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In This Issue of Archives of Internal Medicine
July 25, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(14):1227. doi:10.1001/archinternmed.2011.316

The Care Transitions Intervention (CTI) patient activation model reduced 30-day hospital readmissions by roughly 30% in a randomized controlled trial in an integrated health system but requires testing to establish effectiveness in other systems and nonresearch settings. Rhode Island's Quality Improvement Organization (Quality Partners of Rhode Island) implemented the CTI as one component of a project funded by the Centers for Medicare & Medicaid to address readmissions among hospitalized Medicare fee-for-service patients. The implementation successfully reduced readmission among 257 patients who received coaching (odds ratio, 0.61; 95% confidence interval, 0.42-0.88).

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This study prospectively assessed the impact of an advanced practice nurse–led transitional care program to reduce readmission for patients with heart failure (HF) at Baylor Medical Center Garland, a community-based hospital, compared with other hospitals in the Baylor Health Care System. The intervention reduced 30-day readmission rates by 48% but had little impact on length of stay or total 60-day hospital direct costs. Under the current payment system, the intervention reduced the hospital financial contribution margin on average $227 for each patient with HF. The intervention has the potential to be effective for hospitals to reduce HF readmissions, but payment reform may be required to ensure that these programs are financially sustainable.

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Increasing prevalence of uropathogens resistant to antimicrobial agents has stimulated interest in cranberries to prevent recurrent urinary tract infections (rUTIs). In a randomized trial, Beerepoot et al compared prophylaxis with cranberries (500 mg twice daily) with trimethoprim-sulfamethoxazole (TMP-SMX, 480 mg once daily) in 221 premenopausal women with rUTIs. The between-group difference in the mean number of symptomatic UTIs over 12 months was 2.2 favoring TMP-SMX, at the expense of emerging antibiotic resistance among Escherichia coli from the commensal fecal flora, from urine of asymptomatic women, and among uropathogenic E coli.

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McEvoy et al performed a large prospective matched-cohort study evaluating the downstream impact of screening computed tomographic angiography (CCTA) on physician prescriptions and referrals, as well as patient medication use and cardiac events over 18 months. In this low-risk cohort, an abnormal CCTA finding was predictive of increased aspirin and statin use at both 90 days and 18 months in multivariable analysis, although medication use lessened over time. Imaging with CCTA was also associated with increased invasive testing, without any difference in events at 18 months. Thus, the potential benefits of increased preventive medication use in those with an abnormal CCTA result are tempered by the risks of further testing, which lack any evidence-based indication.

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Little is known about how to reduce the risk of cognitive impairment among those with vascular disease or conditions. Vercambre et al examined the relation between total recreational physical activity or walking and cognitive decline in 2809 women with prevalent vascular disease or 3 or more coronary risk factors. Over 5.4 years, the authors administered 4 repeated telephone cognitive interviews to assess global cognition, verbal memory, and category fluency. Regular physical activity, the equivalent of daily 30-minute walks at a brisk pace, was significantly associated with better preservation of cognitive function in older women with vascular disease or risk factors.

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