Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Repeated hospitalizations are frequent toward the end of life, where each admission should be an opportunity to initiate advance-care planning to high-risk patients. ⋯ In a medical population, we identified 4 main risk factors that were significantly associated with 30-day potentially avoidable readmission due to end-of-life care issues, producing a model with very good to excellent discrimination. Patients with these risk factors might benefit from palliative care consultation prior to discharge in order to improve end-of-life care and possibly reduce unnecessary rehospitalizations.
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Identifying needs in patients who utilize the emergency department (ED) soon after being discharged from inpatient care is essential for planning appropriate care-transition interventions. ⋯ Our findings suggest the difficulty in forming unified definitions for root cause of ED visits soon after hospital discharge and support the use of multiple stakeholders in identifying appropriate targets for care-transition interventions.
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Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I. ⋯ Nonresumption of an ACE-I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE-I within postoperative day 0 to 14 is, however, associated with decreased 30-day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE-I is indicated.
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To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. ⋯ For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions.
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Little is currently known regarding physicians' opinions on the relative appropriateness of inpatient management of medical conditions unrelated to the reason for admission. ⋯ Physicians are more likely to rate inpatient medication changes as appropriate when they are related to the reason for admission. Our results suggest that opportunities for meaningful medical interventions may be underutilized in current systems that adhere to a strict dichotomy of inpatient and outpatient roles.Medicine.