Readmissions

Want To Keep Your Patient Out of the Hospital? Here Is Your Crystal Ball.

If I told you I planned to close a quarter of the country's cardiac catheterization labs, how would you react? You would probably express outrage and accuse me of mismanagement of our entire health system.  And that is to say nothing of all the harm that would come to patients.  But as docs, we reason in a prejudiced fashion.  We do medicine.  We write prescriptions.  We look at blood test results.  That is our profession after all.  It is how we extend lives and improve people’s well-being.  If we can measure, see, or manipulate a variable, anything attached to it must have value.  We have been trained to infer from that ethos with everything else taking a back seat. However, what if I then said I would reinvest every dime saved from those closures above and direct them towards all the people in our communities.  How many more lives might…

The Next Hospital Decade: Broken Hips Versus Band-Aid Strips

  I had planned on writing on MACRA and the inability of those who criticize the law to offer up alternatives to fix the flaws.  I got tired of the conclusions from the skeptics: let providers be and they will do the right thing.  That is a recipe for the pendulum to swing too far in one direction.  The "right thing" will wind up costing the Treasury a ton of dough.  History has already born that out. I am one of the skeptics as well, though.  I had no idea how CMS was planning to stitch this whole thing together--and I was waiting for hints from Andy Slavitt, top dog at CMS, based on his testimony last week on the Hill. Well, if you shorted Kleenex stock, pat yourself on the back. You can put your hankies away because it looks like CMS may postpone the start date.  My screed…

Here’s Why This Is The Best Study On Readmissions To Date

  Love or hate readmission rates as an effective measure of institutional performance, the benchmark has become the coin of the realm for QI gurus, policy geeks, and stat crunchers.  As such, we see new journal releases every week--mostly data dives into large registries where the conclusions proffered are tentative at best.  Clinicians rarely get studies comprised of patient-level information whose findings may impact how to better organize their PI interventions and direct care.  That just changed (see excerpted table at bottom). Andrew Auerbach, MD MPH and colleagues just published, Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients in JAMA IM, and the results merit a deeper look.  Andy was kind enough to answer some questions regarding his group's important paper for the blog. Q:  Andy, first off, you and your collaborators should be congratulated on releasing the most exhaustive study on readmission root causes to date. For readers, can…

Recidivism

  You might wonder why “recidivism” in the subject line. In the context of readmissions, the word comes up often—and in particular, those who cycle from shelters to the street to the ER. Rinse. Repeat.  I focus on the Northeast, but my guess is your regional experience is like mine. You have noticed over the last two to three years, big cities, and NYC in particular, have seen a marked uptick in the number of people sleeping on the sidewalks. The causes of the increase stem from budget cuts, the economy and myriad other factors you can probably surmise. (more…)

Saturdays, Sundays, and Mortality Risk. Again.

If you wish to avert your eyes and palate to the customs of the Brits, fine.  Don't eat fries with vinegar. However, as comparisons go to UK healthcare, you will serve yourself well by absorbing some if not many lessons the NHS has to offer.  Hospitals may differ country to country. Regardless, lower weekend staffing ratios and the proclivity of the sickest folks to wait until the last minute to present to the emergency room, often on Saturday or Sunday, do not differ.  Most acute care facilities do not operate at full staff 24/7.  Most people hate hospitals.  Among many commonalities, Americans and British share as much in those attributes. With that in mind, the BMJ just released a reexamination of NHS 2009-10 data comparing hospital mortality rates on patients admitted on weekdays versus weekends.  The 2013-14 treatment, with greater refinement in methods, replicates earlier findings. Freemantle and colleagues find…
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