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This Week in JAMA
January 23/30, 2013

This Week in JAMA

JAMA. 2013;309(4):309. doi:10.1001/jama.2012.145183

In an analysis of Medicare claims for patients who had been hospitalized for heart failure (approximately 1.3 million admissions), acute myocardial infarction (approximately 550 000 admissions), or pneumonia (approximately 1.2 million admissions), Dharmarajan and colleagues assessed common diagnoses at readmission and timing of readmission. The authors report that in the 30 days after hospital discharge, 24.8% of patients with heart failure, 19.9% of patients with myocardial infarction, and 18.3% of patients with pneumonia were readmitted. Readmission diagnoses were diverse and usually differed from the cause of the index hospitalization. Neither readmission diagnosis nor timing varied by patient characteristics.

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Emergency department (ED) use among patients recently discharged from the hospital may reflect the quality of care transitions and the extent of patients' hospital-based, acute care needs after hospitalization. To assess patterns of ED use in the 30 days after hospital discharge, Vashi and colleagues analyzed 2008-2009 Healthcare Cost and Utilization Project data from more than 4 million patients, aged 18 years or older (mean age 53.4 years), discharged from acute care hospitals in 3 states. The authors found that ED visits within 30-days of hospital discharge were common, and that ED treat-and-release visits accounted for nearly 40% of postdischarge hospital-based acute-care use.

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Berry and colleagues analyzed data from 568 845 admissions to 72 children's hospitals in 2009-2010 and found that the rate of unplanned readmissions at 30 days was 6.5%, and that readmission rates varied significantly across diagnoses and hospitals. In an editorial, Srivastava and Keren discuss patient, family, and quality of care factors that may influence pediatric readmission rates.

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In a study that involved health care and social service personnel in 14 communities, Brock and colleagues assessed whether implementation of quality improvement organization—facilitated interventions to improve patient care transitions would be associated with reduced 30-day rehospitalization rates of Medicare beneficiaries. Rehospitalization rates were assessed in the 14 intervention communities before (2006-2008) and during (2009-2010) program implementation and, to monitor secular trends, compared with rehospitalization rates in 50 communities similar in population, poverty proportion, and hospital care intensity (controls). The authors report that compared with control communities, the intervention communities had lower all-cause 30-day rehospitalization rates and all-cause hospitalization rates per 1000 Medicare beneficiaries. However, there was no significant difference in the rate of all-cause 30-day rehospitalizations as a proportion of hospital discharges.

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A 47-year-old man has a 1-year history of round, hypopigmented, and finely scaled patches on his trunk and extremities. Potassium hydroxide examination of skin scrapings from the lesions is negative. What would you do next?

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Academic medical centers are urged to have an experienced radiologist available for emergency department coverage at all times, rather than relying on a radiology resident during off-hours.

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Thirty-day readmissions as a quality metric

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Improving pay-for-performance programs

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Quality measurement, public reporting, and pay for performance

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Viewing readmission in a community context

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“I felt that my chance to say good-bye was stolen, simply because not one physician had ever had the courage to voice the truth.” From “Hating Hope.”

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Reducing readmissions: a patient-centered approach

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Revisiting hospital readmissions

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Dr Bauchner summarizes and comments on this week's issue. Go to www.jama.com.

Join Daniel S. Chertow, MD, MPH, February 20, 2013, from 2 to 3 PM eastern time to discuss bacterial coinfection in influenza. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about discharge planning.

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