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https://www.readbyqxmd.com/read/28442228/debating-the-role-of-arousal-in-delirium-diagnosis-should-delirium-diagnosis-be-inclusive-or-restrictive
#1
Mark A Oldham, Joseph H Flaherty, James L Rudolph
Delirium is common in acute, postacute, and long-term care settings, and it can be difficult to recognize, especially without deliberate mental status evaluation. Because delirium typically presents with altered arousal and arousal can be assessed within a matter of seconds, routine assessment of arousal offers an efficient means of delirium screening. Nevertheless, impaired arousal often precludes formal assessment of attention and awareness, the cardinal features of delirium per the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition...
April 22, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28433428/effect-of-risk-acceptance-for-bundled-care-payments-on-clinical-outcomes-in-a-high-volume-total-joint-arthroplasty-practice-after-implementation-of-a-standardized-clinical-pathway
#2
James R Kee, Paul K Edwards, Charles L Barnes
BACKGROUND: The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities. METHODS: This practice implemented a standardized CP focused on patient education, managing patient expectations, and maximizing cost outcomes...
March 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28422882/hospital-mortality-after-hip-fracture-surgery-in-relation-to-length-of-stay-by-care-delivery-factors-a-database-study
#3
Boris Sobolev, Pierre Guy, Katie J Sheehan, Eric Bohm, Lauren Beaupre, Suzanne N Morin, Jason M Sutherland, Michael Dunbar, Donald Griesdale, Susan Jaglal, Lisa Kuramoto
Two hypotheses were offered for the effect of shorter hospital stays on mortality after hip fracture surgery: worsening the quality of care and shifting death occurrence to postacute settings.We tested whether the risk of hospital death after hip fracture surgery differed across years when postoperative stays shortened, and whether care factors moderated the association.Analysis of acute hospital discharge abstracts for subgroups defined by hospital type, bed capacity, surgical volume, and admission time.153,917 patients 65 years or older surgically treated for first hip fracture...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28398964/postacute-care-and-recovery-after-cancer-surgery-still-a-long-way-to-go
#4
Courtney J Balentine, Peter A Richardson, Meredith C Mason, Aanand D Naik, David H Berger, Daniel A Anaya
OBJECTIVE: To determine whether postacute care (PAC) facilities can compensate for increased mortality stemming from a complicated postoperative recovery (complications or deconditioning). BACKGROUND: An increasing number of patients having cancer surgery rely on PAC facilities including skilled nursing and rehabilitation centers to help them recover from postoperative complications and the physical demands of surgery. It is currently unclear whether PAC can successfully compensate for the adverse consequences of a complicated postoperative recovery...
May 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28378004/variation-in-the-cost-of-care-for-primary-total-knee-arthroplasties
#5
Derek A Haas, Robert S Kaplan
BACKGROUND: The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. METHODS: Hospital and physician personnel costs were calculated using time-driven activity-based costing...
March 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/28375493/the-continuum-of-neurosurgical-care-increasing-the-neurosurgeon-s-role-and-responsibility
#6
Edie E Zusman, Deborah L Benzil
The Health Care Reform Act has fostered a shift toward capitation and shared risk among providers to improve quality and reduce the escalating costs of healthcare. Like all physicians, neurosurgeons are increasingly being incentivized to participate in efforts to streamline care through the use of surgical pathways to reduce hospital length of stay and prevent readmissions. These changes have expanded the role of the neurosurgeon along the continuum of care for the neurosurgery patient. This paper predicts and advocates for a further broadening of neurosurgery participation from programs that reward physicians for helping to prevent a high-risk patient's need for surgery to management of postacute rehabilitation...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28367457/comparative-assessment-of-cytokine-pattern-in-early-and-late-onset-of-neonatal-sepsis
#7
Kh S Khaertynov, S V Boichuk, S F Khaiboullina, V A Anokhin, A A Andreeva, V C Lombardi, M A Satrutdinov, E A Agafonova, A A Rizvanov
Neonatal sepsis is a significant health issue associated with high mortality. Immune responses associated with neonatal sepsis, such as proinflammatory cytokine production, are believed to play a central role in the pathogenesis of this disease. In the present study, serum levels of the proinflammatory cytokines TNF-α, IL1-β, and IL-6 and the anti-inflammatory cytokines IL-4 and IL-10 were evaluated for 25 subjects with neonatal sepsis. We observed that subjects with late onset of sepsis (LOS), as well as those with early onset of sepsis (EOS), had a substantial increase in serum TNF-α...
