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By M. Carmen Martinez Velasco Internal Medicine
Carlos Jackson, Mohammad Shahsahebi, Tiffany Wedlake, C Annette DuBard
PURPOSE: Timely outpatient follow-up has been promoted as a key strategy to reduce hospital readmissions, though one-half of patients readmitted within 30 days of hospital discharge do not have follow-up before the readmission. Guidance is needed to identify the optimal timing of hospital follow-up for patients with conditions of varying complexity. METHODS: Using North Carolina Medicaid claims data for hospital-discharged patients from April 2012 through March 2013, we constructed variables indicating whether patients received follow-up visits within successive intervals and whether these patients were readmitted within 30 days...
March 2015: Annals of Family Medicine
William P Moran, Jingwen Zhang, Mulugeta Gebregziabher, Elisha L Brownfield, Kimberly S Davis, Andrew D Schreiner, Brent M Egan, Raymond S Greenberg, T Rogers Kyle, Justin E Marsden, Sarah J Ball, Patrick D Mauldin
RATIONALE, AIMS AND OBJECTIVES: Develop a risk-stratification model that clusters primary care patients with similar co-morbidities and social determinants and ranks 'within-practice' clusters of complex patients based on likelihood of hospital and emergency department (ED) utilization. METHODS: A retrospective cohort analysis was performed on 10 408 adults who received their primary care at the Medical University of South Carolina University Internal Medicine clinic...
February 4, 2015: Journal of Evaluation in Clinical Practice
Donna Rocks, Elizer Cooper-Audain
Patients with multiple chronic conditions have been shown to have significant Medicare expenditures. Care coordination programs have been implemented targeting this population by organizations striving to achieve the triple aim of (a) improving healthcare quality, (b) improving the patient experience, and (c) reducing costs. Outcomes of these programs have been mixed. This research brief profiles four published articles that address different aspects of care coordination. Readers are encouraged to access the full articles to learn more details about the intervention strategies and findings described in these articles...
February 2015: Home Healthcare Now
Laura Hurd Clarke, Erica Bennett
This article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women 'learn to live' with the physical and social realities of multiple morbidities? (c) How are older adults' experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption...
February 1, 2013: Ageing and Society
Songprod Jonathan Lorgunpai, Marianthe Grammas, David S H Lee, Gail McAvay, Peter Charpentier, Mary E Tinetti
OBJECTIVE: The 75% of older adults with multiple chronic conditions are at risk of therapeutic competition (i.e. treatment for one condition may adversely affect a coexisting condition). The objective was to determine the prevalence of potential therapeutic competition in community-living older adults. METHODS: Cross-sectional descriptive study of a representative sample of 5,815 community-living adults 65 and older in the U.S, enrolled 2007-2009. The 14 most common chronic conditions treated with at least one medication were ascertained from Medicare claims...
2014: PloS One
Oliver Reich, Thomas Rosemann, Roland Rapold, Eva Blozik, Oliver Senn
OBJECTIVES: To describe the prevalence and determinants of potentially inappropriate medication (PIM) use and association with hospitalizations in an elderly managed care population in Switzerland. METHODS: Using health care claims data of four health insurers for a sample of managed care patients 65 years of age and older to compare persons on PIM with persons not on PIM. Beers' 2012 and PRISCUS criteria were used to determine the potential inappropriateness of prescribed medications...
2014: PloS One
Gina Koch, Bonnie J Wakefield, Douglas S Wakefield
The prevalence of multiple chronic conditions (MCC) is increasing, creating challenges for patients, families, and the health care system. A systematic literature search was conducted to locate studies describing patient's perceptions of facilitators and barriers to management of MCC. Thirteen articles met study inclusion criteria. Patients reported nine categories of barriers including financial constraints, logistical challenges, physical limitations, lifestyle changes, emotional impact, inadequate family and social support, and the complexity of managing multiple conditions, medications, and communicating with health care providers...
April 2015: Western Journal of Nursing Research
Jeanne T Black
OBJECTIVES: To examine the population of inpatients with multiple hospitalizations at a large urban medical center in order to understand the types of patients who are at highest risk for 30-day readmission. STUDY DESIGN: Descriptive retrospective cohort analysis using hospital administrative data. METHODS: Bivariate analysis of clinical and sociodemographic characteristics of 19,049 adult inpatients discharged with a medical MS-DRG between July 1, 2009, and December 2010, and all subsequent inpatient admissions in the 180 days following each index discharge...
June 2014: American Journal of Managed Care
W-C Liao, C-L Lin, S-N Chang, C-Y Tu, C-H Kao
BACKGROUND AND PURPOSE: Chronic obstructive pulmonary disease (COPD) is frequently associated with various comorbidities. However, the proportion of COPD patients with dementia has not been adequately examined. This retrospective cohort study investigated the association between COPD and dementia by using a nationwide population-based database in Taiwan. METHODS: Data were retrieved from the Taiwanese National Health Insurance Research Database and analyzed using multivariate Cox proportional hazards regression models to assess the effects of COPD on the risk of dementia after adjusting for demographic characteristics and comorbidities...
February 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Alanna M Chamberlain, Jennifer L St Sauver, Yariv Gerber, Sheila M Manemann, Cynthia M Boyd, Shannon M Dunlay, Walter A Rocca, Lila J Finney Rutten, Ruoxiang Jiang, Susan A Weston, Véronique L Roger
BACKGROUND: Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented. METHODS: The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010...
January 2015: American Journal of Medicine
Fay Wright, Marilyn J Hammer, Gail D'Eramo Melkus
PROBLEM IDENTIFICATION: To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy. LITERATURE SEARCH: A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity...
July 1, 2014: Oncology Nursing Forum
Brian W Ward, Jeannine S Schiller, Richard A Goodman
The objective of this research was to update earlier estimates of prevalence rates of single chronic conditions and multiple (>2) chronic conditions (MCC) among the noninstitutionalized, civilian US adult population. Data from the 2012 National Health Interview Survey (NHIS) were used to generate estimates of MCC for US adults and by select demographic characteristics. Approximately half (117 million) of US adults have at least one of the 10 chronic conditions examined (ie, hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, current asthma, or chronic obstructive pulmonary disease [COPD])...
2014: Preventing Chronic Disease
Elizabeth Chrischilles, Kathleen Schneider, June Wilwert, Gregory Lessman, Brian O'Donnell, Brian Gryzlak, Kara Wright, Robert Wallace
BACKGROUND: Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data. POPULATION: The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007...
March 2014: Medical Care
Hyunsoon Cho, Carrie N Klabunde, K Robin Yabroff, Zhuoqiao Wang, Angela Meekins, Iris Lansdorp-Vogelaar, Angela B Mariotto
BACKGROUND: Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons. OBJECTIVE: To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions. DESIGN: Population-based cohort study. SETTING: A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information...
November 19, 2013: Annals of Internal Medicine
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