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Article ; Online: Novel Calculator to Estimate the Risk of Clinically Relevant Postoperative Pancreatic Fistula Following Distal Pancreatectomy.

Nassour, Ibrahim / AlMasri, Samer / Hodges, Jacob C / Hughes, Steven J / Zureikat, Amer / Paniccia, Alessandro

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 26, Issue 7, Page(s) 1436–1444

Abstract: Background: Drain management algorithms are based on studies that predict clinically relevant postoperative pancreatic fistula (CR-POPF) using drain fluid amylase level on POD1 (DFA1). These studies are focused on pancreaticoduodenectomy which is ... ...

Abstract	Background: Drain management algorithms are based on studies that predict clinically relevant postoperative pancreatic fistula (CR-POPF) using drain fluid amylase level on POD1 (DFA1). These studies are focused on pancreaticoduodenectomy which is inherently different than distal pancreatectomy. Moreover, the change of DFA between POD1 and POD3 (ΔDFA) is underutilized despite its importance in predicting CR-POPF. We sought to generate a calculator that estimates the risk of CR-POPF following distal pancreatectomy. Methods: The 2014-2018 pancreas-targeted ACS-NSQIP database was used to identify patients who underwent elective distal pancreatectomy. Models to predict CR-POPF were constructed using DFA1 with/without ΔDFA. The fittest model was used to construct a calculator. Results: Out of 12,042 distal pancreatectomies, 692 patients met the study's inclusion criteria. The risk of CR-POPF was 15.9% in the included cohort versus 14.8% in the excluded one (P = 0.421). The predictors of the CR-POPF were age, operative time, DFA1, and ΔDFA. Adding ΔDFA decreased the Akaike's information criterion of the model (507.7 vs 544.7)-indicating a significantly better model fit-and improved the cross-validated area under the curve from 0.731 to 0.791. An easy-to-use calculator was created for surgeons to estimate the risk of CR-POPF based on the abovementioned variables. A sensitivity/specificity table was created at various cutoffs to direct clinical decision-making with respect to early drain removal. Conclusions: This study highlights the importance of ΔDFA, in addition to DFA1, in predicting CR-POPF. The provided calculator will facilitate predicting CR-POPF and postoperative drain management following distal pancreatectomy.
MeSH term(s)	Amylases ; Drainage/methods ; Humans ; Pancreas ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreatic Fistula/diagnosis ; Pancreatic Fistula/etiology ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Time Factors
Chemical Substances	Amylases (EC 3.2.1.-)
Language	English
Publishing date	2022-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05275-3
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Article ; Online: The risk of clinically-relevant pancreatic fistula after pancreaticoduodenectomy is better predicted by a postoperative trend in drain fluid amylase compared to day 1 values in isolation.

Ahmad, Sarwat B / Hodges, Jacob C / Nassour, Ibrahim / Casciani, Fabio / Lee, Kenneth K / Paniccia, Alessandro / Vollmer, Charles M / Zureikat, Amer H

Surgery

2023 Volume 174, Issue 4, Page(s) 916–923

Abstract: Background: Recent studies support early drain removal after pancreaticoduodenectomy in patients with a drain fluid amylase on postoperative day 1 (DFA1) level of ≤5,000. The use of DFA1 to guide drain management is increasingly common among pancreatic ... ...

