Reconsidering Hospital Readmission Measures.

Abstract:

:Current hospital readmission measures are part of the Centers for Medicare & Medicaid Services Five-Star Quality Rating System but are inadequate for reporting hospital quality. We review potential biases in the readmission measures and offer policy recommendations to address these biases. Hospital readmission rates are influenced by multiple sources of variation (eg, mix of patients served, bias in the performance measure); true differences in quality of care are often a much smaller source of this variation. Thus, variation from caring for large proportions of socioeconomically disadvantaged or tertiary-care patients will bias a hospital's ratings. Ratings aside, readmission measures may indirectly harm patients because low readmission rates do not correlate with reduced mortality, yet the Five-Star Quality Rating System weighs readmission equally with mortality. We propose that hospital quality rankings not use readmission measures as currently constructed.

journal_name

J Hosp Med

authors

Pronovost PJ,Brotman DJ,Hoyer EH,Deutschendorf A

doi

10.12788/jhm.2799

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

1009-1011

issue

12

eissn

1553-5592

issn

1553-5606

journal_volume

12

pub_type

杂志文章
  • Reliability of a point-based VTE risk assessment tool in the hands of medical residents.

    abstract:BACKGROUND:Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with ass...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.860

    authors: Beck MJ,Haidet P,Todoric K,Lehman E,Sciamanna C

    更新日期:2011-04-01 00:00:00

  • Development of a pediatric hospitalist sedation service: training and implementation.

    abstract:OBJECTIVE:There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There i...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.979

    authors: Turmelle M,Moscoso LM,Hamlin KP,Daud YN,Carlson DW

    更新日期:2012-04-01 00:00:00

  • Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay.

    abstract:BACKGROUND:Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE:To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay. DESIGN:Retrospective obser...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2592

    authors: Smith GR Jr,Ma M,Hansen LO,Christensen N,O'Leary KJ

    更新日期:2016-10-01 00:00:00

  • Monitoring the pulse of hospital activity: electronic health record utilization as a measure of care intensity.

    abstract:BACKGROUND:Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR). METHO...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2068

    authors: Blecker S,Austrian JS,Shine D,Braithwaite RS,Radford MJ,Gourevitch MN

    更新日期:2013-09-01 00:00:00

  • How complete is the evidence for thromboembolism prophylaxis in general medicine patients? A meta-analysis of randomized controlled trials.

    abstract:OBJECTIVES:Guidelines recommend pharmacologic prophylaxis for hospitalized medical patients at increased risk of thromboembolism. Despite recommendations, multiple studies demonstrate underutilization. Factors contributing to underutilization include uncertainty that prophylaxis reduces clinically relevant events, as w...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,meta分析

    doi:10.1002/jhm.450

    authors: Bump GM,Dandu M,Kaufman SR,Shojania KG,Flanders SA

    更新日期:2009-05-01 00:00:00

  • ACUTE center for eating disorders.

    abstract:BACKGROUND:While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs. METHODS:We developed the ACUTE Center at D...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.1906

    authors: Chu ES,Gaudiani JL,Mascolo M,Statland B,Sabel A,Carroll K,Mehler PS

    更新日期:2012-04-01 00:00:00

  • Teaching Physical Examination to Medical Students on Inpatient Medicine Teams: A Prospective, Mixed-Methods Descriptive Study.

    abstract::Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during th...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.2972

    authors: Bergl PA,Taylor AC,Klumb J,Quirk K,Muntz MD,Fletcher KE

    更新日期:2018-06-01 00:00:00

  • Non-housestaff medicine services in academic centers: models and challenges.

    abstract::Non-housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapi...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.311

    authors: Sehgal NL,Shah HM,Parekh VI,Roy CL,Williams MV

    更新日期:2008-05-01 00:00:00

  • Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations.

    abstract:BACKGROUND AND OBJECTIVE:Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation rec...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3275

    authors: Hoefgen ER,Jones Y,Courter J,Hare A,Garcia JAT,Simmons J

    更新日期:2020-01-01 00:00:00

  • Use of dexmedetomidine for sedation of children hospitalized in the intensive care unit.

    abstract:BACKGROUND:Dexmedetomidine is a potentially useful sedative for hospitalized children, but there is little published data regarding its safety, dosage, or efficacy. OBJECTIVE:To report our experience with dexmedetomidine for the sedation of hospitalized children. DESIGN:Retrospective case series. SETTING:Pediatric I...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.282

    authors: Carroll CL,Krieger D,Campbell M,Fisher DG,Comeau LL,Zucker AR

    更新日期:2008-03-01 00:00:00

  • Impact of Preoperative Specialty Consults on Hospitalist Comanagement of Hip Fracture Patients.

