Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients.
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Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices. ⋯ Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions.
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Comparative Study
Readmission penalties and health insurance expansions: a dispatch from Massachusetts.
Payers are penalizing hospitals for high readmission rates. It is unknown whether major changes in population insurance coverage can affect readmission rates, despite the Affordable Care Act's coverage expansions coming into effect this year. ⋯ The Affordable Care Act's insurance expansion may be associated with an increase in unadjusted readmission rates among hospitals that cared for disproportionate numbers of uninsured patients. Risk-adjustment appears to take this effect into account.
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A previously published, retrospectively derived prediction rule for death within 30 days of hospital admission has the potential to launch parallel interdisciplinary team activities. Whether or not patient care improves will depend on the validity of prospectively generated predictions, and the feasibility of generating them on demand for a critical proportion of inpatients. ⋯ Important prognostic information is feasible to obtain in a real-time, single-assessment process for a sizeable proportion of hospitalized patients.