Journal of general internal medicine
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Reducing hospital readmissions is a federal policy priority, and predictive models of hospital readmissions have proliferated in recent years; however, most such models tend to focus on the 30-day readmission time horizon and do not consider readmission over shorter (or longer) windows. ⋯ It is more difficult to predict distant readmissions than proximal readmissions, and the more information the model uses, the better the predictions. Inclusion of utilization-based risk factors add substantially to the discriminative ability of the model, much more than any other included risk factor domain. Our best-performing models perform well relative to other published readmission prediction models. It is possible that these predictions could have operational utility in targeting readmission prevention interventions among high-risk individuals.
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With an aging population, older adults are increasingly serving as caregivers to others, which may increase their risk of adverse interpersonal experiences. ⋯ In this national cohort of older community-dwelling adults, caregiving was independently associated with experiencing emotional and financial mistreatment after age 60. Findings suggest that efforts to prevent or mitigate elder mistreatment should put more emphasis on vulnerable older caregivers.
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Observational Study
The Association of Teamlets and Teams with Physician Burnout and Patient Outcomes.
Primary care "teamlets" in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team. ⋯ Most general internists and family physicians practice in teamlets, and some practice in teams, but neither practicing in a teamlet, in a team, or in the two together was associated with lower physician burnout, better outcomes for patients, or lower Medicare spending. Further study is indicated to investigate whether certain types of teamlet, teams, or teamlets within teams can achieve higher performance.
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Observational Study
Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach.
Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. ⋯ The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact.
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Insurance status may influence quality of opioid analgesic (OA) prescribing among patients seen by the same clinician. ⋯ Clinicians prescribe high-risk OAs differently based on insurance type. The relationship between insurance and opioid prescribing quality goes beyond where patients receive care.