Determinants of preventable readmissions in the United States: a systematic review

<p>Abstract</p> <p>Background</p> <p>Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.</p> <p>Methods</p> <p>We conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.</p> <p>Results</p> <p>The review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.</p> <p>Conclusions</p> <p>The current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.</p

The Family Acholeplasmataceae (Including Phytoplasmas)The Prokaryotes

The family Acholeplasmataceae was originally established to accommodate the genus Acholeplasma, comprising the mollicutes that could be cultivated without the supplement of cholesterol and that use UGA as a stop codon instead of coding for tryptophan. It was later shown that the phytoplasmas, a large group of uncultivable, wall-less, non-helical mollicutes that are associated with plants and insects, shared taxonomically relevant properties with members of the genus Acholeplasma. Being not cultivable in vitro in axenic culture, the phytoplasmas could not be classified using the standards used for other mollicutes and are named using the category of Candidatus, as “Ca. Phytoplasma.” Although phytoplasmas are associated with habitats and ecology different from acholeplasmas, the two genera Acholeplasma and “Candidatus Phytoplasma” are phylogenetically related and form a distinct clade within the Mollicutes. The persisting inability to grow the phytoplasmas in vitro hinders the identification of their distinctive phenotypic traits, important criteria for mollicute classification. Until supplemental phenotypic traits become available, the genus “Candidatus Phytoplasma” is designated, on the basis of phylogeny, as a tentative member in the family Acholeplasmataceae. Phylogenetic analysis based on gene sequences, in particular, ribosomal sequences, has provided the major supporting evidence for the composition and taxonomic subdivision of this group of organisms with diverse habitats and ecology and has become the mainstream for the Acholeplasmataceae systematics. However, without the ability to determine phenotypic properties, the circumscription of related species among the non culturable members of the family remains a major issue. The genus Acholeplasma comprises 14 species predominantly associated with animals and isolated from mammalian fluids but regarded as not normally pathogenic. Conversely, the genus “Ca. Phytoplasma” includes plant pathogens of major economic relevance worldwide. To date, 36 “Ca. Phytoplasma species” have been described