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Hari Nathan, Jyothi R Thumma, Andrew M Ryan, Justin B Dimick
OBJECTIVE: To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. BACKGROUND: ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown. METHODS: We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]...
May 16, 2018: Annals of Surgery
Lisa Langsetmo, Allyson M Kats, Peggy M Cawthon, Jane A Cauley, Tien N Vo, Brent C Taylor, Marcia L Stefanick, Nancy E Lane, Katie L Stone, Eric S Orwoll, John T Schousboe, Kristine E Ensrud
Background: To examine the associations between objective physical activity measures and subsequent health care utilization. Methods: We studied 1,283 men (mean age 79.1 years, SD 5.3) participating in the Osteoporotic Fractures in Men Study. Participants wore a SenseWear® Pro Armband monitor for 1 week. Data was summarized as daily (i) step counts, (ii) total energy expenditure, (iii) active energy expenditure, and (iv) activity time (sedentary, ≥ light, ≥ moderate)...
October 9, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Stephanie N Lueckel, Cyrus M Kosar, Joan M Teno, Sean F Monaghan, Daithi S Heffernan, William G Cioffi, Kali S Thomas
BACKGROUND: Traumatic brain injury is a leading cause of death and disability in the United States. In survivors, traumatic brain injury remains a leading contributor to long-term disability and results in many patients being admitted to skilled nursing facilities for postacute care. Despite this very large population of traumatic brain injury patients, very little is known about the long-term outcomes of traumatic brain injury survivors, including rates of discharge to home or risk of death in long-term nursing facilities...
May 9, 2018: Surgery
Yannick Béjot, Christelle Blanc, Benoit Delpont, Pierre Thouant, Cécile Chazalon, Anaïs Daumas, Guy-Victor Osseby, Marie Hervieu-Bègue, Frédéric Ricolfi, Maurice Giroud, Charlotte Cordonnier
OBJECTIVE: To evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: All patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985-1993, 1994-2002, and 2003-2011)...
May 4, 2018: Neurology
Neus Gual, Alessandro Morandi, Laura Monica Pérez, Laura Brítez, Pamela Burbano, Flor Man, Marco Inzitari
BACKGROUND: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. METHODS: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months...
May 3, 2018: Dementia and Geriatric Cognitive Disorders
Joseph E Andrews, J Brian Moore, Richard B Weinberg, Mysha Sissine, Sabina Gesell, Jacquie Halladay, Wayne Rosamond, Cheryl Bushnell, Sara Jones, Paula Means, Nancy M P King, Diana Omoyeni, Pamela W Duncan
Cluster randomised clinical trials present unique challenges in meeting ethical obligations to those who are treated at a randomised site. Obtaining informed consent for research within the context of clinical care is one such challenge. In order to solve this problem it is important that an informed consent process be effective and efficient, and that it does not impede the research or the healthcare. The innovative approach to informed consent employed in the COMPASS study demonstrates the feasibility of upholding ethical standards without imposing undue burden on clinical workflows, staff members or patients who may participate in the research by virtue of their presence in a cluster randomised facility...
May 2, 2018: Journal of Medical Ethics
Nazi Derakhshanrad, Hooshang Saberi, Mir Saeed Yekaninejad, Mohammad Taghi Joghataei, Abdolreza Sheikhrezaei
OBJECTIVE Granulocyte-colony stimulating factor (G-CSF) is a major growth factor for activation and differentiation of granulocyte colonies in the bone marrow. This cytokine has been widely and safely employed in different conditions over many years. The purpose of this study was to investigate the efficacy of G-CSF administration for traumatic spinal cord injury (TSCI). METHODS This double-blind parallel randomized, placebo-controlled, clinical trial, a phase III study, was performed from June 2013 to June 2016 in the Brain and Spinal Cord Injury Research (BASIR) center at Tehran University of Medical Sciences (TUMS)...
April 27, 2018: Journal of Neurosurgery. Spine
Leeanne M Carey, Thomas A Matyas, Carolyn Baum
OBJECTIVE: Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors. METHOD: Participants (N = 268) were assessed at hospital admission for somatosensory and motor impairment using the National Institutes of Health Stroke Scale. Participation was assessed using the Activity Card Sort (ACS) in the postacute phase. Between-group differences in activity participation were analyzed for participants with and without somatosensory impairment and with or without paresis...
