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  1. Article ; Online: Individual- and Community-Level Predictors of Hospital-at-Home Outcomes.

    Williams, Cynthia / Paulson, Nels / Sweat, Jeffrey / Rutledge, Rachel / Paulson, Margaret R / Maniaci, Michael / Burger, Charles D

    Population health management

    2024  

    Abstract: Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study ... ...

    Abstract Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (
    Language English
    Publishing date 2024-03-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2454546-6
    ISSN 1942-7905 ; 1942-7891
    ISSN (online) 1942-7905
    ISSN 1942-7891
    DOI 10.1089/pop.2023.0297
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods Study.

    Paulson, Nels / Paulson, Margaret P / Maniaci, Michael J / Rutledge, Rachel A / Inselman, Shealeigh / Zawada, Stephanie J

    Journal of patient experience

    2023  Volume 10, Page(s) 23743735231189354

    Abstract: To understand why US patients refused participation in hospital-at-home (H@H) during the coronavirus disease 2019 Public Health Emergency, eligible adult patients seen at 2 Mayo Clinic sites, Mayo Clinic Health System-Northwest Wisconsin region (NWWI) ... ...

    Abstract To understand why US patients refused participation in hospital-at-home (H@H) during the coronavirus disease 2019 Public Health Emergency, eligible adult patients seen at 2 Mayo Clinic sites, Mayo Clinic Health System-Northwest Wisconsin region (NWWI) and Mayo Clinic Florida (MCF), from August 2021 through March 2022, were invited to participate in a convergent-parallel study. Quantitative associations between H@H participation status and patient baseline data at hospital admission were investigated. H@H patients were more likely to have a Mayo Clinic patient portal at baseline (
    Language English
    Publishing date 2023-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2857285-3
    ISSN 2374-3743 ; 2374-3735
    ISSN (online) 2374-3743
    ISSN 2374-3735
    DOI 10.1177/23743735231189354
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Machine Learning-Based Predictive Models for 90-Day Readmission of Total Joint Arthroplasty Using Comprehensive Electronic Health Records and Patient-Reported Outcome Measures.

    Park, Jaeyoung / Zhong, Xiang / Miley, Emilie N / Rutledge, Rachel S / Kakalecik, Jaquelyn / Johnson, Matthew C / Gray, Chancellor F

    Arthroplasty today

    2023  Volume 25, Page(s) 101308

    Abstract: Background: The Centers for Medicare & Medicaid Services currently incentivizes hospitals to reduce postdischarge adverse events such as unplanned hospital readmissions for patients who underwent total joint arthroplasty (TJA). This study aimed to ... ...

    Abstract Background: The Centers for Medicare & Medicaid Services currently incentivizes hospitals to reduce postdischarge adverse events such as unplanned hospital readmissions for patients who underwent total joint arthroplasty (TJA). This study aimed to predict 90-day TJA readmissions from our comprehensive electronic health record data and routinely collected patient-reported outcome measures.
    Methods: We retrospectively queried all TJA-related readmissions in our tertiary care center between 2016 and 2019. A total of 104-episode care characteristics and preoperative patient-reported outcome measures were used to develop several machine learning models for prediction performance evaluation and comparison. For interpretability, a logistic regression model was built to investigate the statistical significance, magnitudes, and directions of associations between risk factors and readmission.
    Results: Given the significant imbalanced outcome (5.8% of patients were readmitted), our models robustly predicted the outcome, yielding areas under the receiver operating characteristic curves over 0.8, recalls over 0.5, and precisions over 0.5. In addition, the logistic regression model identified risk factors predicting readmission: diabetes, preadmission medication prescriptions (ie, nonsteroidal anti-inflammatory drug, corticosteroid, and narcotic), discharge to a skilled nursing facility, and postdischarge care behaviors within 90 days. Notably, low self-reported confidence to carry out social activities accurately predicted readmission.
    Conclusions: A machine learning model can help identify patients who are at substantially increased risk of a readmission after TJA. This finding may allow for health-care providers to increase resources targeting these patients. In addition, a poor response to the "social activities" question may be a useful indicator that predicts a significant increased risk of readmission after TJA.
    Language English
    Publishing date 2023-12-28
    Publishing country United States
    Document type Journal Article
    ISSN 2352-3441
    ISSN 2352-3441
    DOI 10.1016/j.artd.2023.101308
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Development and evaluation of best practice advisory alert for patient eligibility in a hospital-at-home program: A multicenter retrospective study.

    Maniaci, Michael J / Torres-Guzman, Ricardo A / Avila, Francisco R / Maita, Karla / Garcia, John P / Forte, Antonio J / Rutledge, Rachel / Dugani, Sagar B / Campbell, Shannon M / Pritchard, Ingrid J / Paulson, Margaret R

    Journal of hospital medicine

    2024  Volume 19, Issue 3, Page(s) 165–174

    Abstract: Background: Hospital-at-home (HaH) is a growing model of care that has been shown to improve patient outcomes, satisfaction, and cost-effectiveness. However, selecting appropriate patients for HaH is challenging, often requiring burdensome manual ... ...

