Discovery Park

Research Speaker Series: Parikh

February 22 @ 11:30 AM - 1:00 PM - MANN 203

Pratik Parikh, Industrial and Human Factors Engineering, Wright State University, will present on a joint project with Purdue's Nan Kong on acute hospital discharge planning.

ABSTRACT:

 

Discharging acute care patients from hospitals is a complex process and depends on both patient- and system-specific factors. In light of the Readmissions Reduction Program by CMS, hospitals are increasingly pressured to lower post-discharge readmission rates (~20%), which may encourage them to hold patients longer in the hospital. In contrast, the effect of emergency department (ED) crowding on resource utilization and ambulance diversion (over 200 hours annually) may encourage hospitals to discharge patients earlier. We focus on understanding the discharge process at US hospitals, identifying the relevant patient- and system-specific factors, and analyzing the impact of discharge timing on a variety of performance measures. We first discuss a model for predicting readmission upon discharge of patients with heart failure, where some patients may or may not have chronic kidney disease and acute kidney injury during inpatient stay. Factors such as a patient’s socio-demographic profile, payer information, comorbidities, and residence location were included. We then discuss, at the system level, interdependencies between the ED and inpatient units. The underlying causes for ED crowding and boarding, and ambulance diversions will be discussed. We developed a discrete-event simulation framework to evaluate the tradeoff between early and late discharges on a variety of performance measures. Our proposed novel dynamic discharge policies are discussed and compared against a static policy using this framework. Considering the substantial merit of these dynamic policies, and the recent post-discharge interventions introduced at some hospitals in our region, it is likely that hospitals may now not only benefit from improved ED measures, but also mitigate increases in readmissions. Our framework would also allow us to evaluate the recent changes in reimbursement policies (e.g., Medicare's new bundled payments initiative) from a system's perspective. Future work in this area includes detailed modeling of natural history of a medical condition during inpatient stay, considering other patient pathways into the hospital, and considering discharge location decisions.

 

Lunch begins at 11:30 a.m.

Presentation begins at noon.

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