Readmission

Cet article démontre qu'il est nécessaire de bien réfléchir au projet de « normaliser » la réadmission dans les relations extérieures de l’UE, plus particulièrement dans un contexte régional où les rapports d'interdépendance entre acteurs étatiques ont changé radicalement au cours des deux dernières décennies. Si d’aucuns reconnaissent la faible corrélation entre la coopération en matière de réadmission et la politique des visas, créer un lien de conditionnalité entre ces deux domaines ne saurait garantir la coopération durable des pays tiers, surtout lorsque ces derniers sont, aujourd’hui, en mesure de capitaliser sur leur position stratégique vis-à-vis de certains États membres de l’UE.

La présence de migrants sub-sahariens, relativement nouvelle au Maroc, n’a été reconnue qu’après 2000. En effet, bien que les projets de ces migrants ne soient pas nécessairement linéaires, ils sont considérés comme des migrants « en transit » dans le cadre des négociations avec les pays européens. En fait, le Maroc n’est pas le simple exécutant des politiques migratoires européennes : la présence de ces migrants sur son territoire, de même que sa situation stratégique proche des frontières de l’Union européenne, a pu servir de « rente géographique ». Ainsi, les différents niveaux de négociations – nationaux ou européen – sont utilisés pour obtenir le plus d’avantages possibles en échange d’une participation active à la lutte contre les migrations irrégulières, notamment à travers la signature d’accords de réadmission. L’interprétation de ces accords lors de leur mise en oeuvre créé également de nouvelles opportunités de négociations.

Background: Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting
the effectiveness of widespread implementation of mHealth technologies.

Objective: This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes
can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes
(ie, patient engagement, patient experience, and patient satisfaction).
Methods: We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all
patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities.

Results: The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment.

Conclusions: A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.

If the EU insists upon the revision of Turkey's anti-terror laws, while the country is fighting against terror groups such FETO, DAESH and the PKK/PYD, it will not be surprising to see a cancelation of the readmission agreement between Turkey and the EU.

With the emergence of the Hospital Readmission Reduction Program of the Center for Medicare and Medicaid Services on October 1, 2012, forecasting unplanned patient readmission risk became crucial to the healthcare domain. There are tangible works in the literature emphasizing on developing readmission risk prediction models; However, the models are not accurate enough to be deployed in an actual clinical setting. Our study considers patient readmission risk as the objective for optimization and develops a useful risk prediction model to address unplanned readmissions. Furthermore, Genetic Algorithm and Greedy Ensemble is used to optimize the developed model constraints.

Prospects of the readmission agreement between the EU and Belarus are analyzed. Drawing on the characteristics of illegal migration flows through Belarus and assessment of the implementation of readmission agreements between the EU and Russia and between the EU and Ukraine, numbers of individuals that Belarus would have to readmit from the European Union are projected. The main conclusion of the study is Belarus' exaggeration of the negative impact of the readmission agreements with the EU. It is projected that Belarus would have to readmit up to 100-200 third-country nationals and stateless persons annually as a result of the readmission agreement with the EU.

Introduction: About half of hospital readmissions can be avoided with preventive interventions. Developing decision support tools for identification of patients’ emergency readmission risk is an important area of research. Because, it remains unclear how to design features and develop predictive models that can adjust continuously to a fast-changing healthcare system and population characteristics. The objective of this study was to develop a generic ensemble Bayesian risk model of emergency readmission. Methods: We produced a decision support tool that predicts risk of emergency readmission using England&#39;s Hospital Episode Statistics inpatient database. Firstly, we used a framework to develop an optimal set of features. Then, a combination of Bayes Point Machine (BPM) models for different cohorts was considered to create an optimised ensemble model, which is stronger than the individual generative and non-linear classifications. The developed Ensemble Risk Model of Emergency Ad...

Reificazione, flessibilità e “negabilità” sono concetti utili per cogliere le ragioni per cui la Commissione europea ha dovuto allineare il suo modus operandi sulla consolidata prassi bilaterale di alcuni Stati membri. Forse, mai prima d'ora il bilateralismo è stato così intrecciato con il sovranazionalismo. Tali sviluppi politici hanno portato all’espansione di una zona grigia dove la trasparenza, il rispetto delle obbligazioni internazionali e le responsabilità degli attori coinvolti sfumano dietro lo schermo dell’operabilità ad ogni costo.