    abstract:BACKGROUND:Hip fractures typically occur in frail elderly patients. Preoperative specialty consults, in addition to hospitalist comanagement, are often requested for preoperative risk assessment. OBJECTIVE:Determine if preoperative specialty consults meaningfully influence management and outcomes in hip fracture patie...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3264

    authors: Bellas N,Stohler S,Staff I,Majk K,Lewis C,Davis S,Kumar M

    更新日期:2020-01-01 00:00:00

  • Hospitals during recession and recovery: vulnerable institutions and quality at risk.

    abstract::For generations, American hospitals have been considered recession-proof, but there is reason to believe the current economic crisis is an exception. Hospitals have shown declining financial margins and decreased admissions. The severe recession has adversely affected many hospitals' finances, creating a risk of closu...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,评审

    doi:10.1002/jhm.654

    authors: Sussman JB,Halasyamani LK,Davis MM

    更新日期:2010-05-01 00:00:00

  • Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum.

    abstract:BACKGROUND:Little is known about management of hyperglycemia in inpatients. OBJECTIVE:To gain insight into caring for hospitalized patients with hyperglycemia. DESIGN:Retrospective analysis. SETTING:Teaching hospital. PATIENTS:Data on all patients discharged between January 1, 2001, and December 31, 2004 with a dia...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.188

    authors: Cook CB,Castro JC,Schmidt RE,Gauthier SM,Whitaker MD,Roust LR,Argueta R,Hull BP,Zimmerman RS

    更新日期:2007-07-01 00:00:00

  • Body mass index (BMI) and risk of noncardiac postoperative medical complications in elderly hip fracture patients: a population-based study.

    abstract:BACKGROUND:Obese patients are thought to be at higher risk of postoperative medical complications. We determined whether body mass index (BMI) is associated with postoperative in-hospital noncardiac complications following urgent hip fracture repair. METHODS:We conducted a population-based study of Olmsted County, Min...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.527

    authors: Batsis JA,Huddleston JM,Melton LJ 3rd,Huddleston PM,Larson DR,Gullerud RE,McMahon MM

    更新日期:2009-10-01 00:00:00

  • Use of UpToDate and outcomes in US hospitals.

    abstract:BACKGROUND:Computerized clinical knowledge mana-gement systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known. OBJECTIVE:To examine the impact of UpToDate on outcomes of care. DESIGN:Retrospective study. SETTING:National sample of US inpatie...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.944

    authors: Isaac T,Zheng J,Jha A

    更新日期:2012-02-01 00:00:00

  • The characteristics of patients frequently admitted to academic medical centers in the United States.

    abstract:BACKGROUND:The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishin...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2375

    authors: Szekendi MK,Williams MV,Carrier D,Hensley L,Thomas S,Cerese J

    更新日期:2015-09-01 00:00:00

  • Bridging the gap between evidence and practice in acute decompensated heart failure management.

    abstract::Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,评审

    doi:10.1002/jhm.395

    authors: Michota FA Jr,Amin A

    更新日期:2008-11-01 00:00:00

  • Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice.

    abstract:BACKGROUND:Few studies have examined alternative structures for inpatient clerkships. OBJECTIVE:Compare 2 inpatient clerkship structures using multiple outcome variables. DESIGN:Prospective, randomized controlled trial. SETTING:Tertiary-care, freestanding children's hospital. SUBJECTS:All medical students enrolled ...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/jhm.250

    authors: Antommaria AH,Firth SD,Maloney CG

    更新日期:2007-11-01 00:00:00

  • Pediatric hospitalist preoperative evaluation of children with neuromuscular scoliosis.

    abstract:WHAT'S NEW:This is the first study of a pediatric hospitalist preoperative clinic. Pediatric hospitalists frequently make significant recommendations for patients with neuromuscular scoliosis prior to spinal surgery, especially those with medical complexity. Certain clinical criteria are statistically significantly ass...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2101

    authors: Rappaport DI,Cerra S,Hossain J,Sharif I,Pressel DM

    更新日期:2013-12-01 00:00:00

  • Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.

    abstract:BACKGROUND:Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE:To understand impact of radiologic incidental findings on resource utilization in patients hospitaliz...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.2722

    authors: Gundareddy VP,Maruthur NM,Chibungu A,Bollampally P,Landis R,Eid SM

    更新日期:2017-05-01 00:00:00

  • Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.

