episodes and patient centered medical homes

BACKGROUND: Interventions that focus on the self-management of heart failure are vital to promoting health in patients with heart failure. Mobile health (mHealth) apps are becoming more integrated into practice to promote self-management strategies for chronic diseases, optimize care delivery, and reduce health disparities. OBJECTIVE: The purpose of this study was to explore the experience of using a self-management mHealth intervention in individuals with heart failure to inform a future mHealth intervention study...

BACKGROUND: A growing number of studies have demonstrated the efficacy of high-flow nasal cannula therapy (HFNC) for treating children with acute respiratory distress. However, it remains unknown whether HFNC is effective in bedridden patients with acute respiratory distress. METHOD: We retrospectively reviewed the medical records of bedridden patients with acute respiratory distress who were treated with HFNC using a home ventilator in continuous positive airway pressure mode at our center between March 2014 and August 2016...

OBJECTIVES: To determine whether there is a link between the place of death and the type of health-care provider: Primary Healthcare Team (PHT), Home Palliative Care Support Team (HPCST), or both. To identify other variables that may affect the place of death. DESIGN OF STUDY: Descriptive, observational, retrospective study. SETTING: Three primary care center, Dirección Asistencial Sureste, Comunidad de Madrid (Madrid, Spain). PARTICIPANTS: Patients over the age of 18 with an A...

BACKGROUND: A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish "good" from "poor" performance. OBJECTIVE: The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold...

BACKGROUND: Hospital at Home (HaH) is a growing model of care with proven patient benefits. However, for the types of services required to provide an episode of HaH, full Medicare reimbursement is traditionally paid only if care is provided in inpatient facilities. DESIGN: This project identifies HaH services that could be reimbursable under Medicare to inform episodic care within fee-for-service (FFS) Medicare. SETTING: All data are derived from acute services provided from the Mount Sinai HaH program between 2014 and 2017 as part of a Center for Medicare and Medicaid Innovation (CMMI) demonstration program...

BACKGROUND: Bites from nonnative snakes are uncommon, accounting for 1.1% of envenomations reported to poison centers between 2015 and 2018. Here we discuss two monocled cobra (Naja kaouthia) envenomations resulting in respiratory failure. CASE REPORTS: A 30-year-old man and a 40-year-old man were bitten by their captive monocled cobras. At the first hospital, the first patient was mildly hypotensive, transiently bradycardic, and confused. He was intubated for respiratory distress...

BACKGROUND: Acute myocardial infarction complicated by cardiogenic shock (AMICS) occurs in up to 10% of acute myocardial infarction admissions and is associated with high mortality, frequent adverse outcomes, prolonged hospitalizations, extensive medical resource utilization, and major cost. Using hospital cost data for Medicare Fee-for-Service (FFS) patients with AMICS, we sought to evaluate in hospital and 45-day outcomes and cost, comparing patients treated with percutaneous ventricular assist device (pVAD) versus extracorporeal membrane oxygenation (ECMO)...

Introduction: Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students)...

Background: Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking. Objective: To compare outcomes of home hospital versus usual hospital care for patients requiring admission. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT03203759). Setting: Academic medical center and community hospital...

OBJECTIVE: There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge...

Electronic cigarettes, also known as e-cigarettes (E-cig), are lithium-battery-powered devices, which became available for sale in the United States in 2017. It has gained significant popularity among younger-generation tobacco smokers due to its advertisement as a non-toxic inhalation property and a potential smoking-cessation aid. The US Food and Drug Administration (FDA) has been regulating e-cigarettes as tobacco products and not as drug-delivery devices, as many medical experts think it should be categorized...

BACKGROUND AND AIMS: Despite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients. METHODS: LT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B)...

BACKGROUND: The diagnosis of paroxysmal events in infants is often challenging. Reasons include the child's inability to express discomfort and the inability to record video electroencephalography at home. The prevalence of mobile phones, which can record videos, may be beneficial to these patients. In China, this advantage may be even more significant given the vast population and the uneven distribution of medical resources. OBJECTIVE: The aim of this study is to investigate the value of mobile phone videos in increasing the diagnostic accuracy and cost savings of paroxysmal events in infants...

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are major sources of morbidity, death, and healthcare costs in patients who receive home parenteral nutrition (HPN). The majority of HPN-dependent children in southern Israel reside in poor communities with substandard living conditions, which creates significant challenges for the safe provision of HPN. We developed a pilot intervention that aimed to reduce the rates of CLABSI and central venous catheter (CVC) replacements in this vulnerable population in our region...

There are major gaps and barriers for patients and caregivers after hospital discharge to achieve safe medication use. Patients and caregivers are often not ready to take on the responsibility for medication management when transitioned from inpatient care. Current approaches tend to focus on adding isolated strategies. A system thinking can enable a fundamental transformation to redesign professionals' interactions with patients and caregivers with an explicit goal to develop patients and caregivers into true partners, with targeted roles, skills, attitude, knowledge, and tool support...

CASE STUDY RS, a 36-year-old female, presented to the emergency department (ED) of a large academic medical center upon the advice of her primary care provider because of 3 weeks of progressive mental status changes, weakness, and decreased oral intake. According to her husband, RS was diagnosed with stage IIIA large cell lung cancer 8 months earlier and was treated with concurrent chemotherapy (carboplatin, pemetrexed, and bevacizumab) and radiation therapy that was completed 4 months prior to admission. No other specific information about her treatment or outside health records was available...

OBJECTIVES: To analyze the effectiveness of a Bundled Payments for Care Improvement (BPCI) initiative at a large urban medical center for hip fracture patients included in the bundle payment program with respect to improving patient outcomes and reducing cost. DESIGN: Retrospective cohort. SETTING: Single Academic Institution. PATIENTS/PARTICIPANTS: Patients discharged with the diagnosis-related group codes 469-470 performed for hip fractures between July 2011 and September 2014 were evaluated...

days of hospitalization, a greater number of complementary tests, the need for artificial nutritional support and / or drugs to treat complications, which is a very important economic burden. Most patients who are malnourished, or at risk, can benefit from oral nutritional support, which includes dietary modifications (fortification, extra snacks, etc.), prescription of a personalized diet by a registered dietitian and the use of oral nutritional supplements (ONS). The use of ONS has shown benefits, in several meta-analysis, in weight recovery, reduction in the number of complications or hospital readmissions and functional improvement, without a reduction in the usual food intake...

days of hospitalization, a greater number of complementary tests, the need for artificial nutritional support and / or drugs to treat complications, which is a very important economic burden. Most patients who are malnourished, or at risk, can benefit from oral nutritional support, which includes dietary modifications (fortification, extra snacks, etc.), prescription of a personalized diet by a registered dietitian and the use of oral nutritional supplements (ONS). The use of ONS has shown benefits, in several meta-analysis, in weight recovery, reduction in the number of complications or hospital readmissions and functional improvement, without a reduction in the usual food intake...

This final rule with comment period updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per- visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2019. This rule also: Updates the HH PPS case-mix weights for calendar year (CY) 2019 using the most current, complete data available at the time of rulemaking; discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CYs 2014 through 2017; finalizes a rebasing of the HH market basket (which includes a decrease in the labor-related share); finalizes the methodology used to determine rural add-on payments for CYs 2019 through 2022, as required by section 50208 of the Bipartisan Budget Act of 2018 (Pub...