Abstract	Background: Recent studies support early drain removal after pancreaticoduodenectomy in patients with a drain fluid amylase on postoperative day 1 (DFA1) level of ≤5,000. The use of DFA1 to guide drain management is increasingly common among pancreatic surgeons; however, the benefit of checking additional drain fluid amylases beyond DFA1 is less known. We sought to determine whether a change in drain fluid amylase (ΔDFA) is a more reliable predictor of clinically relevant postoperative fistula than DFA1 alone. Methods: Using the American College of Surgeons National Surgical Quality Improvement Plan, pancreaticoduodenectomy patients with intraoperative drain placement, known DFA1, highest recorded drain fluid amylase value on postoperative day 2 to 5 (DFA2nd), day of drain removal, and clinically relevant postoperative fistula status were reviewed. Logistic models compared the predictive performance of DFA1 alone versus DFA1 + ΔDFA. Results: A total of 2,417 patients with an overall clinically relevant postoperative fistula rate of 12.6% were analyzed. On multivariable regression, clinical predictors for clinically relevant postoperative fistula included body mass index, steroid use, operative time, and gland texture. These variables were used to develop model 1 (DFA1 alone) and model 2 (DFA1 + ΔDFA). Model 2 outperformed model 1 in predicting the risk of clinically relevant postoperative fistula. According to model 2 predictions, the risk of clinically relevant postoperative fistula increased with any rise in drain fluid amylase, regardless of whether the DFA1 was above or below 5,000 U/L. The risk of clinically relevant postoperative fistula significantly decreased with any drop in drain fluid amylase, with an odds reduction of approximately 50% corresponding with a 70% decrease in drain fluid amylase (P < .001). A risk calculator was developed using DFA1 and a secondary DFA value in conjunction with other clinical predictors for clinically relevant postoperative fistula. Conclusion: Clinically relevant postoperative fistula after pancreaticoduodenectomy is more accurately predicted by DFA1 and ΔDFA versus DFA1 in isolation. We developed a novel risk calculator to provide an individualized approach to drain management after pancreaticoduodenectomy.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Pancreatic Fistula/diagnosis ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Pancreatectomy ; Drainage ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Amylases ; Risk Factors
Chemical Substances	Amylases (EC 3.2.1.-)
Language	English
Publishing date	2023-07-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.06.009
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Article ; Online: Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System.

Lukanski, Amy / Watters, Shelley / Bilderback, Andrew L / Buchanan, Dan / Hodges, Jacob C / Burwell, David / Triola, Amy / Marroquin, Oscar C / Martin, Susan C / Zapf, Rachel L / Kip, Paula L / Minnier, Tami E

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

2023 Volume 45, Issue 6, Page(s) 315–323

Abstract: Abstract: In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have ... ...

Abstract	Abstract: In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have significantly higher rates of care complications and hospital readmissions. This study is an observational quality improvement project completed from April 17, 2020 to January 31, 2022 at 22 hospitals in a large, integrated academic health system. A nurse-led scripted discharge follow-up phone call program was implemented to contact all patients discharged from inpatient care within 72 hours of discharge. Readmission rates were tracked before and after project implementation. Over a 21-month span, 137,515 phone calls were placed, and 57.92% of patients were successfully contacted within 7 days of discharge. The 7-day readmission rate for contacted patients was 2.91% compared with 4.73% for noncontacted patients. The 30-day readmission rate for contacted patients was 11.00% compared with 12.17% for noncontacted patients. We have found that discharge follow-up phone calls targeting patients decreases risk of readmission, which improves overall patient outcomes.
MeSH term(s)	Humans ; Patient Discharge ; Patient Readmission ; Continuity of Patient Care ; Follow-Up Studies ; Delivery of Health Care, Integrated
Language	English
Publishing date	2023-10-03
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1472097-8
ISSN	1945-1474 ; 1062-2551
ISSN (online)	1945-1474
ISSN	1062-2551
DOI	10.1097/JHQ.0000000000000400
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Article ; Online: Applying Real-World Data to Inform Continuous Glucose Monitoring Use in Clinical Practice.

Zheng, Yaguang / Siminerio, Linda M / Krall, Jodi / Anton, Bonnie B / Hodges, Jacob C / Bednarz, Lori / Li, Dan / Ng, Jason M

Journal of diabetes science and technology

2021 Volume 15, Issue 4, Page(s) 968–969

MeSH term(s)	Blood Glucose ; Blood Glucose Self-Monitoring ; Diabetes Mellitus, Type 1 ; Glycated Hemoglobin A/analysis ; Humans
Chemical Substances	Blood Glucose ; Glycated Hemoglobin A
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/1932296821997403
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Article ; Online: Healthcare-associated infections during the coronavirus disease 2019 (COVID-19) pandemic and the modulating effect of centralized surveillance.