    Abstract Background: Hospital-at-home (HaH) is a growing model of care that has been shown to improve patient outcomes, satisfaction, and cost-effectiveness. However, selecting appropriate patients for HaH is challenging, often requiring burdensome manual screening by clinicians. To facilitate HaH enrollment, electronic health record (EHR) tools such as best practice advisories (BPAs) can be used to alert providers of potential HaH candidates.
    Objective: To describe the development and implementation of a BPA for identifying HaH eligible patients in Mayo Clinic's Advanced Care at Home (ACH) program, and to evaluate the provider response and the patient characteristics that triggered the BPA.
    Design, setting, and participants: We conducted a retrospective multicenter study of hospitalized patients who triggered the BPA notification for ACH eligibility between March and December 2021 at Mayo Clinic in Jacksonville, FL and Mayo Clinic Health System in Eau Claire, WI. We extracted demographic and diagnosis data from the patients as well as characteristics of the providers who received the BPA notification.
    Intervention: The BPA was developed based on the ACH inclusion and exclusion criteria, which were derived from clinical guidelines, literature review, and expert consensus. The BPA was integrated into the EHR and displayed a pop-up message to the provider when a patient met the criteria for ACH eligibility. The provider could choose to refer the patient to ACH, dismiss the notification, or defer the decision.
    Main outcomes and measures: The main outcomes were the number and proportion of BPA notifications that resulted in a referral to ACH, and the number and proportion of referrals that were accepted by the ACH clinical team and transferred to ACH. We also analyzed the factors associated with the provider's decision to refer or not refer the patient to ACH, such as the provider's role, location, and specialty.
    Results: During the study period, 8962 notifications were triggered for 2847 patients. Providers opted to refer 711 (11.4%) of the total notifications linked to 324 unique patients. After review by the ACH clinical team, 31 of the 324 referrals (9.6%) met clinical and social criteria and were transferred to ACH. In multivariable analysis, Wisconsin nurses, physician assistants, and in-training personnel had lower odds of referring the patients to ACH when compared to attending physicians.
    MeSH term(s) Humans ; Retrospective Studies ; Electronic Health Records ; Consensus ; Health Personnel ; Hospitals
    Language English
    Publishing date 2024-01-19
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.13275
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Nasal Embryonal Rhabdomyosarcoma in the Pediatric Population: Literature Review and Report of Midline Presentation.

    Larson, Jordan H / Rutledge, Rachel / Hunnell, Laura / Choi, Daniel K / Kellogg, Robert G / Naran, Sanjay

    Plastic and reconstructive surgery. Global open

    2021  Volume 9, Issue 4, Page(s) e3534

    Abstract: Background: Congenital midline nasal masses are rare anomalies and are typically benign nasal dermoid sinus cysts (NDSCs). Rhabdomyosarcomas (RMSs) are even less common, and only a fraction affect sites like the external nose, nasal cavity, nasopharynx, ...

    Abstract Background: Congenital midline nasal masses are rare anomalies and are typically benign nasal dermoid sinus cysts (NDSCs). Rhabdomyosarcomas (RMSs) are even less common, and only a fraction affect sites like the external nose, nasal cavity, nasopharynx, and paranasal sinuses. We review the clinical presentation and treatment of nasal, nasopharyngeal, and paranasal RMSs and report the first documented midline presentation.
    Methods: We queried PubMed for articles with titles containing the terms rhabdomyosarcoma or sarcoma botryoides and nose, nasal, paranasal, sinonasal, nasopharynx, or nasopharyngeal. We then searched the references of each included article using the same parameters and continued this process iteratively until no new articles were found.
    Results: The paranasal sinuses were the most commonly affected site, followed by the nasopharynx, nasal cavity, and external nose. Two patients presented with involvement of the external nose, but each presented with involvement of the right ala rather than a midline mass. The rates of intracranial extension and/or skull base involvement were comparable to those of NDSCs. The alveolar subtype was most common, followed by the embryonal subtype.
    Conclusions: Most midline nasal masses are benign; however, we report the first documented presentation of an RMS as a midline nasal mass. Accordingly, RMS should be included in the differential diagnosis of midline nasal masses in the pediatric population. Surgery for midline nasal masses is sometimes delayed due to the risks of interfering with developing structures and early anesthesia. However, early surgical treatment should be considered given this new differential and its predilection for early metastasis.
    Language English
    Publishing date 2021-04-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2851682-5
    ISSN 2169-7574 ; 2169-7574
    ISSN (online) 2169-7574
    ISSN 2169-7574
    DOI 10.1097/GOX.0000000000003534
    Database MEDical Literature Analysis and Retrieval System OnLINE

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