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Medical Care

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https://www.readbyqxmd.com/read/27906769/measuring-harm-in-health-care-optimizing-adverse-event-review
#1
Kathleen E Walsh, Polina Harik, Kathleen M Mazor, Deborah Perfetto, Milena Anatchkova, Colleen Biggins, Joann Wagner, Pamela J Schoettker, Cassandra Firneno, Robert Klugman, Jennifer Tjia
OBJECTIVE: The objective of this study was to identify modifiable factors that improve the reliability of ratings of severity of health care-associated harm in clinical practice improvement and research. METHODS: A diverse group of clinicians rated 8 types of adverse events: blood product, device or medical/surgical supply, fall, health care-associated infection, medication, perinatal, pressure ulcer, surgery. We used a generalizability theory framework to estimate the impact of number of raters, rater experience, and rater provider type on reliability...
November 30, 2016: Medical Care
https://www.readbyqxmd.com/read/27755391/predicting-readmission-at-early-hospitalization-using-electronic-clinical-data-an-early-readmission-risk-score
#2
Ying P Tabak, Xiaowu Sun, Carlos M Nunez, Vikas Gupta, Richard S Johannes
BACKGROUND: Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. METHODS: We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression...
November 29, 2016: Medical Care
https://www.readbyqxmd.com/read/27875482/impact-of-community-health-workers-on-elderly-patients-advance-care-planning-and-health-care-utilization-moving-the-dial
#3
Debra K Litzelman, Thomas S Inui, Wilma J Griffin, Anthony Perkins, Ann H Cottingham, Kathleen M Schmitt-Wendholt, Steven S Ivy
BACKGROUND: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. OBJECTIVE: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. RESEARCH DESIGN: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation...
November 21, 2016: Medical Care
https://www.readbyqxmd.com/read/27875481/receipt-of-caregiving-and-fall-risk-in-us-community-dwelling-older-adults
#4
Geoffrey J Hoffman, Ron D Hays, Steven P Wallace, Martin F Shapiro, Olga Yakusheva, Susan L Ettner
BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults...
November 21, 2016: Medical Care
https://www.readbyqxmd.com/read/27870661/should-the-positive-predictive-value-be-used-to-validate-complications-measures
#5
John S Hughes
No abstract text is available yet for this article.
November 18, 2016: Medical Care
https://www.readbyqxmd.com/read/27870660/patients-negatively-impacted-by-discontinuity-of-nursing-care-during-acute-hospitalization
#6
Olga Yakusheva, Deena K Costa, Marianne Weiss
BACKGROUND: Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES: This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hospitalization. RESEARCH DESIGN: Retrospective longitudinal analysis of electronic health records (EHR). Average point-in-time discontinuity was estimated from time of admission to discharge and compared with theoretical predictions for optimal continuity and random nurse assignment...
November 18, 2016: Medical Care
https://www.readbyqxmd.com/read/27820597/a-methodology-to-identify-a-cohort-of-medicare-beneficiaries-residing-in-large-assisted-living-facilities-using-administrative-data
#7
Kali S Thomas, David Dosa, Pedro L Gozalo, David C Grabowski, Jennifer Nazareno, Rajesh Makineni, Vincent Mor
BACKGROUND: Assisted living is a popular option for housing and long-term care. OBJECTIVE: To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs). RESEARCH DESIGN: We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and addresses of 11,751 ALFs...
November 4, 2016: Medical Care
https://www.readbyqxmd.com/read/27820596/understanding-treatment-disconnect-and-mortality-trends-in-renal-cell-carcinoma-using-tumor-registry-data
#8
Marc C Smaldone, Brian Egleston, John M Hollingsworth, Brent K Hollenbeck, David C Miller, Todd M Morgan, Simon P Kim, Aseem Malhotra, Elizabeth Handorf, Yu-Ning Wong, Robert G Uzzo, Alexander Kutikov
BACKGROUND AND OBJECTIVES: The paradoxical rise in overall and cancer-specific mortality despite increased detection and treatment of renal cell carcinoma (RCC) is termed "treatment disconnect." We reassess this phenomenon by evaluating impact of missing data and rising incidence on mortality trends. RESEARCH DESIGN, SUBJECTS, AND MEASURES: Using Surveillance, Epidemiology, and End Results data, we identified patients with RCC diagnosis from 1973 to 2011. We estimated mortality rates by tumor size after accounting for lags from diagnosis to death using multiple imputations for missing data from 1983...
November 4, 2016: Medical Care
https://www.readbyqxmd.com/read/27820595/the-relationship-between-index-hospitalizations-sepsis-and-death-or-transition-to-hospice-care-during-30-day-hospital-readmissions
#9
Brett W Dietz, Tiffanie K Jones, Dylan S Small, David F Gaieski, Mark E Mikkelsen
BACKGROUND: Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown. OBJECTIVES: Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death...
November 4, 2016: Medical Care
https://www.readbyqxmd.com/read/27820594/knowledge-as-a-predictor-of-insurance-coverage-under-the-affordable-care-act
#10
Maximiliane Hoerl, Amelie Wuppermann, Silvia H Barcellos, Sebastian Bauhoff, Joachim K Winter, Katherine G Carman
BACKGROUND: The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured. OBJECTIVES: To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant...