Snyder, Graham M / Wagester, Suzanne / Harris, Patricia L / Valek, Abby L / Hodges, Jacob C / Bilderback, Andrew L / Kader, Fazrina / Tanner, Colleen A / Metzger, Amy P / DiNucci, Susan E / Colaianne, Bonnie V / Chung, Ashley / Zapf, Rachel L / Kip, Paula L / Minnier, Tamra E

Antimicrobial stewardship & healthcare epidemiology : ASHE

2023 Volume 3, Issue 1, Page(s) e72

Abstract: We analyzed efficacy of a centralized surveillance infection prevention (CSIP) program in a healthcare system on healthcare-associated infection (HAI) rates amid the coronavirus disease 2019 (COVID-19) pandemic. HAI rates were variable in CSIP and non- ... ...

Abstract	We analyzed efficacy of a centralized surveillance infection prevention (CSIP) program in a healthcare system on healthcare-associated infection (HAI) rates amid the coronavirus disease 2019 (COVID-19) pandemic. HAI rates were variable in CSIP and non-CSIP facilities. Central-line-associated bloodstream infection (CLABSI),
Language	English
Publishing date	2023-04-11
Publishing country	England
Document type	Journal Article
ISSN	2732-494X
ISSN (online)	2732-494X
DOI	10.1017/ash.2023.139
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Article ; Online: Development and implementation of a centralized surveillance infection prevention program in a multi-facility health system: A quality improvement project.

Antimicrobial stewardship & healthcare epidemiology : ASHE

2023 Volume 3, Issue 1, Page(s) e56

Abstract: Objective: To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program.: Design: Observational quality improvement project.: Setting: An integrated academic healthcare system.: ... ...

Abstract	Objective: To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program. Design: Observational quality improvement project. Setting: An integrated academic healthcare system. Intervention: The CSIP program comprises senior infection preventionists who are responsible for healthcare-associated infection (HAI) surveillance and reporting, allowing local infection preventionists (LIPs) a greater portion of their time to non-surveillance patient safety activities. Four CSIP team members accrued HAI responsibilities at 8 facilities. Methods: We evaluated the effectiveness of the CSIP program using 4 measures: recovery of LIP time, efficiency of surveillance activities by LIPs and CSIP staff, surveys characterizing LIP perception of their effectiveness in HAI reduction, and nursing leaders' perception of LIP effectiveness. Results: The amount of time spent by LIP teams on HAI surveillance was highly variable, while CSIP time commitment and efficiency was steady. Post-CSIP implementation, 76.9% of LIPs agreed that they spend adequate time on inpatient units, compared to 15.4% pre-CSIP; LIPs also reported more time to allot to non-surveillance activities. Nursing leaders reported greater satisfaction with LIP involvement with HAI reduction practices. Conclusion: CSIP programs are a little-reported strategy to ease burden on LIPs with reallocation of HAI surveillance. The analyses presented here will aid health systems in anticipating the benefit of CSIP programs.
Language	English
Publishing date	2023-03-22
Publishing country	England
Document type	Journal Article
ISSN	2732-494X
ISSN (online)	2732-494X
DOI	10.1017/ash.2023.126
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Article ; Online: Evaluation of Adjuvant Chemotherapy Survival Outcomes Among Patients With Surgically Resected Pancreatic Carcinoma With Node-Negative Disease After Neoadjuvant Therapy.

Hammad, Abdulrahman Y / Hodges, Jacob C / AlMasri, Samer / Paniccia, Alessandro / Lee, Kenneth K / Bahary, Nathan / Singhi, Aatur D / Ellsworth, Susannah G / Aldakkak, Mohammed / Evans, Douglas B / Tsai, Susan / Zureikat, Amer

JAMA surgery

2022 Volume 158, Issue 1, Page(s) 55–62

Abstract: Importance: Neoadjuvant therapy (NAT) is rarely associated with a complete histopathologic response in patients with pancreatic ductal adenocarcinoma (PDAC) but results in downstaging of regional nodal disease. Such nodal downstaging after NAT may have ... ...

