JAMA internal medicine
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JAMA internal medicine · Sep 2019
Regression to the Mean in the Medicare Hospital Readmissions Reduction Program.
Excess 30-day readmissions have declined substantially in hospitals initially penalized for high readmission rates under the Medicare Hospital Readmissions Reduction Program (HRRP). Although a possible explanation is that the policy incentivized penalized hospitals to improve care processes, another is regression to the mean (RTM), a statistical phenomenon that predicts entities farther from the mean in one period are likely to fall closer to the mean in subsequent (or preceding) periods owing to random chance. ⋯ Most of the decline in readmission rates in hospitals with high rates during the measurement window for the first year of the HRRP appeared to be due to RTM. These findings seem to call into question the notion of an HRRP policy effect on readmissions.
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JAMA internal medicine · Sep 2019
Association of Opioid Overdose With Opioid Prescriptions to Family Members.
Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk, individuals may still access prescription opioids dispensed to family members. ⋯ In this analysis, opioid prescriptions to family members were associated with overdose among individuals who do not receive opioid prescriptions. Interventions may focus on expanding access to opioid antagonists, locking prescription opioids in the home, and providing greater patient education to limit fatal overdose among family members.