May 2018: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
Lorene Zerah, Lucile Dourthe, Judith Cohen-Bittan, Marc Verny, Mathieu Raux, Anthony Mézière, Frédéric Khiami, Cendrine Tourette, Christian Neri, Yannick Le Manach, Bruno Riou, Hélène Vallet, Jacques Boddaert
OBJECTIVES: To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacute rehabilitation settings. DESIGN: Retrospective study. SETTING: Perioperative geriatric care unit. PARTICIPANTS: All individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in our perioperative geriatric care unit (N=667; n=193 in the liberal transfusion group, n=474 in the restrictive transfusion group) from July 2009 to April 2016...
April 20, 2018: Journal of the American Geriatrics Society
Oanh Kieu Nguyen, Anil N Makam, Christopher Clark, Song Zhang, Sandeep R Das, Ethan A Halm
BACKGROUND: Readmissions after hospitalization for acute myocardial infarction (AMI) are common. However, the few currently available AMI readmission risk prediction models have poor-to-modest predictive ability and are not readily actionable in real time. We sought to develop an actionable and accurate AMI readmission risk prediction model to identify high-risk patients as early as possible during hospitalization. METHODS AND RESULTS: We used electronic health record data from consecutive AMI hospitalizations from 6 hospitals in north Texas from 2009 to 2010 to derive and validate models predicting all-cause nonelective 30-day readmissions, using stepwise backward selection and 5-fold cross-validation...
April 17, 2018: Journal of the American Heart Association
Li Wang, Michel Grignon, Sheril Perry, Xi-Kuan Chen, Alison Ytsma, Sara Allin, Katerina Gapanenko
OBJECTIVE: To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. DATA SOURCES/STUDY SETTING: Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. STUDY DESIGN: We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only)...
April 17, 2018: Health Services Research
Peter S Khang, Susan E Wang, In-Lu Amy Liu, Heather L Watson, Sandra Y Koyama, Dan N Huynh, Janet S Lee, Huong Q Nguyen
BACKGROUND: Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM: Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN: Retrospective cohort design. SETTING/PARTICIPANTS: Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort...
March 13, 2018: Journal of Palliative Medicine
Jared S Preston, Darleen Caccavale, Amy Smith, Lauren E Stull, David A Harwood, Stephen Kayiaros
BACKGROUND: To help slow the rising costs associated with total joint arthroplasty (TJA), the Centers for Medicare and Medicaid Services introduced the Bundled Payments for Care Improvement (BPCI) initiative. The purpose of this study is to report our 1-year experience with BPCI in our 2 arthroplasty surgeon private practice. METHODS: In this series, a historical baseline group is compared with our first year under BPCI. We reviewed the cohorts with respect to hospital length of stay (LOS), readmission rates, discharge disposition, postacute care LOS, and overall savings on a per episode basis...
March 14, 2018: Journal of Arthroplasty
Cyrus M Kosar, Kali S Thomas, Pedro L Gozalo, Jessica A Ogarek, Vincent Mor
OBJECTIVES: To examine the effect of obesity (body mass index (BMI)≥30.0 kg/m2 ) on outcomes of older adults admitted to skilled nursing facilities (SNFs) for hip fracture postacute care (PAC). DESIGN: Retrospective cohort study. SETTING: U.S. Medicare- and Medicaid-certified SNFs from 2008 to 2015. PARTICIPANTS: Medicare fee-for-service beneficiaries discharged to a SNF after hospitalization for hip fracture (N=586,683; n=82,768 (14...
April 3, 2018: Journal of the American Geriatrics Society
Kimberly S Erler, Shannon B Juengst, Gale G Whiteneck, Joseph J Locascio, Jennifer A Bogner, Jamie Kaminski, Joseph T Giacino
OBJECTIVE: To determine whether rehospitalization during the first 2 years after moderate to severe traumatic brain injury (TBI) is associated with poor participation at 5 years post-TBI, after controlling for demographic and severity factors. SETTING: TBI Model Systems Program. PARTICIPANTS: Community-dwelling individuals with TBI, 16 years or older (n = 1940). DESIGN: Retrospective data analysis of a multicenter prospective study...
