August 7, 2019

“Interventions to Improve Transitional Care Between Nursing Homes and Hospitals.” (Journal of the American Geriatrics Society, volume 58, number 4, pp 777-782)

Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for […]
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Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISIWeb, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high-quality transitional care.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02776.x/abstract

August 7, 2019

Continuity of care: a multidisciplinary review

Patients are increasingly seen by an array of providers in a wide variety of organizations and places, raising concerns about fragmentation of care. Policy reports and charters worldwide urge a concerted effort to enhance continuity, 1 – 3 but efforts to describe the problem or formulate solutions are complicated by […]
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Patients are increasingly seen by an array of providers in a wide variety of organizations and places, raising concerns about fragmentation of care. Policy reports and charters worldwide urge a concerted effort to enhance continuity, 1 – 3 but efforts to describe the problem or formulate solutions are complicated by the lack of consensus on the definition of continuity. To add to the confusion, other terms such as continuum of care, coordination of care, discharge planning, case management, integration of services, and seamless care are often used synonymously. This synthesis was commissioned by three Canadian health services policy and research bodies. The aim was to develop a common understanding of the concept of continuity as a basis for valid and reliable measurement of practice in different settings.
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http://www.bmj.com/content/327/7425/1219.extract

August 7, 2019

Comprehensive discharge planning with post-discharge support for older patients with congestive heart failure: a meta-analysis

CONTEXT Comprehensive discharge planning plus post-discharge support may reduce readmission rates for older patients with congestive heart failure (CHF). OBJECTIVE To evaluate the effect of comprehensive discharge planning plus post-discharge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), […]
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CONTEXT Comprehensive discharge planning plus post-discharge support may reduce readmission rates for older patients with congestive heart failure (CHF). OBJECTIVE To evaluate the effect of comprehensive discharge planning plus post-discharge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), and medical costs. DATA SOURCES We searched MEDLINE (1966 to October 2003), the Cochrane Clinical Trials Register (all years), Social Science Citation Index (1992 to October 2003), and other databases for studies that described such an intervention and evaluated its effect in patients with CHF. Where possible we also contacted lead investigators and experts in the field. STUDY SELECTION We selected English-language publications of randomized clinical trials that described interventions to modify hospital discharge for older patients with CHF (mean age =55 years), delineated clearly defined inpatient and outpatient components, compared efficacy with usual care, and reported readmission as the primary outcome. DATA ABSTRACTION Two authors independently reviewed each report, assigned quality scores, and extracted data for primary and secondary outcomes in an unblinded standardized manner. DATA SYNTHESIS Eighteen studies representing data from 8 countries randomized 3304 older inpatients with CHF to comprehensive discharge planning plus post-discharge support or usual care. During a pooled mean observation period of 8 months (range, 3-12 months), fewer intervention patients were readmitted compared with controls (555/1590 vs. 741/1714, number needed to treat = 12; relative risk [RR], 0.75; 95% confidence interval [CI], 0.64-0.88). Analysis of studies reporting secondary outcomes found a trend toward lower all-cause mortality for patients assigned to an intervention compared with usual care (RR, 0.87; 95% CI, 0.73-1.03; n = 14 studies), similar initial LOS (mean [SE]: 8.4 [2.5] vs 8.5 [2.2] days, P = .60; n = 10), greater percentage improvement in QOL scores compared with baseline scores (25.7% [95% CI, 11.0%-40.4%] vs 13.5% [95% CI, 5.1%-22.0%]; n = 6, P = .01), and similar or lower charges for medical care per patient per month for the initial hospital stay, administering the intervention, outpatient care, and readmission (-$359 [95% CI, -$763 to $45]; n = 4, P = .10 for non-US trials and -$536 [95% CI, -$956 to -$115]; n = 4, P = .03, for US trials). CONCLUSION Compreh
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http://jama.ama-assn.org/content/291/11/1358.abstract

August 7, 2019

White Space or Black Hole: What Can We Do To Improve Care Transitions?

