Clinical identification of patients readmitted to hospitals: why patients return.

Background: Increased interest in hospital outcomes has supported the need for clear and useful identification of patients who are readmitted. These patients have frequently been identified by the principal diagnosis of the initial admission.

Findings: In order to evaluate the effectiveness of identifying patients who were subsequently readmitted, those with two frequently encountered conditions, principal diagnoses of congestive heart failure and pneumonia, in the hospitals of Syracuse New York were evaluated.

Quantitative tools for addressing hospital readmissions.

Background: Increased interest in health care cost containment is focusing attention on reduction of hospital readmissions. Major payors have already developed financial penalties for providers that generate excess readmissions. This subject has benefitted from the development of resources such as the Potentially Preventable Readmissions software.

Healthcare cost containment and integration of care in the United States: implications at the local level.

As the urgency of healthcare cost containment in the United States increases, this study concerns the impact of this process at the community level in the metropolitan area of Syracuse, New York. It suggests that the responses of the Syracuse hospitals to cost containment have resulted in greater numbers of adult medicine patients. This development has been paralleled by a reduced integration of services with long-term care and ambulatory care providers.

Reducing potentially preventable complications at the multi hospital level.

Background: This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes.

Findings: This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems.

Inpatient hospital complications and lengths of stay: a short report.

Background: Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area.

Findings: This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York.

Integrating hospital competition and co-operation at the community level.

During the past few decades, relations among healthcare providers at the community level have been characterized by competition and co-operation. Opinions concerning the merits of these approaches vary.

Electronic daily reporting of community-wide healthcare information.

The development of electronic healthcare data systems has proceeded rapidly; concerns regarding the impact and costs of electronic healthcare data have also been raised. This study describes the development and implementation of a community-wide program for daily electronic exchange of aggregate healthcare data in Syracuse, NY, addressing major concerns and producing important lessons learned.

Linking health services at the Community level.

This study describes a series of interventions linking hospitals, medical staff physicians, long-term care providers and mental health services in the metropolitan area of Syracuse, New York. The objectives of these interventions were to improve patient outcomes and system-wide efficiency. The study demonstrated that these linkages, including system-wide data feedback, contributed to limitation of emergency department overcrowding, reduction of physician lengths of stay, elimination of duplication of medical staff credentialing, as well as access to and efficiency of long-term care and mental health services.

Community wide electronic distribution of summary health care utilization data.

Background: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data.

Development and implementation of a community-wide infusion therapy program by hospitals and nursing homes in Syracuse, New York.

The development and implementation of an infusion therapy program in the metropolitan area of Syracuse, New York is described. The program was implemented in a number of nursing homes with training and financial support from area hospitals. It resulted in a reduced number of hospital patient days and related savings for the healthcare system.

Managing hospital length of stay reduction: a multihospital approach.

Major financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions with physicians and nursing homes to reduce inpatient lengths of stay by four hospitals in Syracuse, New York. These initiatives saved over 28,000 patient days and an average daily census of 96.

Improving outcomes with community-wide distribution of health care data.

This study describes the impact of the exchange of daily, weekly, and quarterly information among a full range of health care administrators and practitioners on the accessibility and efficiency of care. These efforts produced increased accessibility of hospital emergency departments and greater efficiency of acute and long-term care.

Reducing ambulance diversion: a multihospital approach.

Objective: To evaluate the impact of procedures for reducing ambulance diversion in the metropolitan area of Syracuse, New York.

Methods: This was a retrospective review of procedures for reducing ambulance diversion at the system-wide and hospital-specific levels between January 1, 2001, and June 30, 2002. System-wide procedures involved exchange of information concerning diversion.

Utilization and impact of ambulance diversion at the community level.

Objective: To evaluate the utilization and impact of ambulance diversion in the metropolitan area of Syracuse, New York.

Methods: This was a retrospective review of the ambulance diversion system operated by the hospitals of Syracuse, New York. This system allows each emergency department to divert incoming ambulances during periods of extreme overcrowding.

Hospital readmissions at the communitywide level: implications for case management.

This study describes the development of information concerning the distribution of hospital readmissions by diagnosis in seven different United States metropolitan areas. The data demonstrated that circulatory disorders were associated with the largest number of communitywide readmissions in all of the communities. It also showed that circulatory, respiratory, and digestive disorders accounted for a majority of readmissions in all of the areas.

Analyzing hospital readmissions using statewide discharge databases.

Hospital readmissions are an important indicator of the outcomes of care as well as a source of unnecessary health care expenditures. This study focused on development of a uniform algorithm for identification of hospital readmission data. It involved development of a uniform definition of readmissions which could be applied to multiple statewide computer databases.

Special report: mining admissions data. Benchmarking hospital admission rates by ages.

In this second part of our two-part series on mining hospital admissions data, Ronald Lagoe, executive director of the Hospital Executive Council, a four-hospital system in Syracuse, NY shows how admissions data readily available from various state agencies can be analyzed for patterns by age groups. As he points out below, this information will be particularly valuable as Medicare managed care takes over. For a discussion of data sources, methodology and analysis, see part one, beginning on p.

Benchmarking and clinical pathway implementation on a multihospital basis.

Hospital utilization data for communities with high levels of managed care penetration can be readily used to develop utilization benchmarks in any proactive efforts to prepare for oncoming prospective pricing system (PPS) initiatives. In a cooperative effort among all four Syracuse, NY hospitals, the combined average hospital LOS for one surgical and three medical DRGs was compared with benchmarks derived from similar populations in three heavily managed care-penetrated west coast communities. Implementation of clinical or critical paths are a widely accepted approach to shortening hospital lengths of stay and improving both resource usage and clinical outcomes.

Enlisting physician support for practice guidelines in hospitals.

Available experience indicates that physician support is crucial if clinical pathways are to support quality of care while reducing lengths of stay and resource use. Enlisting such support requires understanding of physician perspectives concerning the quality and delivery of health care. It also requires the development of data systems as a means of communication with physicians.

Adding nursing facility beds: impact on hospital nonacute care.

The study evaluated the impact of admitting 235 nonacute patients who had been backed up in hospitals to new nursing facility beds in the metropolitan area of Syracuse, New York, during a 12-month period. The data indicated that these admissions reduced the hospital nonacute census by 53 percent and produced substantial declines in numbers of nonacute patients with postacute stays longer than one month and with Medicaid as principal payer. Numbers of patients waiting for Medicaid eligibility were not affected by admissions to the new beds.

Long-term care patients in acute care beds: a community-based analysis.

This paper describes an analysis of hospital utilization by alternate care patients, those who receive long-term care in hospital beds because postdischarge services are not available. During a 3-year period, the number of hospital beds occupied by these patients in Syracuse, New York reached 184, or 14% of the area's medical-surgical capacity. These patients were heterogeneous with respect to disposition, age, functional ability, and payor status.

A comparison of hospital-integrated and freestanding ambulatory-surgery programs. Their uses of selected procedures.

For a variety of good reasons, the use of ambulatory surgery in the U.S. grew significantly during the 1980s.

Relieving overcrowded emergency departments through ambulance diversion.

One city's solution to overcrowded emergency departments and a shortage of beds was the installation of an ambulance-diversion system, whereby ambulances carrying patients with relatively minor injuries were diverted, when necessary, from the city's busy emergency departments to less crowded ones in neighboring counties.