Abstract	Importance: Neoadjuvant therapy (NAT) is rarely associated with a complete histopathologic response in patients with pancreatic ductal adenocarcinoma (PDAC) but results in downstaging of regional nodal disease. Such nodal downstaging after NAT may have implications for the use of additional adjuvant therapy (AT). Objectives: To examine the prognostic implications of AT in patients with node-negative (N0) disease after NAT and to identify factors associated with progression-free (PFS) and overall survival (OS). Design, setting, and participants: A retrospective review was conducted using data from 2 high-volume, tertiary care academic centers (University of Pittsburgh Medical Center and the Medical College of Wisconsin). Prospectively maintained pancreatic cancer databases at both institutes were searched to identify patients with localized PDAC treated with preoperative therapy and subsequent surgical resection between 2010 and 2019, with N0 disease on final histopathology. Exposures: Patients received NAT consisting of chemotherapy with or without concomitant neoadjuvant radiation (NART). For patients who received NART, chemotherapy regimens were gemcitabine or 5-fluoururacil based and included stereotactic body radiotherapy (SBRT) or intensity-modulated radiation therapy (IMRT) after all intended chemotherapy and approximately 4 to 5 weeks before anticipated surgery. Adjuvant therapy consisted of gemcitabine-based therapy or FOLFIRINOX; when used, adjuvant radiation was commonly administered as either SBRT or IMRT. Main outcomes and measures: The association of AT with PFS and OS was evaluated in the overall cohort and in different subgroups. The interaction between AT and other clinicopathologic variables was examined on Cox proportional hazards regression analysis. Results: In this cohort study, 430 consecutive patients were treated between 2010 and 2019. Patients had a mean (SD) age of 65.2 (9.4) years, and 220 (51.2%) were women. The predominant NAT was gemcitabine based (196 patients [45.6%]), with a median duration of 2.7 cycles (IQR, 1.5-3.4). Neoadjuvant radiation was administered to 279 patients (64.9%). Pancreatoduodenectomy was performed in 310 patients (72.1%), and 160 (37.2%) required concomitant vascular resection. The median lymph node yield was 26 (IQR, 19-34); perineural invasion (PNI), lymphovascular invasion (LVI), and residual positive margins (R1) were found in 254 (59.3%), 92 (22.0%), and 87 (21.1%) patients, respectively. The restricted mean OS was 5.2 years (95% CI, 4.8-5.7). On adjusted analysis, PNI, LVI, and poorly differentiated tumors were independently associated with worse PFS and OS in N0 disease after NAT, with hazard ratios (95% CIs) of 2.04 (1.43-2.92; P < .001) and 1.68 (1.14-2.48; P = .009), 1.47 (1.08-1.98; P = .01) and 1.54 (1.10-2.14; P = .01), and 1.90 (1.18-3.07; P = .008) and 1.98 (1.20-3.26; P = .008), respectively. Although AT was associated with prolonged survival in the overall cohort, the effect was reduced in patients who received NART and strengthened in patients with PNI (AT × PNI interaction: hazard ratio, 0.55 [95% CI, 0.32-0.97]; P = .04). Conclusions and relevance: The findings of this cohort study suggest a survival benefit for AT in patients with N0 disease after NAT and surgical resection. This survival benefit may be most pronounced in patients with PNI.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Pancreatic Neoplasms/surgery ; Pancreatic Neoplasms/drug therapy ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Neoadjuvant Therapy/methods ; Cohort Studies ; Chemotherapy, Adjuvant ; Carcinoma, Pancreatic Ductal/drug therapy ; Carcinoma, Pancreatic Ductal/surgery ; Retrospective Studies ; Gemcitabine ; Pancreatic Neoplasms
Chemical Substances	Gemcitabine
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.5696
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Article ; Online: Assessment of the effectiveness of ultraviolet-C disinfection on transmission of hospital-acquired pathogens from prior room occupants.

