Category Archives: Inpatient care

How do mental health conditions contribute to preventable hospitalizations?

By | December 21, 2017

What role does mental health play in preventable hospitalizations?  In a new article in the January 2018 issue of Medical Care, Dr. Laura Medford-Davis and colleagues report that in Texas, mental illnesses were associated with higher odds of preventable hospitalizations. Using an administrative database of all Texas hospital admissions from 2005-2008, the authors found that 13% of… Read More »

Hitching our Wagon to the Stars: Making the Most of Quality Reporting

By | December 7, 2017

The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »

The HOSPITAL Score – A Prediction Tool for Potentially Preventable (and Therefore Costly) Readmissions

By | January 5, 2017

In the era of value-based care, caregivers and policymakers alike are intensely interested in strategies to reduce 30-day hospital readmissions. Researchers continue to offer up helpful tools in this effort. Recently published online ahead of print in Medical Care, Burke and colleagues make an important contribution with their article The Hospital Score Predicts Potentially Preventable 30-Day Readmissions… Read More »

Continuity of Care vs. Nurse Shift Length

By | December 29, 2016

If you have ever been in a hospital, you are probably familiar with what seems like a continuously revolving door of staff members providing care.  With nurses making up the largest occupation in healthcare and the largest segment of hospital staff, continuity of nursing care for hospitalized patients is an important factor in the delivery of quality healthcare.… Read More »

Hospital interpretation and payment incentives

By | December 1, 2016

Access to interpreters improves health care and is generally required by law. Why then, is interpretation access hard to come by in hospitals? From a hospital staff perspective, appropriate policies may be in place, and hospital staff motivated to offer excellent patient care, but all the demands of providing medical care can lead to system breakdown.… Read More »

Confusing the Confused: The impact of lacking professional interpretation services

By | November 23, 2016

Being hospitalized with a serious medical condition, surrounded by strange equipment, and listening to medical jargon you’ve never heard before is an intimidating situation for anyone. Compounding the uncertainty and stress of the situation would be not understanding the primary language spoken by your providers, not being able to read your procedure consents, and knowing… Read More »

Healthcare Utilization Rates after Oregon’s 2008 Medicaid Expansion: The Long View

By | October 28, 2016

Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »

Health care services use after Medicaid-to-dual transition for adults with mental illness

By | August 11, 2016

In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »

Tools to improve coordination in primary care

By | July 28, 2016

Last month, I left readers with a bit of cliffhanger: How do we actually improve care coordination? Last time, I suggested there were some great ideas, and now it’s time to delve into three promising strategies: 1) individualize and personalize the electronic medical record (EMR); 2. fix the hospital discharge process; and 3) make it a part of normal practice to measure care coordination. Read on for more about each of these tools…

All Falls Are Not Equal

By | June 9, 2016

All falls are not equal, nor is the financial impact of how Medicare defines fall-related injuries (FRI). In a new Medical Care article published ahead of print, I worked with colleagues at UCLA’s Fielding School of Public Health to explore whether Medicare expenditures associated with fall-related injuries (FRI) depend on how FRIs are identified in… Read More »

Multidimensional frailty score as a predictor of postoperative mortality

By | June 2, 2016

According to the 2010 U.S. Census, there are 40 million people (13% of the population) older than 65 years of age living in the U.S. This population has increased dramatically during the last two decades. Currently more than half of all surgeries are performed on this group of patients in the U.S. Frailty is typically defined by… Read More »

Pressure ulcers: risk factors and the power of policy

By | May 5, 2016

Medical Care has recently published two papers on the topic of pressure ulcers — costly, painful, largely preventable infections associated with poorer quality care. In the first, from researchers at the University of Manitoba, York University, and the University of British Columbia, lead author Malcolm Doupe, PhD and colleagues focus on the risk of developing stage… Read More »

The Impact of Gasoline Costs on the Healthcare Industry

By | April 28, 2016

The higher the cost of gasoline, the higher the healthcare costs for the treatment of injuries caused by motorcycle crashes. In an article published ahead of print in Medical Care this week, He Zhu and colleagues discuss the association between gas prices in the United States, hospital costs, and utilization for both motorcycle and non-motorcycle related injuries. Remember… Read More »

Death is not always an adverse event

By | April 21, 2016

Quality in healthcare can be a slippery concept. But in general, our medical system treats mortality as the ultimate adverse event. Higher mortality is thought to indicate poorer quality care. But what if death were the appropriate and preferred outcome for an individual? Consider the hypothetical case of an 87-year-old man named Philip. Philip has a living… Read More »

Racial Disparities in Ambulatory Care Sensitive Admissions

By | February 11, 2016

Using 2003-2009 Agency for Healthcare Research and Quality (AHRQ) hospital discharge data from 6 geographically and demographically diverse states, Mukamel and colleagues found that African Americans continue to experience poorer quality primary care, especially for chronic conditions.