Journal of the American Geriatrics Society
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Multicenter Study Pragmatic Clinical Trial
GP-Led Deprescribing in Community-Living Older Australians: An Exploratory Controlled Trial.
To assess feasibility, effectiveness, and safety of a multifaceted general practitioner (GP) led intervention to reduce potentially inappropriate polypharmacy in community-living older people. ⋯ The deprescribing intervention appears feasible, was modestly effective, and was not associated with any major safety events. J Am Geriatr Soc 68:403-410, 2020.
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Although preventable, healthcare-associated infections (HAIs) are commonly observed in post-acute care settings for at-risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post-acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. ⋯ SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370-378, 2020.
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Inadequate Risk Adjustment Impacts Geriatricians' Performance on Medicare Cost and Quality Measures.
Medicare value-based payment programs evaluate physicians' performance on their patients' annual Medicare costs and clinical outcomes. However, little is known about how geriatricians, who disproportionately provide care for medically complex older adults, perform on these measures. ⋯ Medicare should consider risk adjusting for frailty, long-term institutionalization, dementia, and depression to avoid inappropriately penalizing geriatricians who care for vulnerable older adults. J Am Geriatr Soc 68:297-304, 2020.
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Randomized Controlled Trial Multicenter Study
Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia.
Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. ⋯ The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305-312, 2020.