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https://www.readbyqxmd.com/read/29336390/long-term-quality-of-life-postacute-kidney-injury-in-cardiac-surgery-patients
#1
Pankaj Kumar Mishra, Heyman Luckraz, Jayanta Nandi, Alan Nevill, Ramesh Giri, Andrew Panayiotou, Johann Nicholas
BACKGROUND: Acute renal failure after cardiac surgery is known to be associated with significant short-term morbidity and mortality. There have as yet been no major reports on long-term quality of life (QOL). This study assessed the impact of acute kidney injury (AKI) and renal replacement therapy (RRT) on long-term survival and QOL after cardiac surgery. The need for long-term RRT is also assessed. MATERIALS AND METHODS: Patients who underwent cardiac surgery between 2005 and 2011 (n = 6087) and developed AKI (RIFLE criteria, n = 570) were included...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29298176/untapped-potential-using-the-hrs-medicare-linked-files-to-study-the-changing-nursing-home-population
#2
Julie C Lima, Jessica Ogarek, Vincent Mor
BACKGROUND: Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care. OBJECTIVE: To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group. RESEARCH DESIGN: Descriptive retrospective panel study. SUBJECTS: HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS)...
January 2, 2018: Medical Care
https://www.readbyqxmd.com/read/29282724/the-impact-of-enhanced-critical-care-training-and-24-7-tele-icu-support-on-medicare-spending-and-postdischarge-utilization-patterns
#3
Matthew J Trombley, Andrea Hassol, Jennifer T Lloyd, Timothy G Buchman, Allison F Marier, Alan White, Erin Colligan
OBJECTIVE: To estimate the effect of implementing a tele-ICU and a critical care residency training program for advanced practice providers on service utilization and total Medicare episode spending. DATA SOURCES/STUDY SETTINGS: Medicare claims data for fee-for-service beneficiaries at 12 large, inpatient hospitals in the Atlanta Hospital Referral Region. STUDY DESIGN: Difference-in-differences design where changes in spending and utilization for Medicare beneficiaries eligible for treatment in participating ICUs was compared to changes in a comparison group of clinically similar beneficiaries treated at similar hospitals' ICUs in the same hospital referral region...
December 27, 2017: Health Services Research
https://www.readbyqxmd.com/read/29282464/association-of-informal-clinical-integration-of-physicians-with-cardiac-surgery-payments
#4
Russell J Funk, Jason Owen-Smith, Samuel A Kaufman, Brahmajee K Nallamothu, John M Hollingsworth
Importance: To reduce inefficiency and waste associated with care fragmentation, many current programs target greater clinical integration among physicians. However, these programs have led to only modest Medicare spending reductions. Most programs focus on formal integration, which often bears little resemblance to actual physician interaction patterns. Objectives: To examine how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments...
December 27, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29280708/justifying-rehabilitation-intensity-through-functional-performance-measures-in-postacute-care
#5
Christine Kroll, Thomas Fisher
The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising...
January 2018: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
https://www.readbyqxmd.com/read/29280644/does-the-presence-of-pressure-ulcers-entail-high-risk-of-negative-outcomes-in-geriatric-rehabilitation-results-from-a-retrospective-cohort-study
#6
Francisco J Tarazona-Santabalbina, Miquel Àngel Mas, Sebastià J Santaeugènia, Ana Maria Alventosa, Manoli García, Albert Monterde, Alicia Gutiérrez, Joan Cunill
AIM: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. METHODS: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit...
November 16, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/29275938/the-prevalence-of-burnout-among-nursing-home-physicians-an-international-perspective
#7
Arif Nazir, Martin Smalbrugge, Andrea Moser, Jurgis Karuza, Charles Crecelius, Cees Hertogh, Sid Feldman, Paul R Katz
Physician burnout is a critical factor influencing the quality of care delivered in various healthcare settings. Although the prevalence and consequences of burnout have been well documented for physicians in various jurisdictions, no studies to date have reported on burnout in the postacute and long-term care setting. In this exploratory study, we sought to quantify the prevalence of burnout among 3 cohorts of physicians, each practicing in nursing homes in the United States (US), Canada, or The Netherlands...