Objectives Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions. Design Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen's Kappa measured pairwise agreement of considering readmission as predictable/ preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability. Setting 15 hospitals in four European countries Participants 1398 medical patients readmitted unscheduled within 30 days Main Outcome(s) and Measure(s) (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions. Results The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49). Conclusions There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.

Background: We retrospectively assessed the independent effects of patient and clinical factors on length of stay and all-cause 90-day, one-year, and two-year readmission following elective total joint replacement. We also evaluated the independent association between length of stay and readmission with postoperative five-year mortality.
Methods: Longitudinal data from 819 men who had had total joint replacement were integrated with validated hospital morbidity data and mortality records. Length of stay, readmission, and mortality following total joint replacement were each modeled using multivariable proportional
hazards regression. Results: Mean age at surgery was 76.3 ± 4.3 years. Median length of stay following total joint replacement decreased by 25% from 12 days in 1997–1998 to nine days in 2005–2007. Age, inhospital complications, total knee replacement, private hospital, and increased body
weight were significantly associated with longer stay. A dose-response relationship between weight and length of stay was observed (P = 0.003). Crude 90-day, one-year, and two-year
readmission rates were 17.3%, 47.4%, and 65.0%, respectively. Ninety-day readmission was associated with comorbidity, inhospital complications, and treatment in public hospitals. Age,
comorbidity, socioeconomic disadvantage, and increased weight significantly increased the risk of one-year and two-year readmission. Patients with a body mass index $ 30 kg/m2 were 34% more likely to be readmitted within two years compared with those having a body mass index of 18.5–24.9 kg/m2. All-cause one-year and two-year readmission rates were significantly higher in patients undergoing a total knee replacement than those undergoing a total hip replacement.
No independent associations between length of stay and all-cause readmission or mortality were observed. All-cause 90-day and one-year readmission independently increased the risk of long-term postoperative mortality. Conclusion: After adjusting for confounding factors, including age, comorbidity, obesity, and inhospital complications, length of stay was not independently associated with post-discharge readmission or death. We report that the obese, those having total knee replacement, and the socioeconomically disadvantaged are the highest consumers of hospital resources following elective
total joint replacement in elderly men. Our findings may assist clinicians in better selection of elderly patients for surgery, and informing them about their individual level of risk.

Since 2006, an inventory of the bilateral agreements linked to readmission, concluded by the EU Member States, has been done.
The rationale for the inventory is not only informative. It is also aimed at showing that a whole "readmission system" exists linking today more than 125 countries of destination, of transit and of origin, whether these are poor or rich, large or small, conflict-ridden or not, democratically organized or authoritarian.
This is a powerfully inclusive system.

http://www.jeanpierrecassarino.com/datasets/ra/

The New York Declaration recalled everyone's right to leave any country, including his own, and to return to his or her country. Declaration also reminds that States must readmit their returning nationals and ensure that they are received without undue delay, following confirmation of their nationalities under national legislation. These and other principles were crystallized in the adoption of two non-binding Compacts, the Global Compact on Refugees (GCR) and the Global Compactfor Safe, Orderly, and Regular Migration (GCM). This paper analyzes the links between these relevant non-binding documents and new trends in the European Union readmission policy.
The main focus of the analysis is Objective 21 GCM which calls for increased cooperation in readmission matters in full compliance with international human rights obligations. The return and readmission of people who do not have the right to remain in European territory are one of the main objectives of the EU immigration policy. To this end, the EU already has its competence, albeit shared with states, to conclude
readmission agreements with third parties that speed up identifying and returning third country nationals. A quite new trend in EU readmission policy is to conclude practical readmission agreements (better-called arrangements or deals) in an informal form. These informal arrangements fall within the category of soft law and affect legal certainty and other structural principles in the EU legal order. With the example of the renewed arrangement with Afghanistan, the possible compatibility between these practices and the GCM would be examined. A conclusion on the future trends ahead within the proposed New Pact on Migration and Asylum is made to understand if the trend  to  use informal instruments is expected to continue.

