Journal of general internal medicine
-
Medicare is estimated to cover 14% of the population of the USA (Henry J Kais Fam Found 2017), over fifty million people. Despite covering a smaller percentage of the population than employer-sponsored insurance and Medicaid, Medicare is the most common payer for inpatient encounters. The Healthcare Cost and Utilization Project estimated that in 2015, Medicare was the primary payer for 39.4% of hospitalizations (HCUP 2019). While in daily practice it may be practical to assume that patients eligible for Medicare are financially insulated from the costs of care, the reality is that no care exists in a vacuum. Medicare is a complex program that mitigates but does not completely eliminate costs to patients. ⋯ This review aims to shed light for providers on the basics of Medicare, and how beneficiaries are impacted financially by their care to better understand some of the social barriers our patients face in seeking care.
-
Complex health interventions (CHIs) are increasingly studied in comparative effectiveness research (CER), and there is a need for improvements in CHI research practices. The Patient-Centered Outcomes Research Institute (PCORI) Methodology Committee (MC) launched an effort in 2016 to develop formal guidance on this topic. ⋯ The new standards offer three major contributions to research: (1) they provide a simple framework to help investigators address the major methodological features of a CHI study, (2) they emphasize the importance of the causal model and the need to understand how a CHI achieves its effects rather than simply measuring these effects, and (3) they require description of a CHI using the concepts of core functions and forms. While these standards apply formally to PCORI-funded CER studies, they have broad applicability.
-
Review Case Reports
Going Skin Deep: Excavating a Diagnosis of Intravascular Large B Cell Lymphoma.
A fever of unknown origin is often pursued diagnostically under the framework of infectious, rheumatologic, and neoplastic causes. When encephalopathy ensues, the differential diagnosis narrows, but can remain elusive, particularly when dealing with rare diseases. We present the case of a patient with fever of unknown origin and intermittent encephalopathy that spanned multiple hospital admissions and ultimately yielded a diagnosis of intravascular large B cell lymphoma complicated by hemophagocytic lymphohistiocytosis. We review the varying presentations of this disease, when to consider this as a diagnosis, and how to most accurately make the diagnosis.
-
Review Meta Analysis
Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis.
Polypharmacy and use of inappropriate medications have been linked to increased risk of falls, hospitalizations, cognitive impairment, and death. The primary objective of this review was to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults. ⋯ PROSPERO - CRD42019132420.
-
Review Meta Analysis
Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis.
Polypharmacy and use of inappropriate medications have been linked to increased risk of falls, hospitalizations, cognitive impairment, and death. The primary objective of this review was to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults. ⋯ PROSPERO - CRD42019132420.