January 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29261829/association-between-medicare-expenditure-growth-and-mortality-rates-in-patients-with-acute-myocardial-infarction-a-comparison-from-1999-through-2014
#8
Donald S Likosky, Jessica Van Parys, Weiping Zhou, William B Borden, Milton C Weinstein, Jonathan S Skinner
Importance: Many studies have considered the association between Medicare spending and health outcomes at a point in time; few have considered the association between the long-term growth in spending and outcomes. Objective: To assess whether components of growth in Medicare expenditures are associated with mortality rates between January 1, 1999, and June 30, 2014, for beneficiaries hospitalized for acute myocardial infarction. Design, Setting, and Participants: Cross-sectional analysis of a random 20% sample of fee-for-service Medicare beneficiaries from January 1, 1999, through December 31, 2000 (n=72 473) and January 1, 2004, through December 31, 2004 (n=38 248), and 100% sample from January 1, 2008, through December 31, 2008 (n=159 558) and January 1, 2013, through June 30, 2014 (n=209 614) admitted with acute myocardial infarction to 1220 hospitals...
December 20, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29251766/handing-off-the-older-patient-improved-documentation-of-geriatric-assessment-in-transitions-of-care
#9
Ben A Blomberg, Rebekah C Mulligan, Stephen J Staub, Laura C Hanson, Margaret A Drickamer, Maureen C Dale
OBJECTIVES: To improve assessment and documentation of function, cognition, and advance care planning (ACP) in admission and discharge notes on an Acute Care of the Elderly (ACE) unit. DESIGN: Continuous quality improvement intervention with episodic data review. SETTING: ACE unit of an 866-bed academic tertiary hospital. PARTICIPANTS: Housestaff physicians rotating on the ACE unit (N = 31). INTERVENTION: Introduction of templated notes, housestaff education, leadership outreach, and posted reminders...
December 18, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29244035/interprofessional-collaboration-and-peer-mentors-for-bowel-education-in-spinal-cord-injury-a-case-consultation
#10
Ralph D Cabigon, Elizabeth Wojciechowski, Lisa Rosen, David Miller, Cristina Mix, David Chen
BACKGROUND: Evidence shows that having a bowel management program prevents rehospitalization postacute rehabilitation discharge for persons with a spinal cord injury (SCI). Peer mentors have been used to assist patients in managing their care. PURPOSE: The aim of the study was to illustrate how interprofessional collaboration led to utilizing resources of the inpatient rehabilitation facility's peer mentor program and incorporating peer mentors into bowel education for persons with SCI...
December 13, 2017: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
https://www.readbyqxmd.com/read/29240850/hospitalist-and-internal-medicine-leaders-perspectives-of-early-discharge-challenges-at-academic-medical-centers
#11
Hemali Patel, Margaret C Fang, Michelle Mourad, Adrienne Green, Robert M Wachter, Ryan D Murphy, James D Harrison
Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation...
December 6, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29229128/thirty-day-readmission-and-mortality-among-medicare-beneficiaries-discharged-to-skilled-nursing-facilities-after-vascular-surgery
#12
Sara Fernandes-Taylor, Stephen Berg, Rebecca Gunter, Kyla Bennett, Maureen A Smith, Paul J Rathouz, Caprice C Greenberg, K Craig Kent
BACKGROUND: Readmission within 30 d of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNFs), making postacute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery...
January 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29223321/is-there-value-in-retrospective-90-day-bundle-payment-models-for-shoulder-arthroplasty-procedures
#13
Susan M Odum, Nady Hamid, Bryce A Van Doren, Leo R Spector
BACKGROUND: The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. METHODS: Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015...
December 7, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29204496/comparison-of-postarthroplasty-functional-outcomes-in-skilled-nursing-facilities-among-medicare-and-managed-care-beneficiaries
#14
Brandon A Haghverdian, David J Wright, Ran Schwarzkopf
Background: After home health care, the skilled nursing facility (SNF) is the most commonly used postacute care modality, among Medicare beneficiaries, after total joint arthroplasty. Prior studies demonstrated that a loss in postsurgical ambulatory gains is incurred in the interval between hospital discharge and arrival at the SNF. The aim of this present study is to determine the consequences of that loss in function, as well as compare SNF-related outcomes in patients with Medicare vs Managed Care (MC) insurance...
