Medical care
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Multicenter Study Clinical Trial
Exploring Meaningful Patient Engagement in ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness).
Genuine patient engagement can improve research relevance, impact and is required for studies using the National Patient-Centered Clinical Research Network including major multicenter research projects. It is unclear, however, how best to integrate patients into governance of such projects. ⋯ With adequate support, a cadre of committed patient leaders can provide substantial value to design and implementation of a major multicenter clinical trial.
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Patient-centered medical homes are expected to reduce expenditures by increasing the use of primary care services, shifting care from inpatient to outpatient settings, and reducing avoidable utilization. Under the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare joined Medicaid and commercial payers in 8 states to support ongoing patient-centered medical home initiatives. ⋯ Although the MAPCP Demonstration did not have strong, consistent impacts on utilization and expenditures, this evaluation provides insights that may be useful for the design of future health care transformation models.
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Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors. ⋯ Several comorbidities indicative of opioid use disorder and greater exposure to opioids and concomitant benzodiazepines were associated with unintentional prescription opioid overdose fatalities. Prescribers and state agencies should be aware of these addressable patient-level factors among the Medicaid population. Targeting these factors with appropriate policy interventions and education may prevent future deaths.
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Care transitions programs have been shown to reduce hospital readmissions. ⋯ The MCCT significantly reduces preventable readmissions, suggesting that access to multidisciplinary care can reduce readmissions and improve outcomes for high-risk elders.
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Hospital readmission within 30 days of discharge (30-d readmission) is an undesirable outcome. Readmission of patients with diabetes is common and costly. Most of the studies that have examined readmission risk factors among diabetes patients did not include potentially important clinical data. ⋯ There are numerous risk factors for 30-day readmission among patients with diabetes. Postdischarge factors add to the predictive accuracy achieved by predischarge factors. A better understanding of readmission risk may ultimately lead to lowering that risk.