Heart Failure 30-Day Readmission Frequency, Rates, and HF Classification

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who are readmitted within 30 days from prior hospitalization for heart failure. Hospitals risk losing millions of dollars due to poor performance. A reduction in CHF readmission rates not only improves healthcare system expenditures, but also patients’ mortality, morbidity, and quality of life. Purpose The purpose of this DNP project is to determine the 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. Specific aims include comparing computed annual re-admission rates with national average, determine the number of multiple 30-day re-admissions, provide descriptive data for demographic variables, and correlate age and heart failure classification with the number of multiple re-admissions. Methods A retrospective chart review was used to collect hospital admission and study data. The setting occurred in an urban hospital in Memphis, TN. The study was reviewed by the UTHSC Internal Review Board and deemed exempt. The electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. Data was cleaned such that each patient admitted had only one heart failure ICD-10 code. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients re-admitted within 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. Results A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were re-admitted on multiple occasions sequentially, ranging from 2-8 re-admissions. The median age was 60 and 60% male. Due to the skewed distribution (most re-admitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple re-admissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553)

La recherche ethnographique en éducation

Cet ouvrage constitue une introduction générale essentielle aux méthodes de recherche en éducation et un outil de référence incontournable, tant pour le praticien que pour l'étudiant-chercheur, qu'il soit au baccalauréat, à la maîtrise ou au doctorat. Tout comme dans les éditions précédentes, les thèmes retenus répondent à des besoins variés et sont structurés de façon à ce que le lecteur trouve facilement son chemin à travers les nombreuses perspectives adoptées par les auteurs, qui accordent une attention particulière aux enjeux d'ordre épistémologique et éthique - au cœur de toute démarche de recherche. Le lecteur sera amené à découvrir la fascinante aventure de la recherche en éducation, ainsi que les défis qu'elle contient, dont celui - fondamental - de faciliter une plus grande collaboration entre praticiens et chercheurs. Cette quatrième édition comprend un nouveau chapitre sur la recherche ethnographique ainsi que sur l'analyse des données qualitatives