Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Patients who are dual eligible for both Medicare and Medicaid have previously been shown to have increased healthcare utilization and cost. However, this relationship has not been examined for patients at the end of life. Dual eligible patients enrolled in hospice may receive more comprehensive care in the community, reducing readmissions in the final weeks or months of life. ⋯ Dual eligibility for Medicare and Medicaid is associated with lower 30-day readmission rates in patients enrolled in a hospice program. Insurance coverage that increases access to custodial care (home attendant hours and residential care) may help decrease burdensome hospital readmissions near the end of life. Journal of Hospital Medicine 2016;11:688-693. © 2016 Society of Hospital Medicine.
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More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. ⋯ Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. Journal of Hospital Medicine 2016;11:694-700. © 2016 Society of Hospital Medicine.
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The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-wide all-cause readmission rates, which are key indicators of quality and waste. Understanding hospital characteristics that are associated with lower readmission rates is important. ⋯ Hospitals should focus on modifiable organizational factors that influence patient outcomes such as hospitalist and RN staffing levels and explore hospital-physician arrangements that result in the greatest alignment between hospital and physician incentives. Journal of Hospital Medicine 2016;11:682-687. © 2016 Society of Hospital Medicine.
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Observational Study
Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay.
Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. ⋯ Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016;11:669-674. © 2016 Society of Hospital Medicine.
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Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions. ⋯ Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701-707. © 2016 Society of Hospital Medicine.