Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial
Kathleen Reeves,
Nicolle Strand,
Byron Udegbe,
Bryson Hoover-Hankerson,
Steuart Wright,
Victor Jegede,
Susan Freeman,
Jeffrey Slocum,
Arthur Garson
Issue:
Volume 11, Issue 2, June 2022
Pages:
40-44
Received:
19 April 2022
Accepted:
5 May 2022
Published:
12 May 2022
Abstract: While numerous approaches have been used to reducing hospital readmissions, few have been subjected to a randomized clinical trial (RCT). This RCT studied the effectiveness of a “Grand-Aides” home visitation program in the reduction of readmissions and emergency department (ED) visits for patients with heart failure. High-risk patients (N=97) were randomized to receive care either with Grand-Aides or an established program to reduce readmissions at one hospital over two years; 85% were covered by Medicare + Medicaid (“Dual Eligibles”). Grand-Aides patients had home visits, while the control patients received telephone follow-up from community health workers. Data on all-cause readmissions and all-cause ED visits were collected at 30 and 180 days. At 6 months: patients with Grand-Aides had a 60% reduction in all-cause 6-month readmissions (65% controls and 26% Grand-Aides), p<0.001, and a 67% reduction in all-cause emergency department visits (33% controls, 11% Grand-Aides), p<0.01. For readmissions in the first 30 days, patients with Grand-Aides had a 48% reduction in readmissions (42% controls, 21.7% Grand-Aides, p=0.03) and a 79% reduction in 30-day all-cause emergency. In the first randomized clinical trial on readmissions and ED, the Grand-Aides program showed significant reductions in patients with heart failure, as compared to the best available program at the time in our health system, suggesting the impact that regular tailored home visits can have on reducing hospital resource utilization and costs. Took out sections.
Abstract: While numerous approaches have been used to reducing hospital readmissions, few have been subjected to a randomized clinical trial (RCT). This RCT studied the effectiveness of a “Grand-Aides” home visitation program in the reduction of readmissions and emergency department (ED) visits for patients with heart failure. High-risk patients (N=97) were ...
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Determinants of the Number of Antenatal Care Visits During Pregnancy Period: The Case of Tigray Reginal State Region, Ethiopia
Sebwedin Surur Jemal,
Nejat Mehammed Aseffa,
Hagos Mekonen
Issue:
Volume 11, Issue 2, June 2022
Pages:
45-56
Received:
8 April 2022
Accepted:
9 May 2022
Published:
19 May 2022
Abstract: Antenatal care could be a preventive obstetric health care program geared toward optimizing maternal fetal outcome through regular monitoring of pregnancy. Whether or not world health organization (WHO) recommends a minimum of 4 antenatal care service (ANC) visits for normal pregnancy, existing evidence from developing countries including Ethiopia indicates there are few women who utilize it thanks to different reasons. 3711 pregnant women from Ethiopia demographic health survey (EDHS) of 2013 were used to analyze the determinants of the barriers in number of antenatal care service visits among pregnant women in Tigray regional state. The data were found to have no excess zeros since the number of zero visits less than non-zero visit of ANC and the variance (7.64) is much higher than its mean (2.46). This study provides numerical and graphical methods for checking the adequacy of the proportional odds regression model. Thus several count models such as Poisson, negative binomial (NB), zero inflated Poisson (ZIP), and zero inflated negative binomial (ZINB) regression models were fitted to select the model which best fits the data. Each of these models was compared using Statistical Package for the Social Sciences (SPSS ver. 16) by their likelihood ratio test (LR), Akaki and Bayesian information criteria and the model that have small Akaki and Bayesian information criteria’s was good fit the data. Negative binomial regression model was found to be better fitted with data which is characterized by non-excess zeros and high variability in the non-zero outcome. Through the analysis, access to modern ANC visits during pregnancy was low in Tigray regional state. Rural residence, absence of ANC, NGO medical institution, absence of education, lack of governmental hospital or medical institution, poverty, and never union with partner was significantly related to not attending ANC visits. The finding of this study indicates that the minimum ANC service within the region is mostly because the results of direct effect with absence of health post available. Policies and plans must improve visit of ANC service of pregnant women by arising health post available in rural residence and creating awareness on ANC for the society.
Abstract: Antenatal care could be a preventive obstetric health care program geared toward optimizing maternal fetal outcome through regular monitoring of pregnancy. Whether or not world health organization (WHO) recommends a minimum of 4 antenatal care service (ANC) visits for normal pregnancy, existing evidence from developing countries including Ethiopia ...
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