This policy brief addresses people’s post-return vulnerabilities and protection needs beyond refoulement and demonstrates that returns can both exacerbate existing, as well as create new vulnerabilities.
In Objective 21 of the Global Compact for Migration, states commit to facilitate safe and dignified return and ensure that reintegration of migrants upon return is sustainable. In this respect, the policy brief asks two questions: Which factors exacerbate existing or create new vulnerabilities after return and thus preclude the sustainability of reintegration? What responsibilities emerge from these vulnerabilities for states that implement returns?
The brief answers these questions on the basis of fieldwork carried out between 2016 and 2019 with people forcibly returned from European countries. Relying on this empirical material, the policy brief argues that rights-based return policies need more robust vulnerability assessments and more extensive monitoring of people’s access to rights and well-being after return.
Return policies are only effective if they are sustainable. Yet, which return trajectories can lead to sustainable reintegration? This is a question which policymakers and practitioners have so far shied away from.

One of the attributes that is frequently associated with a notion of a sovereign state is the right to decide who should be admitted to its territory and – as a consequence of the above – who should be granted a residence permit. This leads to the conclusion that the state has also a right to repatriate those of the foreigners who stay within the state's territory without proper authorisation. However, it has to be born in mind that all of the said rights are limited when the state becomes an EU member state. This is a result of the fact that some of these issues are within the competence of the EU.
This paper explores steps taken by the EU in a field of voluntary returns, regularisations, and readmissions. In particular it focuses on development of these measures taking into account recent EU legislation in the field (including the Lisbon Treaty and return directive). Taking into account EU law and best practices of EU Member States it can be said that these instruments of migration policy are not interchangeable. On the contrary, research shows that by ensuring an existence of a proper linkage between these measures the number of unauthorized migrants residing in the EU may be limited.
Moreover, in this paper correlation between steps taken on an EU level and their impact on EU Member States' laws and practices, in particular on Polish and United Kingdom ones, is analysed. Selection of those countries makes it possible to present experiences of a destination country and a transit-destination country. What is more, an impact of Schengen acquis on a right to admit third country nationals can also be elaborated.

This article concentrates upon an impact of readmission agreements between the EU and Moldova and between the EU and Georgia. It underlines the technical nature of these agreements and presents their role in safeguarding rights of returned migrants.
It cannot be argued that without adequate support imposing higher standards with respect to returns and readmission cannot be achieved by the migration services in Moldova and in Georgia. However, the question arises whether the EU and EU Member States are doing enough in order to help Moldova and Georgia in strengthening capacity building of migration services in those countries. Examples of actions that were taken, have been taken and are being taken in those countries are provided. Special attention is paid to projects implemented under EU Mobility Partnership Agreements in order to verify the usability of this tool in developing migration management systems.

Link: http://www.bailii.org/uk/other/journals/WebJCLI/2012/issue1/sadowski1.html

http://journals.sagepub.com/doi/full/10.1177/0967010614533139 Analyses that develop a postcolonial critique of international relations and security studies have outlined the project of ‘decolonizing’ these disciplines and have underlined the importance of taking into account actors from the South. I seek to do so here through the study of migration policies, in particular by looking for the agency of state actors in so-called countries of origin. This article shows that the study of practices of cooperation is a good strategy for decolonizing the study of international relations. Based upon the example of mid-level cooperation on deportation between France and Morocco, this article focuses on two devices and the practices used for international cooperation on migration controls: the posting of immigration liaison officers and the statistical evaluation of cooperation. This case study shows that such practices open brokering spaces in the transnational security field and allow state actors from the South to challenge the dominance of the North.

Acute myocardial infarction; Relapse; Readmission; Telehealth. Telehealth is an endeavor to prevent readmission in patients with Acute Miocard Infarct (AMI). The objective of this study was to identify the effect of Telehealth as a reoccurrence and readmission strategy for a patient with AMI. This study was a literature review with article searches in some databases including ScienceDirect, Sage Journals, Ebsco, Scopus, and Cochrane for the last ten years. The selected articles were limited to those in English with free full text. Studies that were involving adult AMI in the adult patient and obtaining intervention or monitoring via phone or Telehealth were included. The result from reviewed articles showed that Telehealth can be used as an alternative intervention to prevent readmission in patients with AMI. Various methods which are explained in the literature can be implemented as a strategy to prevent reoccurrence or readmission for the patient with AMI.

