reduction Program (HRRP) in an attempt to improve quality of patient care and lower costs (James, 2013). In order to avoid these penalties, healthcare leaders must recognize that CMS has identified a correlation between readmissions and a lack of quality care. Therefore, the aim is not to focus solely on hospital readmissions, but to seek clinical excellence by investing in quality improvement (Silow-Carrol, Edwards & Lashbrook, 2011). However, reducing readmissions is a complex undertaking, because not all readmissions can or should be prevented. Indeed, some readmissions are planned as part of sound clinical care. Furthermore, while hospitals work to reduce readmissions caused
The hospital readmission (HR) may be regarded as an indicator of the quality of hospital care and, indirectly, of primary care. Some factors may foster HR, such as low quality of supportive care, early discharge, lack of treatment adherence on the part of users and their families, age, absence of specific guidance and post-discharge follow-up, as well as socioeconomic and cultural conditions. Therefore, in order to perform a resolute care, one needs to know the profile of admissions and of HR, thereby enhancing the planning and the implementation of strategies. In order to raise the aforementioned questions, this study had the purpose of analyzing the profile of readmissions of children treated in the pediatric sector of the Regional Hospital in Ceilândia (HRC) in March, April and May 2015. This
In an effort to curb these costs, in 2013 the Center for Medicare and Medicaid Services (CMS) enacted the Hospital Readmissions Reduction Program. Under this program, hospitals are penalized for readmissions occurring in the first 30 days. The penalties apply to specific conditions for CMS recipients including acute myocardial infarction, heart failure, coronary artery bypass graft
The significance of this study is to determine if a preadmission clinic process can be developed and