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https://www.readbyqxmd.com/read/28214235/effects-of-postacute-settings-on-readmission-rates-and-reasons-for%C3%A2-readmission-following-total-knee-arthroplasty
#1
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)...
February 14, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28192556/changes-in-postacute-care-in-the-medicare-shared-savings-program
#2
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...
February 13, 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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28096203/hospital-variation-in-functional-recovery-after-stroke
#7
Janet Prvu Bettger, Laine Thomas, Li Liang, Ying Xian, Cheryl D Bushnell, Jeffrey L Saver, Gregg C Fonarow, Eric D Peterson
BACKGROUND: Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. METHODS AND RESULTS: Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28079634/characteristics-of-patients-with-satisfactory-functional-gain-following-total-joint-arthroplasty-in-a-postacute-rehabilitation-setting
#8
Avital Hershkovitz, Marina Vesilkov, Yichayaou Beloosesky, Shai Brill
BACKGROUND AND PURPOSE: Total joint arthroplasty (TJA) is an effective and successful treatment of osteoarthritis of the hip and knee as quantified by several measures, such as pain relief, improved walking, improved self-care, functions, and increased quality of life. Data are lacking as to the definition of a satisfactory functional gain in a postacute setting and identifying the characteristics of older patients with TJA who may achieve that gain. Our aim was to characterize patients who may achieve a satisfactory functional gain in a postacute rehabilitation setting following TJA...
January 10, 2017: Journal of Geriatric Physical Therapy
https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#9
Peter J Huckfeldt, José J Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood
Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28069850/spending-on-care-after-surgery-driven-by-choice-of-care-settings-instead-of-intensity-of-services
#10
Lena M Chen, Edward C Norton, Mousumi Banerjee, Scott E Regenbogen, Anne H Cain-Nielsen, John D Birkmeyer
The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries after three common surgical procedures in the period 2009-12, we found that it varied widely between hospitals in the lowest versus highest spending quintiles for postacute care, with differences of 129 percent for total hip replacement, 103 percent for coronary artery bypass grafting (CABG), and 82 percent for colectomy...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28059877/rehabilitation-services-provision-and-payment
#11
Christoph Gutenbrunner, Melanie Blumenthal, Veronika Geng, Christoph Egen
Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care...
February 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28055085/delirium-update-for-postacute-care-and-long-term-care-settings-a-narrative-review
#12
Martin M Forsberg
Advances have been made in our understanding of the neuropathogenesis, recognition, and strategies for reducing the incidence of delirium in acute-care settings. However, relatively little attention has been given to delirium in elderly patients in the postacute care (PAC) and long-term care (LTC) settings. The present article reviews the most relevant current research pertaining to this population. Hospital patients with delirium are often discharged to PAC settings. Delirium that develops in the LTC setting is often more insidious and subtle in presentation...
January 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28055062/cost-of-joint-replacement-using-bundled-payment-models
#13
Amol S Navathe, Andrea B Troxel, Joshua M Liao, Nan Nan, Jingsan Zhu, Wenjun Zhong, Ezekiel J Emanuel
Importance: Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. Objective: To analyze changes in quality, internal hospital costs, and postacute care (PAC) spending for lower extremity joint replacement bundled payment episodes encompassing hospitalization and 30 days of PAC...
February 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28052981/variation-in-functional-status-after-hip-fracture-facility-and-regional-influence-on-mobility-and-self-care
#14
Srinivas Teppala, Kenneth J Ottenbacher, Karl Eschbach, Amit Kumar, Soham Al Snih, Winston J Chan, Timothy A Reistetter
BACKGROUND: Recent reports show substantial geographic variation in postacute health care spending. Little is known about variation in functional outcomes after postacute rehabilitation for patients with hip fracture. We examined variation in mobility and self-care after hip fracture rehabilitation across inpatient rehabilitation facilities (IRFs), hospital referral regions (HRRs) and states. METHODS: Retrospective cohort study using data from the Centers for Medicare and Medicaid Services (CMS) from 2006 to 2009...
January 3, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28032896/extension-for-community-healthcare-outcomes-care-transitions-enhancing-geriatric-care-transitions-through-a-multidisciplinary-videoconference
#15
Grace Farris, Mousumi Sircar, Jonathan Bortinger, Amber Moore, J Elyse Krupp, John Marshall, Alan Abrams, Lewis Lipsitz, Melissa Mattison
OBJECTIVES: To examine whether a novel videoconference that connects an interdisciplinary hospital-based team with clinicians at postacute care sites improves interprofessional communication and reduces medication errors. DESIGN: Prospective cohort. SETTING: One tertiary care medical center and eight postacute care sites. PARTICIPANTS: Hospital-based providers (hospitalists, geriatricians, pharmacists, social workers, medical trainees, and subspecialists) and postacute care clinicians...
December 29, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27984469/commentary-on-physical-therapy-dosing-frequency-and-type-of-intervention-in-pediatric-postacute-hospital-care
#16
Dana McCarty, Kerry Blazek
No abstract text is available yet for this article.
January 2017: Pediatric Physical Therapy
https://www.readbyqxmd.com/read/27984468/physical-therapy-dosing-frequency-and-type-of-intervention-in-pediatric-postacute-hospital-care
#17
Helene M Dumas, Maria A Fragala-Pinkham, Elaine L Rosen, Eric Folmar
PURPOSE: To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. METHODS: Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for all admissions from April 1, 2015, to March 1, 2016. Differences across 2 groups, children with recommendations for "less" (≤3x/wk) or "more" (≥4x/wk) frequent therapy, were examined...
January 2017: Pediatric Physical Therapy
https://www.readbyqxmd.com/read/27956073/an-unintended-consequence-of-culture-change-in-va-community-living-centers
#18
Jill Harrison, Denise A Tyler, Renée R Shield, Whitney L Mills, Kristen E Morgan, Maxwell E Cutty, Danielle L Coté, Susan M Allen
OBJECTIVE: Although a growing body of evidence suggests that culture change and its corollary, person-centered care improves resident outcomes in the nursing home setting, little is known about the effect of culture change in a postacute setting in which patients receive skilled nursing and rehabilitation services for a relatively short period of time before returning home. DESIGN: Data for this study were collected as part of a larger project to understand the impact of Veterans Health Administration (VHA) policies to shift the mission of VHA Community Living Centers (CLCs) from long-stay custodial care to short-stay skilled nursing and rehabilitative care...
December 9, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27926614/clinical-coordination-in-accountable-care-organizations-a-qualitative-study
#19
Valerie A Lewis, Karen Schoenherr, Taressa Fraze, Aleen Cunningham
BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts...
December 6, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27917479/hospital-postacute-care-referral-networks-is-referral-concentration-associated-with-medicare-style-bundled-payments
#20
Ramandeep Kaur, Jennifer N Perloff, Christopher Tompkins, Christine E Bishop
OBJECTIVE: To evaluate whether Medicare-style bundled payments are lower or higher for beneficiaries discharged from hospitals with postacute care (PAC) referrals concentrated among fewer PAC providers. DATA SOURCE: Medicare Part A and Part B claim (2008-2012) for all beneficiaries residing in any of 17 market areas: the Provider of Service file, the Healthcare Cost Report Information System, and the Dartmouth Atlas. STUDY DESIGN: An observational study in which hospitals were distinguished according to PAC referral concentration, which is the tendency to utilize fewer rather than more PAC providers...
December 5, 2016: Health Services Research
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