An emerging consortium of nine leading medical specialty societies – with the support of the ABIM Foundation, AHRQ, IHI, NCQA and others – has recently begun developing principles and initial standards to enhance care transitions. By defining ways to change medical culture, establishing agreed–upon practices, and eventually identifying related measures, […]
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An emerging consortium of nine leading medical specialty societies – with the support of the ABIM Foundation, AHRQ, IHI, NCQA and others – has recently begun developing principles and initial standards to enhance care transitions. By defining ways to change medical culture, establishing agreed–upon practices, and eventually identifying related measures, this consortium – the Stepping Up to the Plate (SUTTP) Alliance – is focused on designing a system of coordination between sites of care with the goal of reducing errors, gaps in care and waste.
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http://www.abimfoundation.org/~/media/Files/Publications/F06-05-2007_6.ashx

August 7, 2019

Medical errors related to discontinuity of care from an inpatient to an outpatient setting

OBJECTIVE To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes. PATIENTS Eighty-six patients who had been hospitalized on the medicine service at a large […]
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OBJECTIVE To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes. PATIENTS Eighty-six patients who had been hospitalized on the medicine service at a large academic medical center and who were subsequently seen by their primary care physicians at the affiliated outpatient practice within 2 months after discharge. DESIGN Each patient's inpatient and outpatient medical record was reviewed for the presence of 3 types of errors related to the discontinuity of care from the inpatient to the outpatient setting: medication continuity errors, test follow-up errors, and work-up errors. MEASUREMENTS Rehospitalizations within 3 months after the initial postdischarge outpatient primary care visit. MAIN RESULTS Forty-nine percent of patients experienced at least 1 medical error. Patients with a work-up error were 6.2 times (95%confidence interval [95% CI], 1.3 to 30.3) more likely to be rehospitalized within 3 months after the first outpatient visit. We did not find a statistically significant association between medication continuity errors (odds ratio [OR], 2.5; 95%CI, 0.7 to 8.8) and test follow-up errors (OR, 2.4; 95%CI, 0.3 to 17.1) with rehospitalizations. CONCLUSION We conclude that the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.
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http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2003.20722.x/abstract

August 7, 2019

Information exchange among physicians caring for the same patient in the community (CMAJ|November 4, 2008; 179 (10). doi:10.1503/cmaj.080430)

Background: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. Methods: We conducted a […]
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Background: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. Methods: We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits. Results: A total of 3250 patients, with a total of 39 469 previous–current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.54–1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21–1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32–0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60–0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92–8.63).
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http://www.cmaj.ca/cgi/content/abstract/179/10/1013

August 7, 2019

Comprehensive Primary Care for Older Patients With Multiple Chronic Conditions: “Nobody Rushes You Through” (JAMA. 2010;304(17):1936-1943.)

Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based […]
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Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers’) active engagement in care, and coordination of professionals in care of the patient—all tailored to the patient's goals and preferences. Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care—the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE)—are described briefly, and steps toward their implementation are discussed.
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http://jama.ama-assn.org/cgi/content/abstract/304/17/1936

August 7, 2019

Transitions through post-acute and long-term care settings: Patterns of use and outcomes for a national cohort of elders

This study provides new information on patterns of post-acute and long-term care use and the types of transitions most likely to be followed by potential problems. The results suggest three broad strategies for improving the outcomes of transitions through post-acute and long-term care settings.
This study provides new information on patterns of post-acute and long-term care use and the types of transitions most likely to be followed by potential problems. The results suggest three broad strategies for improving the outcomes of transitions through post-acute and long-term care settings.
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http://www.jstor.org/pss/3767609

August 7, 2019

Recurrent Readmissions in Medical Patients: A Prospective Study. (JHM 12 OCT 2010 DOI: 10.1002/jhm.811)

