Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?

2014 ◽  
Vol 17 (2) ◽  
pp. 131-151 ◽  
Author(s):  
Darius N. Lakdawalla ◽  
Julia Thornton Snider ◽  
Daniella J. Perlroth ◽  
Chris LaVallee ◽  
Mark T. Linthicum ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Affordable Care Act ◽  
Nutritional Supplement ◽  
Research Database ◽  
Readmission Rates ◽  
Medicare Patient ◽  
Improved Outcomes ◽  
Oral Nutritional Supplements ◽  
Medicare Patients ◽  
Episode Cost

Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.

scholarly journals Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act

2018 ◽  
Vol 131 (11) ◽  
pp. 1324-1331.e14 ◽  
Author(s):  
Suveen Angraal ◽  
Rohan Khera ◽  
Shengfan Zhou ◽  
Yongfei Wang ◽  
Zhenqiu Lin ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Readmission Rates ◽  
Medicare Patients ◽  
The Affordable Care Act

scholarly journals Hospital readmission rates in Medicare

2014 ◽  
Vol 3 (4) ◽  
pp. 109 ◽  
Author(s):  
Erkan Erdem ◽  
Betty Tao Fout ◽  
Holly Korda ◽  
Abisola O. Abolude
Keyword(s):  
Affordable Care Act ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
Medicare Patient ◽  
Hospital Readmission Rates ◽  
Dual Eligible ◽  
Type Size ◽  
Occupancy Rates ◽  
Patient Mix

Hospital readmissions are the focus of many recent efforts to improve quality and reduce spending under the Affordable Care Act (ACA). We examined variations in Medicare readmission rates by hospital characteristics (e.g., type, size, utilization) and Medicare patient mix (i.e., share of dual eligible beneficiaries, share of patients under 65 years of age, health status). Using 2010 data from 3,543 short-stay Medicare-certified hospitals, readmission rates were higher for hospitals that served a greater share of patients who were dual-eligible and less healthy; and larger hospitals and hospitals with higher occupancy rates even after controlling for patient mix.

scholarly journals Fluorescence-Guided Surgery in the Surgical Treatment of Gliomas: Past, Present and Future

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3508
Author(s):  
Rosa Sun ◽  
Hadleigh Cuthbert ◽  
Colin Watts
Keyword(s):  
Surgical Treatment ◽  
Surgical Resection ◽  
Patient Outcomes ◽  
Aminolevulinic Acid ◽  
Guided Surgery ◽  
Improved Outcomes ◽  
Fluorescence Guided Surgery ◽  
Central Nervous Systems ◽  
Extent Of Surgical Resection ◽  
Disease Free

Gliomas are central nervous systems tumours which are diffusely infiltrative and difficult to treat. The extent of surgical resection is correlated with improved outcomes, including survival and disease-free progression. Cancerous tissue can be directly visualised intra-operatively under fluorescence by administration of 5-aminolevulinic acid to the patient. The adoption of this technique has allowed surgeons worldwide to achieve greater extents of resection, with implications for improved prognosis. However, there are practical limitations to use of 5-aminolevulinic acid. New adjuncts in the field of fluorescence-guided surgery aim to improve recognition of the interface between tumour and brain with the objective of improving resection and patient outcomes.

scholarly journals Impact of high energy oral nutritional supplements consumed in the late afternoon on appetite, energy intake and cardio-metabolic risk factors in females with lower BMI

2021 ◽  
Author(s):  
Sadia Fatima ◽  
Konstantinos Gerasimidis ◽  
Charlotte Wright ◽  
Dalia Malkova
Keyword(s):  
Insulin Sensitivity ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Nutritional Supplement ◽  
High Energy ◽  
Fasting Insulin ◽  
Daily Energy Intake ◽  
Late Afternoon ◽  
Oral Nutritional Supplements ◽  
Daily Energy

Abstract Background/Objective Morning consumption of a single dose of high-energy oral nutritional supplement (ONS) in females with a lower BMI displaces some of the food eaten at breakfast but increases overall daily energy intake. This study investigated the effectiveness of ONS intake in the late afternoon and for longer duration. Subjects/Methods Twenty-one healthy females (mean ± SD, age 25 ± 5 years; BMI 18.7 ± 1.2 kg/m2) participated in a randomised, crossover study with two experimental trials. In the afternoon of days 1–5, participants consumed either ONS (2.510 MJ) or low-energy PLACEBO drink (0.377 MJ) and recorded food eaten at home. On day six, energy intake was measured during buffet meals, and energy expenditure, appetite measurements and blood samples were collected throughout the day. Result Over the 5-day period, in the ONS trial energy intake from evening meals was lower (ONS, 2.7 ± 0.25 MJ; Placebo, 3.6 ± 0.25 MJ, P = 0.01) but averaged total daily energy intake was higher (ONS, 9.2 ± 0.3 MJ; PLACEBO, 8.2 ± 0.4 MJ, P = 0.03). On day six, energy intake, appetite scores, plasma GLP-1 and PYY, and energy expenditure were not significantly different between the two trials but fasting insulin concentration and HOMAIR, were higher (P < 0.05) and insulin sensitivity score based on fasting insulin and TAG lower (P < 0.05) in ONS trial. Conclusion Late afternoon consumption of ONS for five consecutive days by females with a lower BMI has only a partial and short-lived energy intake suppression and thus increases daily energy intake but reduces insulin sensitivity.

