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Leora horwitz

Joshua L Denson, Leora I Horwitz, Scott E Sherman
No abstract text is available yet for this article.
March 21, 2017: JAMA: the Journal of the American Medical Association
Leora I Horwitz, Susannah M Bernheim, Joseph S Ross, Jeph Herrin, Jacqueline N Grady, Harlan M Krumholz, Elizabeth E Drye, Zhenqiu Lin
BACKGROUND: Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. OBJECTIVE: To examine the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). DESIGN: This is a retrospective cross-sectional multivariable analysis...
May 2017: Medical Care
Saul Blecker, Talia Meisel, Victoria Vaughan Dickson, Donna Shelley, Leora I Horwitz
BACKGROUND: Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital. METHODS: We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital...
March 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Harry S Saag, Claudette M Lajam, Simon Jones, Nikita Lakomkin, Joseph A Bosco, Rebecca Wallack, Spiros G Frangos, Prashant Sinha, Nicole Adler, Patti Ursomanno, Leora I Horwitz, Frank M Volpicelli
BACKGROUND: Educational and computerized interventions have been shown to reduce red blood cell (RBC) transfusion rates, yet controversy remains surrounding the optimal strategy needed to achieve sustained reductions in liberal transfusions. STUDY DESIGN AND METHODS: The purpose of this study was to assess the impact of clinician decision support (CDS) along with targeted education on liberal RBC utilization to four high-utilizing service lines compared with no education to control service lines across an academic medical center...
December 30, 2016: Transfusion
Nihar R Desai, Joseph S Ross, Ji Young Kwon, Jeph Herrin, Kumar Dharmarajan, Susannah M Bernheim, Harlan M Krumholz, Leora I Horwitz
Importance: Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective: To compare trends in readmission rates for target and nontarget conditions, stratified by hospital penalty status. Design, Setting, and Participants: Retrospective cohort study of Medicare fee-for-service beneficiaries older than 64 years discharged between January 1, 2008, and June 30, 2015, from 2214 penalty hospitals and 1283 nonpenalty hospitals...
December 27, 2016: JAMA: the Journal of the American Medical Association
Joshua L Denson, Ashley Jensen, Harry S Saag, Binhuan Wang, Yixin Fang, Leora I Horwitz, Laura Evans, Scott E Sherman
Importance: Shift-to-shift transitions in care among house staff are associated with adverse events. However, the association between end-of-rotation transition (in which care of the patient is transferred) and adverse events is uncertain. Objective: To examine the association of end-of-rotation house staff transitions with mortality among hospitalized patients. Design, Setting, and Participants: Retrospective multicenter cohort study of patients admitted to internal medicine services (N = 230 701) at 10 university-affiliated US Veterans Health Administration hospitals (2008-2014)...
December 6, 2016: JAMA: the Journal of the American Medical Association
Alana E Sigmund, Yixin Fang, Matthew Chin, Harmony R Reynolds, Leora I Horwitz, Ezra Dweck, Eduardo Iturrate
OBJECTIVE: To determine the clinical significance of tachycardia in the postoperative period. PATIENTS AND METHODS: Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction)...
January 2017: Mayo Clinic Proceedings
Saul Blecker, Stuart D Katz, Leora I Horwitz, Gilad Kuperman, Hannah Park, Alex Gold, David Sontag
Importance: Accurate, real-time case identification is needed to target interventions to improve quality and outcomes for hospitalized patients with heart failure. Problem lists may be useful for case identification but are often inaccurate or incomplete. Machine-learning approaches may improve accuracy of identification but can be limited by complexity of implementation. Objective: To develop algorithms that use readily available clinical data to identify patients with heart failure while in the hospital...
December 1, 2016: JAMA Cardiology
Susannah M Bernheim, Craig S Parzynski, Leora Horwitz, Zhenqiu Lin, Michael J Araas, Joseph S Ross, Elizabeth E Drye, Lisa G Suter, Sharon-Lise T Normand, Harlan M Krumholz
There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status...