Before the summit of European and Turkish delegations, the president ​ Erdogan stressed that they have spent great effort to host 3 million Syrian refugees. The president claimed that Turkey spent $10bn till now. He ​ said​ : "​ EU promised to give us €3bn, 4 months have passed since then (...) The prime minister is in Brussels right now. I hope he returns with that money." ​ In 2015, the EU has pledged €3bn to Turkey on condition that the government can develop projects and apply them. In response, Turkey promised to combat with smugglers more efficiently thereby reducing the migration waves.

This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B=0.54) and nurse assessment (B=...

Examination of readmission data is a standard method for evaluating health service outcomes. Limited work has evaluated the efficacy of mental health rehabilitation, despite the need for evidence-based approaches. To evaluate the impact of inpatient mental health rehabilitation using metrics of psychiatric readmissions routinely collected at occasions of service. Consumers (n = 252) of a nonacute inpatient mental health rehabilitation unit were case matched with normative clients from community mental health services. The impact of inpatient care was measured on: (1) the occurrence of a psychiatric readmission within 12 months of discharge; (2) the total number of psychiatric readmissions within 12 months of discharge; and (3) the number of days to a psychiatric readmission after discharge. The proportion of consumers experiencing a readmission significantly decreased following inpatient care, comparable to the normative group. The number of readmissions also significantly decreased...

Исследование посвящено описанию сущности реадмиссионных договоров и анализу последствий предполагаемого соглашения о реадмиссии между Беларусью и Евросоюзом. Вопрос о реадмиссионном соглашении является ключевым в сфере упрощения визового режима. На основании анализа параметров нелегальной миграции через территорию Беларуси и оценки действия аналогичных соглашений ЕС с Россией и Украиной, в работе оценивается вероятное количество граждан третьих стран и лиц без гражданства, которых Беларусь принимала бы из стран ЕС в рамках действия соглашения о реадмиссии.

Основной вывод исследования заключается в том, что официальный Минск чрезмерно преувеличивает негативные последствия от действия потенциального соглашения о реадмиссии с ЕС. Представляется, что в рамках соглашения о реадмиссии с ЕС число ежегодно принимаемых Беларусью граждан третьих стран и лиц без гражданства не превышало бы 100-200 человек, а скорее составляло бы несколько десятков человек.

Importance  Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving health care quality. The cumulative complexity model conceptualizes patient context. It predicts that highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions.

Objective  To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features—including their impact on treatment burden and on patients’ capacity to enact postdischarge self-care—that might explain their varying effects.

Data Sources  We searched PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Scopus (1990 until April 1, 2013), contacted experts, and reviewed bibliographies.

Study Selection  Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients hospitalized for a medical or surgical cause for more than 24 hours and discharged to home.

Data Extraction and Synthesis  Reviewer pairs extracted trial characteristics and used an activity-based coding strategy to characterize the interventions; fidelity was confirmed with authors. Blinded to trial outcomes, reviewers noted the extent to which interventions placed additional work on patients after discharge or supported their capacity for self-care in accordance with the cumulative complexity model.

Main Outcomes and Measures  Relative risk of all-cause or unplanned readmission with or without out-of-hospital deaths at 30 days postdischarge.

Results  In 42 trials, the tested interventions prevented early readmissions (pooled random-effects relative risk, 0.82 [95% CI, 0.73-0.91]; P < .001; I2 = 31%), a finding that was consistent across patient subgroups. Trials published before 2002 reported interventions that were 1.6 times more effective than those tested later (interaction P = .01). In exploratory subgroup analyses, interventions with many components (interaction P = .001), involving more individuals in care delivery (interaction P = .05), and supporting patient capacity for self-care (interaction P = .04) were 1.4, 1.3, and 1.3 times more effective than other interventions, respectively. A post hoc regression model showed incremental value in providing comprehensive, postdischarge support to patients and caregivers.

Conclusions and Relevance  Tested interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care. Interventions tested more recently are less effective.