Fall-Related Emergency Department Traumas at Thomas Jefferson University Hospital: A Retrospective Analysis of Elderly Adult Trends

Falls are the most common reason for non-fatal injuries treated at Emergency Departments (EDs) in the United States (US), excluding those ages 15-24. Pennsylvania (PA) spends $2.7 billion treating fall-related injuries yearly, with an average per-hospitalization cost of$58,529. PA also has the 5th highest state senior population, and Philadelphia has the 5th oldest senior population among the major American cities. Examining the 2016 Thomas Jefferson University (TJU) ED trauma database, we analysed fall-related traumas in adults ages 65 and over. The sample was stratified into 3 age groups (65-74, 75-84, and ³85) and SAS 9.4 was used to investigate age group trends for fall type, average length of stay (LOS), post-ED destination, loss of consciousness (LOC), incidents by month, and if LOC impacted patient LOS. We found a significant association between LOC and LOS, with those experiencing an LOC staying in hospital an average of 1.7 days. We did not observe significant differences across age groups for fall type, length of stay, post-ED destination, LOC, or number of incidents by month. While results are not significant they are suggestive and may reveal patients being more likely to experience a simple fall (defined as a fall without a slip or trip) as age increases, and less likely to experience a fall with a trip as age increases. All patients, regardless of age group, have average LOS of approximately 7 days. Analysis of our study sample (n=400) describes trends in elderly adult fall-related trauma patients at the TJU ED. We observed that LOC due to a fall is associated with an increased LOS, and for several utilization comparisons there are no significant differences between age groups. This study helps to better understand the patients we serve and identify trends in utilization that may contribute to ongoing fall-prevention efforts at TJU

Primary Care Patient Experience in Pneumonia Patient and the Effects of Readmissions

Patient primary care experience is an essential component of patient care. Research has consistently demonstrated that patient experience correlates with clinical processes of care for prevention and disease management and with better health outcomes. Patients who are admitted to the hospital face numerous challenges upon discharge, including high readmission rates. In fact, one-fifth of Medicare patients admitted to the hospital will be readmitted within 30 days of discharge. With the Affordable Care Act’s creation of the Hospital Readmission Reduction Program (HRRP), hospitals are now penalized for excess readmission rates for common admitting diagnoses such as pneumonia. The purpose of this study was to examine how patients’ baseline primary care experiences relate to the likelihood of readmission. Patients diagnosed with pneumonia were identified during their initial hospitalization and administered the CG-CAHPS 3.0 and Supplementary CAHPS PCMH. The results of these surveys were compared between readmitted and non-readmitted patients. Also, the differences between the primary care experiences of the pneumonia patient cohort and patients at the hospital system’s primary care sites were examined. Results showed that 5 patients out of the 33 patients surveyed were readmitted with non-pneumonia related causes. Patients across 18 primary care sites report higher levels of satisfaction with their PCP (88.7%) compared to patients hospitalized for Pneumonia (66.7%; X2 =14.9,

Remote physiological monitoring: Clinical, financial, and behavioral outcomes in a heart failure population

This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50–92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived health status, self-efficacy, and self-management behaviors. This study is the first to assess the impact of a RPM program following removal of the monitoring equipment. The results indicate that RPM, as a component of a traditional disease management program, has a sustained, beneficial effect on participants’ lifestyles after the monitoring period has ended