Medical care
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For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit (ICU). ⋯ Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in ICUs, incur fewer health care costs driven by a reduction in postacute care utilization, however, invoke higher overall Medicare payments.
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By focusing primarily on outcomes in the inpatient setting one may overlook serious adverse events that may occur after discharge (eg, readmissions, mortality) as well as opportunities for improving outpatient care. ⋯ Our results suggest that interventions that focus on minimizing preventable inpatient safety events as well as improving coordination of care between and across settings may decrease the likelihood of readmission.
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Over the past 20 years, surgical practice organizations have recommended the identification of ≥12 lymph nodes from surgically treated colon cancer patients as an indicator of quality performance for adequate staging; however, studies suggest that significant variation exists among hospitals in their level of adherence to this recommendation. We examined hospital-level factors that were associated with institutional improvement or maintenance of adequate lymph node evaluation after the introduction of surgical quality guidelines. ⋯ Over the 12-year period, there were marked improvements in hospital performance for guideline-recommended lymph node evaluation. Understanding patterns in improvement over time contributes to debates over optimal designs of quality-improvement programs.
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Randomized Controlled Trial
Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial.
Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting. ⋯ CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.
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Provisions of the Affordable Care Act that increase hospitals' financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. ⋯ Improving nurses' work environments and staffing may be effective interventions for preventing readmissions.