Journal of general internal medicine
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Editorial Comment
Rethinking "abnormal" blood pressure: what is the value?
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Seniors frequently struggle during the transition home following an acute hospitalization resulting in frequent rehospitalizations. Studies consistently show a lack of comprehension of discharge instructions. ⋯ Low cognition at discharge is common among elderly patients without dementia, and cognition often improves one month post-hospitalization. Seniors may not comprehend discharge instructions, and patient self-management may be better taught as an outpatient following discharge rather than at the time of hospital discharge. Discharge interventions should incorporate screening of seniors for low cognition prior to hospital discharge to provide optimal transitional care.
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Readmissions cause significant distress to patients and considerable financial costs. Identifying hospitalized patients at high risk for readmission is an important strategy in reducing readmissions. We aimed to evaluate how well physicians, case managers, and nurses can predict whether their older patients will be readmitted and to compare their predictions to a standardized risk tool (Probability of Repeat Admission, or P(ra)). ⋯ This study found (1) overall readmission rates were higher than previously reported, possibly because we employed a more thorough follow-up methodology, and (2) neither providers nor a published algorithm were able to accurately predict which patients were at highest risk of readmission. Amid increasing pressure to reduce readmission rates, hospitals do not have accurate predictive tools to guide their efforts.
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National health insurance reform will pose considerable challenges to the core missions of safety net organizations that serve the uninsured. Those who currently donate money or time will, rightly or wrongly, view uninsured recipients as less deserving on the whole. Nevertheless, safety net organizations can serve several critical functions that continue to justify their existence and support. ⋯ Finally, not all people with insurance will have affordable access to all needed care. Market conditions will continue pushing higher levels of patient cost-sharing through deductibles and co-payments. To serve these multiple needs, safety net organizations should consider adapting their missions and business models so that they accept both insured and uninsured patients under a sliding fee scale that varies charges according to ability to pay.