BACKGROUND: Hospital readmissions are common and costly. A recent previous hospitalization preceding the index admission is a marker of increased risk of future readmission. OBJECTIVES: To identify factors associated with an increased risk of recurrent readmission in medical patients with 2 or more hospitalizations in the past 6 months. DESIGN: […]
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BACKGROUND: Hospital readmissions are common and costly. A recent previous hospitalization preceding the index admission is a marker of increased risk of future readmission. OBJECTIVES: To identify factors associated with an increased risk of recurrent readmission in medical patients with 2 or more hospitalizations in the past 6 months. DESIGN: Prospective cohort study. SETTING: Australian teaching hospital acute medical wards, February 2006-February 2007. PARTICIPANTS: 142 inpatients aged =50 years with a previous hospitalization =6 months preceding the index admission. Patients from residential care, with terminal illness, or with serious cognitive or language difficulties were excluded. VARIABLES OF INTEREST: Demographics, previous hospitalizations, diagnosis, comorbidities and nutritional status were recorded in hospital. Participants were assessed at home within 2 weeks of hospital discharge using validated questionnaires for cognition, literacy, activities of daily living (ADL)/instrumental activities of daily living (IADL) function, depression, anxiety, alcohol use, medication adherence, social support, and financial status. MAIN OUTCOME MEASURE: Unplanned readmission to the study hospital within 6 months. RESULTS: A total of 55 participants (38.7%) had a further unplanned hospital admission within 6 months. In multivariate analysis, chronic disease (adjusted odds ratio [OR] 3.4; 95% confidence interval [CI], 1.3-9.3, P = 0.002), depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P = 0.01), and underweight (adjusted OR, 12.7; 95% CI, 2.3-70.7, P = 0.004) were significant predictors of readmission after adjusting for age, length of stay and functional status. CONCLUSIONS: In this high-risk patient group, multiple chronic conditions are common and predict increased risk of readmission. Post-hospital interventions should consider targeting nutritional and mood status in this population. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.811/abstract

August 7, 2019

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care. METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to find original English […]
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PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care. METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to find original English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence. RESULTS Forty-one research articles reporting the results of 40 studies were identified that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were significantly improved and only 2 were significantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported significantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity. CONCLUSIONS Although the available literature reflects persistent methodologic problems, it is likely that a significant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specific and measurable outcomes and more direct costs and should seek to define and measure interpersonal continuity more explicitly.
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http://www.annfammed.org/cgi/content/abstract/3/2/159

August 7, 2019

Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction. Clancy CM. Am J Med Qual. 2009;24:344-346.

In this commentary, AHRQ Director Carolyn Clancy discusses effective patient discharge as an important factor in patient safety. Specifically, she highlights elements of an AHRQ-funded implementation program for engaging patients along with their clinical team to enable smooth discharge.
In this commentary, AHRQ Director Carolyn Clancy discusses effective patient discharge as an important factor in patient safety. Specifically, she highlights elements of an AHRQ-funded implementation program for engaging patients along with their clinical team to enable smooth discharge.
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http://ajm.sagepub.com/content/24/4/344

August 7, 2019

Using the NO TEARS tool for medication review

The NO TEARS structure can aid efficient medication review within a 10-minute consultation. It is a flexible system that can be tailored to the individual practitioner’s consultation style: N eed/indication, O pen questions, T ests, E vidence, A dverse effects, R isk reduction, S implification/switches.
The NO TEARS structure can aid efficient medication review within a 10-minute consultation. It is a flexible system that can be tailored to the individual practitioner's consultation style: N eed/indication, O pen questions, T ests, E vidence, A dverse effects, R isk reduction, S implification/switches.
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http://www.bmj.com/content/329/7463/434.full.pdf

August 7, 2019

Implications of Reassigning Patients for the Medical Home: A Case Study

PURPOSE Improving patient-doctor continuity is one goal of the medical home, but achieving this goal may require physicians to reduce panel size. This article examines the impact on patient experience and utilization of Group Health Cooperative’s process of reassigning patients to new physicians as part of their medical home demonstration […]
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PURPOSE Improving patient-doctor continuity is one goal of the medical home, but achieving this goal may require physicians to reduce panel size. This article examines the impact on patient experience and utilization of Group Health Cooperative’s process of reassigning patients to new physicians as part of their medical home demonstration project. METHODS This work represents a subanalysis of the Group Health medical home pilot evaluation. Study participants include 8,005 adults who received primary care in 2006 and 2007 at an urban practice owned and operated by a not-for-profit integrated delivery system. Approximately one-quarter of patients were selected to be reassigned to a new physician. Primary care, emergency department, secure messaging, and telephone utilization were captured through automated sources. Patients’ experience was measured before and after implementation of the medical home for a subset of 1,098 patients. RESULTS Patients who were retained by their existing physicians were older, sicker, and had longer preexisting patient-doctor relationships. After reassignment, reassigned patients were less likely to use primary care services but equally likely to use the emergency department. They were no less satisfied with their care experience. CONCLUSIONS Informational and managerial continuity may mitigate deleterious effects of reassignment, but more must be done to actively bind reassigned patients to the medical home to improve relational continuity with younger, healthier patients. Key Words: Patient-centered medical home, primary health care, continuity of patient care, physician-patient relations, patient-centered care
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http://www.annfammed.org/cgi/content/abstract/8/6/493