November 4, 2016: Medical Care
https://www.readbyqxmd.com/read/27811551/comparing-the-contributions-of-acute-and-postacute-care-facility-characteristics-to-outcomes-after-hospitalization-for-hip-fracture
#11
Mark D Neuman, Jeffrey H Silber, Molly R Passarella, Rachel M Werner
OBJECTIVE: To quantify the contribution of acute versus postacute care factors to survival and functional outcomes after hip fracture. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. METHODS: We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes by the ω statistic...
November 2, 2016: Medical Care
https://www.readbyqxmd.com/read/27787352/hyperlipidemia-and-medical-expenditures-by-cardiovascular-disease-status-in-us-adults
#12
Donglan Zhang, Guijing Wang, Jing Fang, Carla Mercado
BACKGROUND: Hyperlipidemia is a major risk factor for cardiovascular disease (CVD), affecting 73.5 million American adults. Information about health care expenditures associated with hyperlipidemia by CVD status is needed to evaluate the economic benefit of primary and secondary prevention programs for CVD. METHODS: The study sample includes 48,050 men and nonpregnant women ≥18 from 2010 to 2012 Medical Expenditure Panel Survey. A 2-part econometric model was used to estimate annual hyperlipidemia-associated medical expenditures by CVD status...
October 26, 2016: Medical Care
https://www.readbyqxmd.com/read/27787351/utilization-of-positive-and-negative-controls-to-examine-comorbid-associations-in-observational-database-studies
#13
Jigar R Desai, Craig L Hyde, Shaum Kabadi, Matthew St Louis, Vinicius Bonato, A Katrina Loomis, Aaron Galaznik, Marc L Berger
BACKGROUND: Opportunities to leverage observational data for precision medicine research are hampered by underlying sources of bias and paucity of methods to handle resulting uncertainty. We outline an approach to account for bias in identifying comorbid associations between 2 rare genetic disorders and type 2 diabetes (T2D) by applying a positive and negative control disease paradigm. RESEARCH DESIGN: Association between 10 common and 2 rare genetic disorders [Hereditary Fructose Intolerance (HFI) and α-1 antitrypsin deficiency] and T2D was compared with the association between T2D and 7 negative control diseases with no established relationship with T2D in 4 observational databases...
October 26, 2016: Medical Care
https://www.readbyqxmd.com/read/27755393/prescriber-continuity-and-disease-control-of-older-adults
#14
Matthew L Maciejewski, Bradley G Hammill, Elizabeth A Bayliss, Laura Ding, Corrine I Voils, Lesley H Curtis, Virginia Wang
BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes. OBJECTIVE: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications...
October 14, 2016: Medical Care
https://www.readbyqxmd.com/read/27755392/the-hospital-score-predicts-potentially-preventable-30-day-readmissions-in-conditions-targeted-by-the-hospital-readmissions-reduction-program
#15
Robert E Burke, Jeffrey L Schnipper, Mark V Williams, Edmondo J Robinson, Eduard E Vasilevskis, Sunil Kripalani, Joshua P Metlay, Grant S Fletcher, Andrew D Auerbach, Jacques D Donzé
BACKGROUND/OBJECTIVES: New tools to accurately identify potentially preventable 30-day readmissions are needed. The HOSPITAL score has been internationally validated for medical inpatients, but its performance in select conditions targeted by the Hospital Readmission Reduction Program (HRRP) is unknown. DESIGN: Retrospective cohort study. SETTING: Six geographically diverse medical centers. PARTICIPANTS/EXPOSURES: All consecutive adult medical patients discharged alive in 2011 with 1 of the 4 medical conditions targeted by the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure) were included...
October 14, 2016: Medical Care
https://www.readbyqxmd.com/read/27753746/one-year-outcomes-of-diabetes-self-management-training-among-medicare-beneficiaries-newly-diagnosed-with-diabetes
#16
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
https://www.readbyqxmd.com/read/27753745/identifying-specific-combinations-of-multimorbidity-that-contribute-to-health-care-resource-utilization-an-analytic-approach
#17
Nicholas K Schiltz, David F Warner, Jiayang Sun, Paul M Bakaki, Avi Dor, Charles W Given, Kurt C Stange, Siran M Koroukian
BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims...
October 6, 2016: Medical Care
https://www.readbyqxmd.com/read/27753744/healthy-life-years-lost-and-excess-bed-days-due-to-6-patient-safety-incidents-empirical-evidence-from-english-hospitals
#18
Katharina D Hauck, Shaolin Wang, Charles Vincent, Peter C Smith
BACKGROUND: There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE: To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN: The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals...
October 6, 2016: Medical Care
https://www.readbyqxmd.com/read/27753743/perceived-discrimination-in-health-care-and-mental-health-substance-abuse-treatment-among-blacks-latinos-and-whites
#19
Vickie M Mays, Audrey L Jones, Ayesha Delany-Brumsey, Courtney Coles, Susan D Cochran
BACKGROUND: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. RESEARCH METHODS: We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment...
October 6, 2016: Medical Care
https://www.readbyqxmd.com/read/27676401/real-world-data-responses-to-zito-and-doshi
#20
Anirban Basu, Kirsten Axelsen, David C Grabowski, David O Meltzer, Daniel Polsky, David B Ridley, Daniel Wiederkehr, Tomas J Philipson
No abstract text is available yet for this article.
September 26, 2016: Medical Care
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