JAMA internal medicine
-
JAMA internal medicine · May 2014
Effect of hospitalist workload on the quality and efficiency of care.
Hospitalist physicians face increasing pressure to maximize productivity, which may undermine the efficiency and quality of care. ⋯ Increasing hospitalist workload is associated with clinically meaningful increases in LOS and cost. Although our findings should be validated in different clinical settings, our results suggest the need for methods to mitigate the potential negative effects of increased hospitalist workload on the efficiency and cost of care.
-
JAMA internal medicine · May 2014
National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations.
Detailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets. ⋯ Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts.
-
JAMA internal medicine · May 2014
High-risk use by patients prescribed opioids for pain and its role in overdose deaths.
From January 1, 2003, through December 31, 2010, drug overdose deaths in Tennessee increased from 422 to 1059 per year. More of these deaths involved prescription opioids than heroin and cocaine combined. ⋯ High-risk use of prescription opioids is frequent and increasing in Tennessee and is associated with increased overdose mortality. Use of prescription drug–monitoring program data to direct risk-reduction measures to the types of patients overrepresented among overdose deaths might reduce mortality associated with opioid abuse.