2017: Journal of Immunology Research
https://www.readbyqxmd.com/read/28353610/association-of-high-waist-to-height-ratio-with-functional-outcomes-in-patients-with-acute-ischemic-stroke-a-report-from-the-across-china-study
#8
MULTICENTER STUDY
Ping Yu, Yuesong Pan, Huaguang Zheng, Xianwei Wang, Hongyi Yan, Xu Tong, Jing Jing, Xiao Zhang, Li Guo, Yilong Wang
The aim of our study was to investigate the relationship between the waist-to-height ratio (WHR) and all-cause mortality and functional outcomes after acute ischemic stroke in a prospective cohort study.A total of 2076 patients (36.66% females) with ischemic stroke were analyzed from ACROSS-China, which is a nationwide, prospective, hospital-based stroke registry aimed to detect the glucose abnormality in China. One-year follow-up evaluation was done by telephone interview. Outcome measures were all-cause mortality and functional outcome defined as modified Rankin score being 6 and from 0 to 6, respectively...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28338215/delirium-during-postacute-nursing-home-admission-and-risk-for-adverse-outcomes
#9
Cyrus M Kosar, Kali S Thomas, Sharon K Inouye, Vincent Mor
OBJECTIVES: To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes. DESIGN: Retrospective cohort study. SETTING: US Medicare- and Medicaid-certified nursing homes, 2011 to 2014. PARTICIPANTS: Individuals admitted to all US nursing homes for PAC, aged ≥65 years, and without prior history of nursing home residence (n = 5,588,702)...
March 24, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28325859/scoping-review-of-potential-quality-indicators-for-hip-fracture-patient-care
#10
Kristen B Pitzul, Sarah E P Munce, Laure Perrier, Lauren Beaupre, Suzanne N Morin, Rhona McGlasson, Susan B Jaglal
OBJECTIVE: The purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture. DESIGN: Scoping review. SETTING: All care settings. SEARCH STRATEGY: English peer-reviewed studies published from January 2000 to January 2016 were included...
March 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28319584/episode-of-care-characteristics-and-costs-for-hip-and-knee-replacement-surgery-in-hospitals-belonging-to-the-high-value-health-care-collaborative-compared-with-similar-hospitals-in-the-same-health-care-markets
#11
William B Weeks, William J Schoellkopf, David J Ballard, Gary S Kaplan, Brent James, James N Weinstein
BACKGROUND: To inform consumers and restrain health care cost growth, efforts to promote transparency and to reimburse for care episodes are accelerating in the United States. OBJECTIVE: To compare characteristics and costs of 30-day episode of care for hip and knee replacement occurring in High Value Healthcare Collaborative (HVHC)-member hospitals to those occurring in like non-HVHC-member hospitals in the same 15 health care markets before interventions by HVHC members to improve health care value for those interventions...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28285902/continued-inpatient-care-after-primary-total-knee-arthroplasty-increases-30-day-post-discharge-complications-a-propensity-score-adjusted-analysis
#12
Alexander S McLawhorn, Michael C Fu, William W Schairer, Peter K Sculco, Catherine H MacLean, Douglas E Padgett
BACKGROUND: Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination. METHODS: All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database...
February 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28272593/the-unmet-need-for-postacute-rehabilitation-among-medicare-observation-patients-a-single-center-study
#13
Jennifer N Goldstein, J Sanford Schwartz, Patricia McGraw, Tobias L Banks, LeRoi S Hicks
BACKGROUND: Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs. OBJECTIVE: To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization. DESIGN/SETTING: Observational study using electronic medical record and administrative data from a regional health system...