August 7, 2019

Safety in numbers: Physicians joining forces to seal the cracks during transitions (Journal of Hospital Medicine, Volume 4, Issue 6, pages 329–330, July/August 2009)

A lack of communication and accountability among healthcare professionals in general and physicians in particular, jeopardizes quality and safety for our patients who are transitioning across sites of care. Our patients, their family caregivers, and our health care professional colleagues on the receiving end of these transfers are often left […]
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A lack of communication and accountability among healthcare professionals in general and physicians in particular, jeopardizes quality and safety for our patients who are transitioning across sites of care. Our patients, their family caregivers, and our health care professional colleagues on the receiving end of these transfers are often left “flying blind” without adequate information or direction to make sound clinical decisions.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.548/abstract

August 7, 2019

Bouncing back: Patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke

OBJECTIVES To identify predictors of complicated transitions within 30 days after discharge from hospitalization for acute stroke. DESIGN Retrospective analysis of administrative data. SETTING Four hundred twenty-two hospitals in the southern and eastern United States. PARTICIPANTS Thirty-nine thousand three hundred eighty-four Medicare beneficiaries aged 65 and older discharged after acute […]
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OBJECTIVES To identify predictors of complicated transitions within 30 days after discharge from hospitalization for acute stroke. DESIGN Retrospective analysis of administrative data. SETTING Four hundred twenty-two hospitals in the southern and eastern United States. PARTICIPANTS Thirty-nine thousand three hundred eighty-four Medicare beneficiaries aged 65 and older discharged after acute ischemic stroke from 1998 to 2000. MEASUREMENTS Complicated transition, defined as movement from less- to more-intensive care setting after hospital discharge, with hospital being most intensive and home without home health care being least intensive. RESULTS Twenty percent of patients experienced at least one complicated transition; 16% of those experienced more than one complicated transition. After adjustment using logistic regression, factors predicting any complicated transition included older age, African-American race, Medicaid enrollment, prior hospitalization, gastrostomy tube, chronic disease, length of stay, and discharge site. Patients with multiple complicated transitions were more likely to be African American (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.13–1.68), be male (OR=1.21, 95% CI=1.04–1.40), have a prior diagnosis of fluid and electrolyte disorder (e.g., dehydration) (OR=1.23, 95% CI=1.07–1.43), have a prior hospitalization (OR=1.18, 95% CI=1.01–1.36), and be initially discharged to a skilled-nursing facility or long-term care (OR=1.22, 95% CI=1.04–1.44) than patients with only one complicated transition. They were less likely to be initially discharged to a rehabilitation center (OR=0.71, 95% CI=0.57–0.89). CONCLUSION Significant numbers of stroke patients experience complicated transitions soon after hospital discharge. Sociodemographic factors and initial discharge site distinguish patients with multiple complicated transitions. These factors may enable prospective identification and targeting of stroke patients at risk for “bouncing back.”
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2007.01091.x/abstract

August 7, 2019

Hospital At Home: Feasibility and Outcomes of a Program to Provide Hospital-Level Care at Home for Acutely Ill Older Patients. (Annals of Internal Medicine, December 6, 2005 vol. 143 no. 11 798-808)

Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital. Objective: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient’s home in a hospital at home. Design: Prospective quasi-experiment. Setting: 3 Medicare-managed care (Medicare + Choice) health […]
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Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital. Objective: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home. Design: Prospective quasi-experiment. Setting: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. Participants: 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. Intervention: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. Measurements: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care. Results: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P?= 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care ($5081 vs. $7480) (P?< 0.001). Limitations: Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences. Conclusions: The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.
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http://www.annals.org/content/143/11/798.abstract

