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Hospital readmission is an important indicator of health care quality and currently used in determining hospital reimbursement rates by Centers for Medicare & Medicaid Services. Given the important policy implications, a better understanding of factors that influence readmission rates is needed. Racial disparities in readmission have been extensively studied, but income and marital status (a postdischarge care support indicator) disparities have received limited attention. By employing three Poisson regression models controlling for different confounders on 8,718 patients in a veterans-integrated health care network, this study assessed racial, income, and martial disparities in relation to total number of readmissions. In contrast to other studies, no racial and income disparities were found, but unmarried patients experienced significantly more readmissions: 16%, after controlling for the confounders. These findings render unique insight into health care policies aimed to improve race and income disparities, while challenging policy makers to reduce readmissions for those who lack family support. [ABSTRACT FROM AUTHOR]

Objectives: To develop a predictive model that hospitals or healthcare systems can use to identify patients at high risk of revisiting the emergency department (ED) within 30 days and thus reduce unnecessary ED use through proactive interventions., Study Design: A retrospective analysis of fiscal years (FYs) 2013 and 2014 data from 4 Veterans Affairs hospitals in upstate New York., Methods: This study developed a predictive model based on administrative data, a publicly available patient classification system, and logistic regression. The study data were from 4 Veterans Affairs hospitals in upstate New York; FY 2013 data were used to predict 30-day revisits in FY 2014. All 22,734 patients with ED visits were included in the analysis. The predictive variables were patient demographics, prior-year utilization, and comorbidities. To prevent overfitting, we validated the model by the split-sample method. The predictive power of the model is measured by C statistics., Results: In the first model using only patient demographics, the C statistics were 0.568 (95% CI, 0.555-0.580) and 0.556 (95% CI, 0.543-0.568) for the development and validation samples, respectively. In the second model with prior-year utilization added, the C statistics were 0.748 (95% CI, 0.737-0.759) for both samples. In the final model with comorbidities added, the C statistics reached 0.773 (95% CI, 0.762-0.784) and 0.763 (95% CI, 0.753-0.774) for the development and validation samples, respectively., Conclusions: The predictive model we developed in this study is straightforward to implement and offers significantly higher predictive power than other models reported in the literature. Hospitals and healthcare systems can use it to identify high-risk "frequent flyers" for early interventions to reduce ED revisits.

Objectives: To explore actionable information that can be used to reduce hospital acute care length of stay (LOS) and to assess racial and income disparities in LOS in an integrated healthcare network., Study Design and Methods: Retrospective analysis of 8718 inpatients in an integrated healthcare network. The LOS was examined by using linear, log-linear, Poisson, generalized Poisson, and negative binomial (NB) models to control for confounding factors. The performances of the 5 models were compared, and the NB model was selected for the final analysis and report., Results: Over 50% of the inpatients were not married. The LOS was 22% longer for the unmarried patients compared with their married counterparts after controlling for confounding factors. No income or racial disparities were found., Conclusions: The prolonged LOS of the unmarried patients and the potential lack of post discharge care support warrant greater attention from discharge planners at hospital level and from policy makers at both the national and local levels. Racial and income disparities are not unavoidable; the way in which care is paid for and delivered may play a role.

The purpose of this study is to develop a reliable and valid tool for measuring the dynamic sitting balance of wheelchair users with spinal cord injury. The balance tests were performed in nine patients with chronic spinal cord injury (average of 17.2 years postinjury) between levels C6 and L1, while they were sitting in their wheelchairs and on a standardized stool (unsupported sitting), twice, 7 days apart. Limits of stability (LOS) and sequential weight shifting (SWS) were designed in this study. The balance tests measured participants' volitional weight shifting in multiple directions within their base of support. Their mobility scores on the Spinal Cord Independence Measure III were correlated with the balance test results. The LOS results showed moderate to excellent test-retest reliability (intraclass correlation coefficients ranged from 0.673 to 0.990) for both the wheelchair and the unsupported sitting. The SWS results showed moderate to excellent reliability (intraclass correlation coefficients ranged from 0.688 to 0.952). The LOS results correlated significantly with the Spinal Cord Independence Measure III mobility scores only in case of unsupported sitting, but the SWS test results showed significant correlations in both sitting conditions. To sum up, the sitting LOS and SWS tests are reliable and valid tools for assessing the dynamic sitting balance control of patients with spinal cord injury.

Objective: To investigate eye-hand coordination in stroke survivors and its relationship with sensori-motor impairments and hand functioning in daily life., Design: Cross-sectional study., Subjects: Fifteen subjects with stroke (mean age 62.5 years (standard deviation (SD) 7.1); time post-stroke 5.2 years (SD 3.0)) recruited by convenience sampling., Methods: A fast finger-pointing task towards a moving visual target was employed to investigate the differences between the subjects' affected and unaffected hands in terms of reaction time, movement time and accuracy. Their sensori-motor impairments in tactile sensation, handgrip strength, Fugl-Meyer scores and Jebsen Taylor Hand Function Test scores were measured., Results: Significant differences were found between the affected and unaffected hands in terms of movement time and accuracy in finger pointing. Movement time was significantly correlated with tactile sensitivity, handgrip strength and total Fugl-Meyer score, while accuracy correlated with tactile sensitivity and total Fugl-Meyer score. Total scores on the hand function test also correlated significantly with reaction time and movement time., Conclusion: The stroke survivors had poorer eye-hand coordination, in terms of slower movement and reduced accuracy when using their affected hand. These performance measures were significantly correlated with several sensori-motor impairments. A significant correlation was also found between eye-hand coordination performance and hand function test scores.