    abstract:BACKGROUND:Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs. OBJECTIVE:To sequentially examine...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2303

    authors: Michtalik HJ,Carolan HT,Haut ER,Lau BD,Streiff MB,Finkelstein J,Pronovost PJ,Durkin N,Brotman DJ

    更新日期:2015-03-01 00:00:00

  • Pediatric hospitalists: training, current practice, and career goals.

    abstract:OBJECTIVE:To determine the range and frequency of experiences, clinical and nonclinical roles, training, work expectations, and career plans of practicing pediatric hospitalists. DESIGN:Mail survey study of a national sample of 530 pediatric hospitalists of whom 67% (N = 338) were from teaching hospitals, 71% (N = 374...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.458

    authors: Freed GL,Dunham KM,Research Advisory Committee of the American Board of Pediatrics.

    更新日期:2009-03-01 00:00:00

  • Hospitalized Medical Patients With Posttraumatic Stress Disorder (PTSD): Review of the Literature and a Roadmap for Improved Care.

    abstract::Posttraumatic stress disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10% and 30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symp...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,评审

    doi:10.12788/jhm.3409

    authors: Fletcher KE,Steinbach S,Lewis F,Hendricks M,Kwan B

    更新日期:2021-01-01 00:00:00

  • Medical management of patients on clozapine: A guide for internists.

    abstract::Clozapine was approved by the US Food and Drug Administration in 1989 for the management of treatment-resistant schizophrenia, and has since proven to reduce symptom burden and suicide risk, increase quality of life, and reduce substance use in individuals with psychotic disorders. Nevertheless, clozapine's psychiatri...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章,评审

    doi:10.1002/jhm.2345

    authors: Lundblad W,Azzam PN,Gopalan P,Ross CA

    更新日期:2015-08-01 00:00:00

  • No hospital left behind? Education policy lessons for value-based payment in healthcare.

    abstract::Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven a...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.2483

    authors: Maurer KA,Ryan AM

    更新日期:2016-01-01 00:00:00

  • Patient Safety Indicator-12 Rarely Identifies Problems with Quality of Care in Perioperative Venous Thromboembolism.

    abstract:BACKGROUND:Patient safety indicators (PSI) were developed for hospitals to screen for healthcare-associated adverse events. PSIs are believed to be preventable and have become a part of major pay-for-performance programs. PSI-12 captures perioperative venous thromboembolism (VTE), which contributes to morbidity and mor...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3298

    authors: Held N,Jung B,Sommervold L,Singh S,Kreuziger LB

    更新日期:2019-11-20 00:00:00

  • Nephrotoxin-Related Acute Kidney Injury and Predicting High-Risk Medication Combinations in the Hospitalized Child.

    abstract:BACKGROUND:In the hospitalized patient, nephrotoxin exposure is one potentially modifiable risk factor for acute kidney injury (AKI). Clinical decision support based on nephrotoxin ordering was developed at our hospital to assist inpatient providers with the prevention or mitigation of nephrotoxin-related AKI. The init...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3196

    authors: Yonekawa KE,Zhou C,Haaland WL,Wright DR

    更新日期:2019-08-01 00:00:00

  • Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis.

    abstract:OBJECTIVES:This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. METHODS:This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphad...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3333

    authors: Desai S,Shah SS,Hall M,Richardson TE,Thomson JE,Pediatric Research in Inpatient Settings (PRIS) Network.

    更新日期:2020-04-01 00:00:00

  • Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system.

    abstract:BACKGROUND:Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. DESIGN, SETTING, PATIENTS:Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED. METHODS:Evaluation of...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.1002/jhm.1979

    authors: Delgado MK,Liu V,Pines JM,Kipnis P,Gardner MN,Escobar GJ

    更新日期:2013-01-01 00:00:00

  • Hospital Medicine Has a Specialty Code. Is the Memo Still in the Mail?

    abstract::The Centers for Medicare and Medicaid Services awarded Hospital Medicine a Medicare specialty code, "C6", in 2016. We examined the early uptake of C6 code using the 2017 Medicare Part B utilization data. We also compared the actual C6 specialty code usage against estimated rates of overall hospitalist billing using th...

    journal_title:Journal of hospital medicine

    pub_type: 杂志文章

    doi:10.12788/jhm.3303

    authors: Flansbaum B,Leykum L,Lapps J

    更新日期:2020-02-01 00:00:00