Roop Sunil Reddy Parlapalli

Readmissions are a major source of burden to patients, hospitals, and third-party payers. Remote patient monitoring (RPM) was initially implemented during the COVID-19 pandemic but was later expanded to other high-risk patients upon discharge from the hospital. The authors used a retrospective data of convenience sample of adult patients enrolled in their RPM program from March 2024 to May 2025. Inclusion criteria included adult patients > 21 years of age, members of Geisinger Health Plan or Keystone Accountable Care Organization, high-priority diagnosis-related groups with elevated Epic readmission risk score, home internet availability, and discharge disposition to home. Exclusion criteria included patients' age < 21 years old, not members of Geisinger Health Plan or Keystone Accountable Care Organization, lack of home internet eligibility, and discharge disposition other than home. The primary outcome measure was 30-day all-cause readmissions. The analysis of patients enrolled in RPM and those who were followed afterward showed a significant reduction in 30-day readmissions, with 30% absolute reduction (11% in enrolled group vs 41% in non-enrolled group). Finally, through modeling, the authors opine on the potential effect of RPM on the national readmission landscape. The RPM program provided a significant benefit to 30-day readmission among the authors' convenience sample.

Background: Gastrointestinal bleeding (GIB) is a common and serious complication in patients with left ventricular assist devices (LVADs), contributing to significant morbidity, prolonged hospitalization, and increased healthcare costs. We evaluated national trends, demographic disparities, and outcomes of GIB in hospitalized LVAD patients. Methods: We analyzed adult (≥18 years) LVAD hospitalizations in the National Inpatient Sample (2016–2021), identifying internal LVADs using ICD-10-PCS code 02HA0QZ. GIB was defined using ICD-10-CM codes and classified into upper (UGIB) and lower (LGIB) sources. Survey-weighted logistic and linear regression models assessed associations with mortality, length of stay (LOS), and total charges. Subgroup analyses explored sex and racial disparities. Results: Among 20,785 weighted adult LVAD admissions, 9.8% had GIB. Of these, 72.3% had LGIB and 31.0% had UGIB. Patients with GIB were older (59.2 vs. 54.8 years) and more likely to be female (43% vs. 40%) and Black (9.2% vs. 7.8%). GIB was associated with longer LOS (+15.3 days, 95% CI: 12.0–18.5), higher charges (+$316,031, 95% CI: $212,435–$419,627), and greater in-hospital mortality (OR 1.69, 95% CI: 1.25–2.29; p < 0.001). Female patients with GIB had higher odds of mortality (OR 1.37) and increased LOS (+5.6 days), though this was not statistically significant. Racial disparities were evident: Black patients with GIB had longer LOS (+8.9 days), while Asian/Pacific Islander patients had shorter LOS (–23.3 days, p < 0.001). From 2016 to 2021, GIB prevalence rose modestly (from 9.4% to 10.7%, p = 0.33), with no significant change in mortality trends (p = 0.13). Conclusions: GIB complicates nearly 1 in 10 LVAD hospitalizations, with lower GI bleeds being most common. GIB is independently associated with higher mortality, LOS, and costs. Persistent gender and racial disparities highlight the need for targeted strategies to improve outcomes in this high-risk population.