Xie, S. and Yih, Y. “Improving Patient Care Transitions at Rural and Urban Hospitals Through Risk Stratification,” Women in Industrial and Systems Engineering – Key Advances and Perspectives on Emerging Topics, edited by A.E. Smith, Women in Engineering and Science Series,  Springer Nature Switzerland AG, 2019, 211-232. https://doi.org/10.1007/978-3-030-11866-2

About the Book:

This book presents a diversity of innovative and impactful research in the field of industrial and systems engineering (ISE) led by women investigators.  After a Foreword by Margaret L. Brandeau, an eminent woman scholar in the field, the book is divided into the following sections:  Analytics, Education, Health, Logistics, and Production.  Also included is a comprehensive biography on the historic luminary of industrial engineering, Lillian Moeller Gilbreth.  Each chapter presents an opportunity to learn about the impact of the field of industrial and systems engineering and women’s important contributions to it. Topics range from big data analysis, to improving cancer treatment, to sustainability in product design, to teamwork in engineering education. A total of 24 topics touch on many of the challenges facing the world today and these solutions by women researchers are valuable for their technical innovation and excellence and their non-traditional perspective. Found within each author’s biography are their motivations for entering the field and how they view their contributions, providing inspiration and guidance to those entering industrial engineering.

https://www.springer.com/us/book/9783030118655#aboutBook

About the Chapter:

Improving Patient Care Transitions at Rural and Urban Hospitals through Risk Stratification

Shan Xie and Yuehwern Yih

Abstract

Rural and urban hospitals may face different challenges in care transition and care coordination. This chapter explored important care transition issues pertaining to rural and urban hospitals and demonstrated how data analytics and risk stratification methods could be applied to help identify patients who would be most likely to benefit from care transition interventions and inform decisions regarding resource allocation and intervention design. Two studies are included in this chapter. The first study examined emergency department (ED) utilization in critical access hospitals (CAHs), especially ED transfers to larger hospitals and non-emergent ED visits. The second study assessed hospital and community characteristics associated with 30-day all-cause hospital readmissions for general medicine patients. The findings identify the need to improve care coordination between local CAH, larger urban hospitals as well as primary care physicians to ensure proper follow-up care for patients discharged to their home community. Hospital and community characteristics are significantly associated with 30-day readmission and hence should be considered when adjusting readmission rates and setting financial penalties.