000007989 001__ 7989
000007989 005__ 20240124114256.0
000007989 0247_ $$2DOI$$a10.6083/f1881m566
000007989 037__ $$aETD
000007989 245__ $$aDuration of inpatient observation after transition to oral diuretics: effect on 30-day readmissions for heart failure patients
000007989 260__ $$bOregon Health and Science University
000007989 269__ $$a2020-06-01
000007989 336__ $$aFinal project
000007989 502__ $$bD.N.P.
000007989 520__ $$aHeart failure, the fifth most common cause for hospitalization, is associated with the highest 30-day readmission rate among all diagnoses in the United States (Finger, Barrett, & Jiang, 2017; McDermott, Elixhauser, & Sun, 2017).  A strong incentive to reduce 30-day readmissions has come from the association between increased mortality and subsequent heart failure readmissions, as well as reimbursement penalties imposed on hospitals in cases of 30-day all-cause readmissions for heart failure patients (Gupta & Fonarow, 2018, Lin, Chin, Sicignano, & Evans, 2017).  Decongestive therapy with intravenous (IV) loop diuretics is part of the standard of care for patients hospitalized with acute-on-chronic decompensated heart failure (Yancy et al., 2013).  A large proportion of patients admitted with acute-on-chronic decompensated heart failure are inadequately decongested prior to discharge, putting them at risk for 30-day hospital readmission (Gheorghiade et al., 2006; Lala et al., 2015).  Since assessment methods for adequate decongestion have demonstrated limitations, current expert recommendations advocate for at least 24 hours of inpatient observation following the transition from IV to oral loop diuretics (Hollenberg et al., 2019).  This quality improvement project designed to elucidate the utility of this recommendation for local implementation did not find evidence to support the use of a 24-hour cutoff point for inpatient observation of patients with chronic stage C heart failure with reduced left ventricular ejection fraction (? 40 percent) hospitalized for acute-on-chronic decompensated heart failure.  This result should be interpreted with caution given the project's methodological limitations inherent to the observational design and small sample size.  
000007989 650__ $$aDiuretics$$017965
000007989 650__ $$aObservation$$031580
000007989 650__ $$aHospitalization$$020335
000007989 650__ $$aHeart Failure$$019939
000007989 650__ $$aInpatients$$020846
000007989 6531_ $$atherapy
000007989 691__ $$aSchool of Nursing$$041370
000007989 7001_ $$aSamuel, Nathan D.$$uOregon Health and Science University$$041354
000007989 8564_ $$95ab48113-f441-4da0-94ce-826b177ebd10$$s199867$$uhttps://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
000007989 905__ $$a/rest/prod/f1/88/1m/56/f1881m566
000007989 909CO $$ooai:digitalcollections.ohsu.edu:7989$$pstudent-work
000007989 980__ $$aTheses and Dissertations