December 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/29190460/clinical-outcomes-in-older-surgical-patients-with-mild-cognitive-impairment
#15
Annie M Racine, Tamara G Fong, Yun Gou, Thomas G Travison, Douglas Tommet, Kristen Erickson, Richard N Jones, Bradford C Dickerson, Eran Metzger, Edward R Marcantonio, Eva M Schmitt, Sharon K Inouye
INTRODUCTION: Older adults, including those with mild cognitive impairment (MCI), are increasingly undergoing surgery. METHODS: Relative risks (RRs) of MCI alone or with delirium on adverse outcomes were estimated in an ongoing prospective, observational cohort study of 560 nondemented adults aged ≥70 years. RESULTS: MCI (n = 61, 11%) was associated with increased RR of delirium (RR = 1.9, P < .001) and delirium severity (RR = 4...
November 27, 2017: Alzheimer's & Dementia: the Journal of the Alzheimer's Association
https://www.readbyqxmd.com/read/29183537/continuing-trauma-the-unmet-needs-of-trauma-patients-in-the-postacute-care-setting
#16
Samir M Fakhry, Pamela L Ferguson, Jama L Olsen, Jennifer J Haughney, Heidi S Resnick, Kenneth J Ruggiero
Trauma care has traditionally focused on prehospital and hospital settings, yet many injured patients report emotional distress in the postacute care setting, which is known to impair recovery. The objective of this study was to assess postdischarge emotional recovery and communication preferences. An observational cohort of 100 adult patients from our Level 1 Trauma Center was surveyed one to two months postdischarge. Among those employed preinjury, 44 per cent had not returned to work. Nearly half screened positive for emotional issues (posttraumatic stress disorder, depression, and/or psychological distress); of these, only 35 per cent considered getting professional help and only 10 per cent received help...
November 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29162345/postacute-care-after-pediatric-hospitalizations-for-a-primary-mental-health-condition
#17
James C Gay, Bonnie T Zima, Tumaini R Coker, Stephanie K Doupnik, Matthew Hall, Jonathan Rodean, Margaret O'Neill, Rustin Morse, Kris P Rehm, Jay G Berry, Naomi S Bardach
OBJECTIVES: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. STUDY DESIGN: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases...
November 18, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29161150/cognitive-impairment-in-schizophrenia-and-depression-a-comparison-of-stability-and-course
#18
Peter Neu, Tina Gooren, Ulrike Niebuhr, Peter Schlattmann
Cognitive deficits are clinically relevant features in schizophrenia and depression, yet little comparative data on changes in both disorders is available. This study compares cognitive performance of inpatients with schizophrenia (N = 52) and unipolar major depression (N = 67) during psychiatric treatment, assessing performance twice: after admission to hospital (acute) and prior to discharge (postacute) on average seven weeks later. A group of healthy controls was tested at comparable intervals. Data was analyzed using a multivariate linear model...
November 21, 2017: Applied Neuropsychology. Adult
https://www.readbyqxmd.com/read/29134630/successful-community-discharge-following-postacute-rehabilitation-for-medicare-beneficiaries-analysis-of-a-patient-centered-quality-measure
#19
Michael P Cary, Janet Prvu Bettger, Jessica M Jarvis, Kenneth J Ottenbacher, James E Graham
OBJECTIVE: To determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. DATA SOURCE: Inpatient Rehabilitation Facility-Patient Assessment Instrument and Medicare Provider Analysis and Review files. STUDY DESIGN: We retrospectively examined 167,664 Medicare beneficiaries discharged from inpatient rehabilitation facilities (IRFs) in 2013 to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge...
November 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/29112078/survival-outcomes-following-the-use-of-extracorporeal-membrane-oxygenation-as-a-rescue-technology-in-critically-ill-patients-results-from-pennsylvania-2007-2015
#20
Marco D Huesch, Andrew Foy, Christoph Brehm
OBJECTIVE: To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade. DESIGN: Retrospective analysis of administrative discharge data. SETTING: State-wide administrative discharge data from Pennsylvania between 2007 and 2015. PATIENTS: All 2,948 consecutive patients billed under a Diagnosis-Related Grouper 3 grouper and in whom a procedural code for extracorporeal membrane oxygenation was present, admitted between the beginning of 2007 and the end of 2015 to hospitals regulated by the state of Pennsylvania...
January 2018: Critical Care Medicine
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