August 1, 2016: Health Affairs
Kumar Dharmarajan, Li Qin, Zhenqiu Lin, Leora I Horwitz, Joseph S Ross, Elizabeth E Drye, Amena Keshawarz, Faseeha Altaf, Sharon-Lise T Normand, Harlan M Krumholz, Susannah M Bernheim
Programs from the Centers for Medicare and Medicaid Services simultaneously promote strategies to lower hospital admissions and readmissions. However, there is concern that hospitals in communities that successfully reduce admissions may be penalized, as patients that are ultimately hospitalized may be sicker and at higher risk of readmission. We therefore examined the relationship between changes from 2010 to 2013 in admission rates and thirty-day readmission rates for elderly Medicare beneficiaries. We found that communities with the greatest decline in admission rates also had the greatest decline in thirty-day readmission rates, even though hospitalized patients did grow sicker as admission rates declined...
July 1, 2016: Health Affairs
Daisy Goodman, Greg Ogrinc, Louise Davies, G Ross Baker, Jane Barnsteiner, Tina C Foster, Kari Gali, Joanne Hilden, Leora Horwitz, Heather C Kaplan, Jerome Leis, John C Matulis, Susan Michie, Rebecca Miltner, Julia Neily, William A Nelson, Matthew Niedner, Brant Oliver, Lori Rutman, Richard Thomson, Johan Thor
Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work...
December 2016: BMJ Quality & Safety
Grace Y Jenq, Margaret M Doyle, Beverly M Belton, Jeph Herrin, Leora I Horwitz
IMPORTANCE: Feasibility, effectiveness, and sustainability of large-scale readmission reduction efforts are uncertain. The Greater New Haven Coalition for Safe Transitions and Readmission Reductions was funded by the Center for Medicare & Medicaid Services (CMS) to reduce readmissions among all discharged Medicare fee-for-service (FFS) patients. OBJECTIVE: To evaluate whether overall Medicare FFS readmissions were reduced through an intervention applied to high-risk discharge patients...
May 1, 2016: JAMA Internal Medicine
Leora I Horwitz
No abstract text is available yet for this article.
January 2017: BMJ Quality & Safety
Soterios Gyftopoulos, Danny Kim, Eric Aaltonen, Leora I Horwitz
OBJECTIVE: Recalling a patient to repeat a radiology examination is an adverse and, in certain cases, preventable event. Our objectives were to assess the rate of patient recalls for all imaging performed in the outpatient setting at our institution and to characterize the underlying reasons for the recalls. MATERIALS AND METHODS: We performed a retrospective review of all repeat imaging requests for an inadequate initial imaging study between January 2012 and March 2015...
April 2016: AJR. American Journal of Roentgenology
Saul Blecker, Norman J Johnson, Sean Altekruse, Leora I Horwitz
No abstract text is available yet for this article.
January 19, 2016: JAMA: the Journal of the American Medical Association
Leora I Horwitz
No abstract text is available yet for this article.
January 2016: JAMA Internal Medicine
Amanda L Brewster, Leslie A Curry, Emily J Cherlin, Kristina Talbert-Slagle, Leora I Horwitz, Elizabeth H Bradley
BACKGROUND: Hospital quality improvement efforts absorb substantial time and resources, but many innovations fail to integrate into organizational routines, undermining the potential to sustain the new practices. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs. METHODS: We conducted a qualitative study using a purposive sample of hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, a collaborative to reduce hospital readmissions that encouraged members to adopt new practices...
2015: Implementation Science: IS
Lindsay E Jubelt, Keith S Goldfeld, Wei-yi Chung, Saul B Blecker, Leora I Horwitz
No abstract text is available yet for this article.
January 2016: JAMA Internal Medicine
Leora I Horwitz, Jacqueline N Grady, Dorothy B Cohen, Zhenqiu Lin, Mark Volpe, Chi K Ngo, Andrew L Masica, Theodore Long, Jessica Wang, Megan Keenan, Julia Montague, Lisa G Suter, Joseph S Ross, Elizabeth E Drye, Harlan M Krumholz, Susannah M Bernheim
BACKGROUND: It is desirable not to include planned readmissions in readmission measures because they represent deliberate, scheduled care. OBJECTIVES: To develop an algorithm to identify planned readmissions, describe its performance characteristics, and identify improvements. DESIGN: Consensus-driven algorithm development and chart review validation study at 7 acute-care hospitals in 2 health systems. PATIENTS: For development, all discharges qualifying for the publicly reported hospital-wide readmission measure...
October 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Neel M Butala, Benjamin K Johnson, Leora I Horwitz
No abstract text is available yet for this article.
March 2015: JAMA Internal Medicine
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