Background: Communication between referring Veterans Health Administration (VHA) facilities and home health care agencies in the community is imperative for comprehensive care for Veterans. However, to date little is known about communication during care transitions from VHA facilities to home health care. The purpose of the present study is to conduct a preliminary exploratory survey [...]

Background: The majority of states have implemented Prescription Drug Monitoring Programs (PDMPs) in an effort to curb opioid prescribing in high-risk patients; however, the effectiveness of these programs at hospital discharge is not well established. Studies in the post-operative setting have demonstrated mixed results in opioid prescribing after requiring PDMP queries.1-2 Little is known about [...]

Background: Prolonged lengths of stay (PLOS) on general internal medicine wards are associated with increased mortality and morbidity for patients and represent a costly source of health care spending [1]. Increasingly, nonmedical barriers to discharge, including the need for guardianship, limited facility options, and lack of home support are recognized as contributors to PLOS in [...]

Background: Post-discharge appointment follow-up is recognized as a key intervention in reducing readmissions. Studies show that having a follow-up visit can reduce readmission risk, particularly for patients at higher risk for readmission. [1] Among Medicaid patients, primary care physician (PCP) follow-up within seven days of discharge was associated with reduced 30 and 90-day readmissions. [2] [...]

Background: Patients who are frequently admitted to the hospital are a highly vulnerable population, facing discontinuity between hospital admissions and care settings. At the Hospital of the University of Pennsylvania, the multidisciplinary STEP program works intensively with patients with extreme hospital utilization on the inpatient general medicine service (minimum of 5 but often 10-30 admissions [...]

Background: Interhospital transfer (IHT), which is often performed to provide patients with necessary procedural and specialized care, is a common occurrence in modern healthcare. Racial/ethnic inequities in IHT have been described using nationally representative data, however such inequities have not been characterized at a more local level, which can provide more granular data to adjust [...]

Background: Care of the pediatric patient does not end after the family exits the hospital doors. Post-discharge issues can lead to significant consternation for families, unnecessary risk to the patient, and re-utilization of healthcare resources. Despite careful preparation for transfer of care to the primary care physician (PCP), some post-discharge issues are unanticipated and lead [...]

Background: Hospitalizations among patients with opioid use disorder (OUD) have skyrocketed in the past 10 years (1). These patients represent an ever-growing portion of the typical hospital medicine census and often have readmission rates greater than expected for their age and other health status. Discharge against medical advice (AMA) is common in this population, and [...]

Background: Therapeutic paracentesis is a common procedure performed to relieve symptoms of ascites most commonly from cirrhosis, heart failure or malignancy. Previous studies have shown that acute kidney injury (AKI) is common after paracentesis and portends a poor prognosis, although these studies have excluded patients with pre-existing chronic kidney disease (CKD). Experiences in our hospital [...]

Background: Readmission among Inflammatory Bowel Disease (IBD) inpatients is common, as is opioid use. Opioid use for IBD has been associated with an increased risk of infection and death, but inconsistently with readmissions. Increasingly, cannabis is viewed as a potentially safer alternative to opioids, though with limited study of potential adverse outcomes such as hospital [...]