Hodges, Jacob C / Bilderback, Andrew L / Bridge, Christine M / Wagester, Suzanne / Colaianne, Bonnie V / Babiker, Ahmed / Minnier, Tami / Zapf, Rachel L / Kip, Paula L / Snyder, Graham M

Antimicrobial stewardship & healthcare epidemiology : ASHE

2022 Volume 2, Issue 1, Page(s) e110

Abstract: Objective: To evaluate the effectiveness of ultraviolet-C (UV-C) disinfection as an adjunct to standard chlorine-based disinfectant terminal room cleaning in reducing transmission of hospital-acquired multidrug-resistant organisms (MDROs) from a prior ... ...

Abstract	Objective: To evaluate the effectiveness of ultraviolet-C (UV-C) disinfection as an adjunct to standard chlorine-based disinfectant terminal room cleaning in reducing transmission of hospital-acquired multidrug-resistant organisms (MDROs) from a prior room occupant. Design: A retrospective cohort study was conducted to compare rates of MDRO transmission by UV-C status from January 1, 2016, through December 31, 2018. Setting: Acute-care, single-patient hospital rooms at 6 hospitals within an academic healthcare system in Pennsylvania. Methods: Transmission of hospital-acquired MDRO infection was assessed in patients subsequently assigned to a single-patient room of a source occupant with carriage of 1 or more MDROs on or during admission. Acquisition of 5 pathogens was compared between exposed patients in rooms with standard-of-care chlorine-based disinfectant terminal cleaning with or without adjunct UV-C disinfection. Logistic regression analysis was used to estimate the adjusted risk of pathogen transfer with adjunctive use of UV-C disinfection. Results: In total, 33,771 exposed patient admissions were evaluated; the source occupants carried 46,688 unique pathogens. Prior to the 33,771 patient admissions, 5,802 rooms (17.2%) were treated with adjunct UV-C disinfection. After adjustment for covariates, exposed patients in rooms treated with adjunct UV-C were at comparable risk of transfer of any pathogen (odds ratio, 1.06; 95% CI, 0.84-1.32; Conclusion: Our analysis does not support the use of UV-C in addition to post-discharge cleaning with chlorine-based disinfectant to lower the risk of prior room occupant pathogen transfer.
Language	English
Publishing date	2022-07-07
Publishing country	England
Document type	Journal Article
ISSN	2732-494X
ISSN (online)	2732-494X
DOI	10.1017/ash.2022.254
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Article ; Online: Robotic Pancreaticoduodenectomy: Increased Adoption and Improved Outcomes: Is Laparoscopy Still Justified?

Khachfe, Hussein H / Nassour, Ibrahim / Hammad, Abdulrahman Y / Hodges, Jacob C / AlMasri, Samer / Liu, Hao / deSilva, Anissa / Kraftician, Jasmine / Lee, Kenneth K / Pitt, Henry A / Zureikat, Amer H / Paniccia, Alessandro

Annals of surgery

2022 Volume 278, Issue 3, Page(s) e563–e569

Abstract: Objective: To compare the rate of postoperative 30-day complications between laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD).: Background: Previous studies suggest that minimally invasive pancreaticoduodenectomy ( ... ...

