Journal of the American Geriatrics Society
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Randomized Controlled Trial Comparative Study
Inflammatory biomarkers and physical function in older, obese adults with knee pain and self-reported osteoarthritis after intensive weight-loss therapy.
To describe the relationships between proinflammatory biomarkers and self-reported and performance-based physical function and to examine the effect of weight loss on these markers of inflammation. ⋯ These results indicate that an intensive weight-loss intervention in older obese adults with knee pain can help improve inflammatory biomarkers and that changes in these concentrations showed associations with physical function.
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Multicenter Study Comparative Study
Do palliative consultations improve patient outcomes?
To determine whether inpatient palliative consultation services improve outcomes of care. ⋯ Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.
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Multicenter Study Comparative Study
Pain, dyspnea, and the quality of dying in long-term care.
To evaluate the relationship between pain, dyspnea, and family perceptions of the quality of dying in long-term care. ⋯ For residents dying in long-term care, pain and dyspnea were not associated with a poorer quality of dying as perceived by families of deceased residents. Instead, dyspnea may alert staff to the need for care. Initiatives to improve the quality of dying in long-term care should focus not only on physical symptoms, but also on the alleviation of nonphysical sources of suffering at the end of life.
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Comparative Study
Rehospitalization after hip fracture: predictors and prognosis from a national veterans study.
To estimate the risk and long-term prognostic significance of 30-day readmission postdischarge of a 4-year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities. ⋯ Patients with HFx with 30-day readmissions were nearly twice as likely to die within 1 year. Identification of several predictive comorbidities at discharge and examination of reasons for subsequent readmission suggests that readmission was largely due to active comorbid clinical problems. These comorbidity findings have implications for the current Centers for Medicare and Medicaid Services (CMS) pay-for-performance initiatives, especially those related to better coordination of care for patients with chronic illnesses. These comorbidity findings for elderly patients with HFx may also provide data to enable CMS and healthcare providers to more accurately differentiate between comorbidities and hospital-acquired complications under the current CMS initiative related to nonpayment for certain types of medical conditions and hospital acquired infections.
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Comparative Study
The positive financial contribution of home-based primary care programs: the case of the Mount Sinai Visiting Doctors.
The coming decade will see a rise in the number of homebound seniors. These vulnerable patients have great difficulty accessing primary care. Home-based primary care (HBPC) can fill this healthcare need. ⋯ Over a 12-month period, the cohort had 398 inpatient admissions and 1,100 non-HBPC outpatient visits, generating an overall contribution to margin of nearly $2.6 million. It is likely that this analysis underestimates the true contribution to margin, because it does not capture patient encounters at specialty clinics not in the Department of Medicine, unaffiliated medical centers, or private community-based practices. Although direct billing for HBPC programs does not generate enough revenue to meet operating costs, they can be significant revenue generators for the wider healthcare system and thus are fiscally worthy of subsidization.