March 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28250679/eclectic-mixed-model-method-for-upper-extremity-functional-recovery-in-stroke-rehabilitation-a-pilot-study
#14
K Vijaya Kumar, Abraham M Joshua, Rakshith Kedambadi, P Prasanna Mithra
BACKGROUND: Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client's individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation. AIM: The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation. METHODOLOGY: Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2-5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively...
January 2017: Journal of Natural Science, Biology, and Medicine
https://www.readbyqxmd.com/read/28214235/effects-of-postacute-settings-on-readmission-rates-and-reasons-for%C3%A2-readmission-following-total-knee-arthroplasty
#15
Rodney Laine Welsh, James E Graham, Amol M Karmarkar, Natalie E Leland, Jacques G Baillargeon, Dana L Wild, Kenneth J Ottenbacher
OBJECTIVES: Examine the effects of postacute discharge setting on unplanned hospital readmissions following total knee arthroplasty (TKA) in older adults. DESIGN: Secondary analyses of 100% Medicare (inpatient) claims files. SETTING: Acute hospitals across the United States. PARTICIPANTS: Medicare fee-for-service beneficiaries ≥66 years of age who were discharged from an acute hospital following TKA in 2009-2011 (n = 608,031)...
April 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28192556/changes-in-postacute-care-in-the-medicare-shared-savings-program
#16
J Michael McWilliams, Lauren G Gilstrap, David G Stevenson, Michael E Chernew, Haiden A Huskamp, David C Grabowski
Importance: Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. Objective: To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred...
April 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28140382/the-need-to-consider-longer-term-outcomes-of-care-racial-ethnic-disparities-among-adult-and-older-adult-emergency-general-surgery-patients-at-30-90-and-180-days
#17
Cheryl K Zogg, Olubode A Olufajo, Wei Jiang, Anna Bystricky, John W Scott, Shahid Shafi, Joaquim M Havens, Ali Salim, Andrew J Schoenfeld, Adil H Haider
OBJECTIVES: Following calls from the National Institutes of Health and American College of Surgeons for "urgently needed" research, the objectives of the present study were to (1) ascertain whether differences in 30/90/180-day mortality, major morbidity, and unplanned readmissions exist among adult (18-64 yr) and older adult (≥65 yr) emergency general surgery (EGS) patients; (2) vary by diagnostic category; and (3) are explained by variations in insurance, income, teaching status, hospital EGS volume, and a hospital's proportion of minority patients...
July 28, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/28130347/non-traumatic-incidental-findings-in-patients-undergoing-whole-body-computed-tomography-at-initial-emergency-admission
#18
Eduard K Kroczek, Gero Wieners, Ingo Steffen, Tobias Lindner, Florian Streitparth, Bernd Hamm, Martin H Maurer
OBJECTIVE: To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre. METHODS: Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports...
January 27, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28127752/malpractice-claim-fears-and-the-costs-of-treating-medicare-patients-a-new-approach-to-estimating-the-costs-of-defensive-medicine
#19
James D Reschovsky, Cynthia B Saiontz-Martinez
OBJECTIVE: To estimate the cost of defensive medicine among elderly Medicare patients. DATA SOURCES: We use a 2008 national physician survey linked to respondents' elderly Medicare patients' claims data. STUDY DESIGN: Using a sample of survey respondent/beneficiary dyads stratified by physician specialty, we estimated cross-sectional regressions of annual costs on patient covariates and a medical malpractice fear index formed from five validated physician survey questions...
January 26, 2017: Health Services Research
https://www.readbyqxmd.com/read/28126142/pneumococcal-vaccination-guidance-for-post-acute-and-long-term-care-settings-recommendations-from-amda-s-infection-advisory-committee
#20
David A Nace, Laurie R Archbald-Pannone, Muhammad S Ashraf, Paul J Drinka, Elizabeth Frentzel, Swati Gaur, Dheeraj Mahajan, David R Mehr, William C Mercer, Philip D Sloane, Robin L P Jump
Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated...
February 1, 2017: Journal of the American Medical Directors Association
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