March 29, 2018: Journal of Head Trauma Rehabilitation
Preeti Sunderaraman, Stephanie Cosentino, Karen Lindgren, Angela James, Maria Schultheis
OBJECTIVE: Primarily, to investigate the association between informant report and objective performance on specific financial capacity (FC) tasks by adults with chronic, moderate to severe acquired brain injury, and to examine the nature of misestimates by the informants. DESIGN: Cross-sectional design. SETTING: A postacute, community-based rehabilitation center. PARTICIPANTS: Data were obtained from 22 chronic acquired brain injury (CABI) adults, mean age of 46...
March 29, 2018: Journal of Head Trauma Rehabilitation
Jean Paul Rwabihama, Etienne Audureau, Marie Laurent, Lalaina Rakotoarisoa, Marc Jegou, Sofiane Saddedine, Sébastien Krypciak, Stéphane Herbaud, Hind Benzengli, Lauriane Segaux, Esther Guery, Gabin Ambime, Marie-Thérèse Rabus, Jean-Guy Perilliat, Jean-Philippe David, Elena Paillaud
OBJECTIVES: To evaluate the efficacy of an intervention on the practice of venous thromboembolism prevention. DESIGN: A multicenter, prospective, controlled, cluster-randomized, multifaceted intervention trial consisting of educational lectures, posters, and pocket cards reminding physicians of the guidelines for thromboprophylaxis use. SETTINGS: Twelve geriatric departments with 1861 beds total, of which 202, 803, and 856 in acute care, postacute care, and long-term care wards, respectively...
March 23, 2018: Journal of the American Medical Directors Association
Cheryl D Bushnell, Pamela W Duncan, Sarah L Lycan, Christina N Condon, Amy M Pastva, Barbara J Lutz, Jacqueline R Halladay, Doyle M Cummings, Martinson K Arnan, Sara B Jones, Mysha E Sissine, Sylvia W Coleman, Anna M Johnson, Sabina B Gesell, Laurie H Mettam, Janet K Freburger, Blair Barton-Percival, Karen M Taylor, Janet Prvu-Bettger, Gladys Lundy-Lamm, Wayne D Rosamond
Many individuals who have had a stroke leave the hospital without postacute care services in place. Despite high risks of complications and readmission, there is no standard in the United States for postacute stroke care after discharge home. We describe the rationale and methods for the development of the COMprehensive Post-Acute Stroke Services (COMPASS) care model and the structure and quality metrics used for implementation. COMPASS, an innovative, comprehensive extension of the TRAnsition Coaching for Stroke (TRACS) program, is a clinician-led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home...
March 23, 2018: Journal of the American Geriatrics Society
Dolores Sánchez-Rodríguez, Cédric Annweiler, Natalia Ronquillo-Moreno, Andrea Tortosa-Rodríguez, Anna Guillén-Solà, Olga Vázquez-Ibar, Ferran Escalada, Josep M Muniesa, Ester Marco
BACKGROUND: Malnutrition is a prevalent condition related to adverse outcomes in older people. Our aim was to compare the diagnostic capacity of the malnutrition criteria of the European Society of Parenteral and Enteral Nutrition (ESPEN) with other classical diagnostic tools. METHODS: Cohort study of 102 consecutive in-patients ≥70 years admitted for postacute rehabilitation. Patients were considered malnourished if their Mini-Nutritional Assessment-Short Form (MNA-SF) score was ≤11 and serum albumin <3 mg/dL or MNA-SF ≤ 11, serum albumin <3 mg/dL, and usual clinical signs and symptoms of malnutrition...
May 2018: Archives of Gerontology and Geriatrics
Ronald E Delanois, Chukwuweike U Gwam, Jeffrey J Cherian, Jennifer I Etcheson, Nicole E George, Kathleen A Schneider, Michael A Mont
BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR...
February 15, 2018: Journal of Arthroplasty
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