Abstract	Objective: To compare the rate of postoperative 30-day complications between laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD). Background: Previous studies suggest that minimally invasive pancreaticoduodenectomy (MI-PD)-either LPD or RPD-is noninferior to open pancreaticoduodenectomy in terms of operative outcomes. However, a direct comparison of the two minimally invasive approaches has not been rigorously performed. Methods: Patients who underwent MI-PD were abstracted from the 2014 to 2019 pancreas-targeted American College of Surgeons National Sample Quality Improvement Program (ACS NSQIP) dataset. Optimal outcome was defined as absence of postoperative mortality, serious complication, percutaneous drainage, reoperation, and prolonged length of stay (75th percentile, 11 days) with no readmission. Multivariable logistic regression models were used to compare optimal outcome of RPD and LPD. Results: A total of 1540 MI-PDs were identified between 2014 and 2019, of which 885 (57%) were RPD and 655 (43%) were LPD. The rate of RPD cases/year significantly increased from 2.4% to 8.4% ( P =0.008) from 2014 to 2019, while LPD remained unchanged. Similarly, the rate of optimal outcome for RPD increased during the study period from 48.2% to 57.8% ( P <0.001) but significantly decreased for LPD (53.5% to 44.9%, P <0.001). During 2018-2019, RPD outcomes surpassed LPD for any complication [odds ratio (OR)=0.58, P =0.004], serious complications (OR=0.61, P =0.011), and optimal outcome (OR=1.78, P =0.001). Conclusions: RPD adoption increased compared with LPD and was associated with decreased overall complications, serious complications, and increased optimal outcome compared with LPD in 2018-2019.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Robotic Surgical Procedures/adverse effects ; Retrospective Studies ; Length of Stay ; Postoperative Complications/etiology ; Laparoscopy/adverse effects ; Pancreatic Neoplasms
Language	English
Publishing date	2022-08-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005687
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Article ; Online: Associations Between Implementation of the Caregiver Advise Record Enable (CARE) Act and Health Service Utilization for Older Adults with Diabetes: Retrospective Observational Study.

Zheng, Yaguang / Anton, Bonnie / Rodakowski, Juleen / Altieri Dunn, Stefanie C / Fields, Beth / Hodges, Jacob C / Donovan, Heidi / Feiler, Connie / Martsolf, Grant / Bilderback, Andrew / Martin, Susan C / Li, Dan / James, Alton Everette

JMIR aging

2022 Volume 5, Issue 2, Page(s) e32790

Abstract: Background: The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers ("family members or friends") upon discharge.: Objective: This study examined the association between the ... ...

Abstract	Background: The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers ("family members or friends") upon discharge. Objective: This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (ie, reducing hospital readmission, emergency department [ED] visits, and mortality) for older adults with diabetes. Methods: The key elements of the CARE Act were implemented and applied to the patients discharged to home. The data between May and October 2017 were pulled from inpatient electronic health records. Likelihood-ratio chi-square tests and multivariate logistic regression models were used for statistical analysis. Results: The sample consisted of 2591 older inpatients with diabetes with a mean age of 74.6 (SD 7.1) years. Of the 2591 patients, 46.1% (n=1194) were female, 86.9% (n=2251) were White, 97.4% (n=2523) had type 2 diabetes, and 69.5% (n=1801) identified a caregiver. Of the 1801 caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre- and postimplementation of the CARE Act; however, no significance was found. No significant differences were detected from the bivariate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multivariate analysis), those who identified a caregiver (12.2%, 219/1801) was associated with higher rates of 30-day hospital readmission than those who declined to identify a caregiver (9.9%, 78/790; odds ratio [OR] 1.38, 95% CI 1.04-1.87; P=.02). Significantly lower rates were detected in 7-day readmission (P=.02), as well as 7-day (P=.03) and 30-day (P=.01) ED visits, among patients with diabetes whose identified caregiver received education and training than those whose identified caregiver did not receive education and training in the bivariate analyses. However, after adjusting for risk factors, no significance was found in 7-day readmission (OR 0.53, 95% CI 0.27-1.05; P=.07), 7-day ED visit (OR 0.63, 95% CI 0.38-1.03; P=.07), and 30-day ED visit (OR 0.73, 95% CI 0.52-1.02; P=.07). No significant associations were found for other outcomes (ie, 30-day readmission and 7-day and 30-day mortality) in both the bivariate and multivariate analyses. Conclusions: Our study found that the implementation of the CARE Act was associated with certain health service utilization. The identification of caregivers was associated with higher rates of 30-day hospital readmission in the multivariate analysis, whereas having identified caregivers who received discharge education was associated with lower rates of readmission and ED visit in the bivariate analysis.
Language	English
Publishing date	2022-06-21
Publishing country	Canada
Document type	Journal Article
ISSN	2561-7605
ISSN (online)	2561-7605
DOI	10.2196/32790
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