August 7, 2019

Primary Care Physicians Should Be Coordinators, Not Gatekeepers

Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine. However, returning to the pre–managed care model of uncoordinated open access to specialists is a poor […]
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Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine. However, returning to the pre–managed care model of uncoordinated open access to specialists is a poor solution. The primary care model should be retained, but PCPs should be transformed from gatekeepers into coordinators of care, in which the goal of the PCP is to integrate both primary and specialty care to improve quality. Changes in the PCP's daily work process, as well as the referral and payment processes, need to be implemented to reach this goal. This model would eliminate the requirement that referrals to specialists be authorized by the primary care physician or managed care organization. Financial incentives would be needed, eg, to encourage PCPs to provide management of complex cases and discourage both overreferral and underreferral to specialists. Budgeting specialists should control excess costs that might be created by the elimination of the primary care gatekeeper. Pilot projects are needed to test and refine this model of PCP as coordinator of care. KEYWORDS: gatekeepers, health service, managed care, programs, physicians' role, physicians, family, policy perspectives , primary care, physicians, referral and consultation.
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http://jama.ama-assn.org/content/281/21/2045.abstract?sid=1ae98db9-f651-4cb8-8e20-00b423514808

August 7, 2019

Joint Principles of the Patient-Centered Medical Home (March 2007)

The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, a
The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, a
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http://www.medicalhomeinfo.org/downloads/pdfs/jointstatement.pdf

August 7, 2019

Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century

This is the second and final report of the Committee on the Quality of Health Care in America, which was appointed in 1998 to identify strategies for achieving a substantial improvement in the quality of health care delivered to Americans. The committee’s first report, To Err Is Human: Building a […]
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This is the second and final report of the Committee on the Quality of Health Care in America, which was appointed in 1998 to identify strategies for achieving a substantial improvement in the quality of health care delivered to Americans. The committee’s first report, To Err Is Human: Building a Safer Health System, was released in 1999 and focused on a specific quality concern—patient safety. This second report focuses more broadly on how the health care delivery system can be designed to innovate and improve care. This report does not recommend specific organizational approaches to achieve the aims set forth. Rather than being an organizational construct, redesign refers to a new perspective on the purpose and aims of the health care system, how patients and their clinicians should relate, and how care processes can be designed to optimize responsiveness to patient needs. The principles and guidance for redesign that are offered in this report represent fundamental changes in the way the system meets the needs of the people it serves. Redesign is not aimed only at the health care organizations and professionals that comprise the delivery system. Change is also required in the structures and processes of the environment in which those organizations and professionals function. Such change includes setting national priorities for improvement, creating better methods for disseminating and applying knowledge to practice, fostering the use of information technology in clinical care, creating payment policies that encourage innovation and reward improvement in performance, and enhancing educational programs to strengthen the health care workforce.
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http://www.nap.edu/openbook.php?isbn=0309072808

August 7, 2019

Defragmenting Care: Stephen F. Jencks, MD, MPH

Rehospitalizations that occur soon after hospital discharge are drawing increasing attention. About 2.5 million Medicare beneficiaries and about 2 million other patients are rehospitalized within 30 days of discharge, with total hospital costs (not including physician services) of about $44 billion (1; Steiner C, Jiang J. Personal communication). From the […]
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Rehospitalizations that occur soon after hospital discharge are drawing increasing attention. About 2.5 million Medicare beneficiaries and about 2 million other patients are rehospitalized within 30 days of discharge, with total hospital costs (not including physician services) of about $44 billion (1; Steiner C, Jiang J. Personal communication). From the perspectives of payers, purchasers, and policymakers, avoidable rehospitalizations represent massive and remediable waste. However, most rehospitalization is the result of clinical deterioration, occurs emergently, and is often necessary by the time the patient reaches the emergency department. Some emergency department visits might be prevented from turning into hospitalizations. However, compelling evidence from a series of controlled studies (2–4), in which interventions to improve the transition from hospital to posthospital care have reduced rehospitalizations by 30% to 50%, suggests that the rehospitalization problem represents a failure of those transitions rather than willful overuse of hospital services. It is a symptom of fragmented care
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http://www.annals.org/content/153/11/757.extract