Journal of general internal medicine
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Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood. ⋯ Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions.
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Successful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions. ⋯ Clinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health.
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Little evidence exists to guide continuation of screening beyond the recommended ages of national guidelines for breast, cervical, and colorectal cancers, although increasing age and comorbidity burden is likely to reduce the screening benefit of lower mortality. ⋯ The odds of screening past guideline-based age decreased with comorbidity burden for breast and cervical cancer screening but not for colorectal. These findings suggest the need to evaluate shared decision tools to help patients understand whether screening is appropriate and to generate more evidence in older populations.
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Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults. ⋯ Black older adults were less likely to fill a new opioid prescription after hospital discharge when compared to White older adults and received lower total MMEs. The factors contributing to these differential prescribing patterns should be investigated further.