Abstract 167: Correlation of 30-day Hospital Readmission Rates by Payer and Penalty Status

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Neel M Butala ◽  
Daniel B Kramer ◽  
Jordan B Strom ◽  
Kevin F Kennedy ◽  
Robert W Yeh
Keyword(s):  
Correlation Coefficients ◽  
Weighted Kappa ◽  
Hospital Performance ◽  
Teaching Hospitals ◽  
Kappa Statistics ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Medicare Patients ◽  
Group B

Background: Readmission rates for heart failure (HF), acute myocardial infarction (MI), and pneumonia (PNA) hospitalizations among Medicare beneficiaries are used to assess hospital quality and determine global reimbursement. However, whether these measures reflect readmission rates for other conditions or insurance groups is unknown. Methods: All hospitals with >30 index admissions for HF, MI or pneumonia in 2013 in the all-payer Nationwide Readmissions Database (NRD) were included. For each hospital, we estimated 30-day all-cause risk-standardized readmission rates (RSRRs) for 3 groups: (A) Medicare beneficiaries admitted with HF/MI/PNA, (B) Medicare beneficiaries admitted for other conditions, and (C) non-Medicare beneficiaries admitted for HF/MI/PNA. Pair-wise correlations of these measures were assessed using Spearman correlation coefficients. Hospitals were divided into quartiles based on their calculated RSRR for each group, and inter-rater agreement between groups was assessed using weighted kappa statistics. We then examined pair-wise Spearman correlations among subgroups based on hospital characteristics (size, ownership status, and teaching status). Results: Among 1,228 hospitals, wide variation in RSRRs was seen across conditions and insurance type. Groups A vs. B had moderate correlation and agreement (Spearman 0.631, quartile weighted kappa 0.440). However, A vs. C had only modest correlation and fair agreement (Spearman 0.399, quartile weighted kappa 0.243). Compared with their quartile rank for the publicly reported group A, 46% of hospitals were ranked in the same quartile for group B and 35% for group C (Figure). Correlations between groups A vs. B and A vs. C were strongest among metro teaching hospitals (Spearman 0.674 and 0.507, respectively). Conclusions: Risk-standardized readmission rates for HF/MI/PNA are generalizable measures of a hospital’s readmission rate for other conditions among Medicare-insured patients. However, publicly reported RSRRs for HF/MI/PNA among Medicare patients are less suitable measures of hospital performance for non-Medicare patients admitted for these conditions.

Abstract 12: Do “Drip and Ship” Cases Incur Higher Costs to Warrant CMS MS-DRG Reassignment?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
William K Mountford ◽  
Jeff Wagner ◽  
Michelle R Krukas ◽  
Darren Tayama ◽  
Frank R Ernst ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Costs ◽  
Primary Diagnosis ◽  
Research Database ◽  
Stroke Patients ◽  
Billing Data ◽  
Hospital Perspective ◽  
Remote Hospital ◽  
Medicare Patients ◽  
To Receive

Background: Telestroke networks enable acute stroke patients to receive r-tPA at a remote hospital (ie, spoke) emergency department and are subsequently transferred to another hospital (ie, hub) for additional care - commonly referred to as “drip and ship” (D&S). While hub hospitals do not administer r-tPA in D&S cases, they handle all subsequent care for these patients upon arrival. It is hypothesized that current CMS reimbursement rates do not reflect the higher cost to hospitals that receive D&S patients. Objective: Compare hospital costs and reimbursement rates for Medicare patients with AIS who received r-tPA, did not receive r-tPA, and were treated and sent to hub hospitals. Methods: The study included Medicare-covered patients hospitalized with a primary diagnosis of AIS (ICD-9 codes 433.x1, 434.x1, 436) admitted between 6/9/2007 and 12/30/2012 from 5 hub hospitals in the Premier research database with telestroke implementation ranging from 10/2009 - 12/2011. Treatment arms were defined as r-tPA (billing data), D&S (ICD-9 =V45.88), or none. Costs were reported from the hospital perspective and compared with CMS reimbursements based on MS-DRG assignment. Median costs were compared using the Wilcoxon ranked sum test. Results: 4122 patients were included in the study, with 84 (2%) receiving r-tPA treatment and 233 (6%) having D&S treatment. Total costs and reimbursement rates are summarized in Table 1. Conclusions: Results from the study demonstrate D&S cases were associated with higher costs than untreated cases, despite not administering r-tPA; however, they were reimbursed similarly. Future reassignment of MS-DRG to these cases may be warranted.

Family interventions in psychosis

2020 ◽  
pp. 531-537
Author(s):  
Juliana Onwumere ◽  
Elizabeth Kuipers
Keyword(s):  
Patient Outcomes ◽  
Family Involvement ◽  
Lived Experiences ◽  
Treatment Guidelines ◽  
Well Being ◽  
Evidence Base ◽  
Family Interventions ◽  
Improved Outcomes ◽  
The Impact

Families can play an important role in supporting individuals living with psychosis disorders and helping to facilitate their improved outcomes. This chapter, offered by Juliana Onwumere and Elizabeth Kuipers, provides an overview of the literature reporting on family involvement in the care of adults with lived experiences of psychosis, the impact of the caregiving role on carer well-being, and the predictive links between caregiving relationships and key patient outcomes including relapse. The chapter reports on the application of family interventions, the evidence base supporting its application and inclusion in treatment guidelines, and implementation issues.

scholarly journals Quality of the Evidence Supporting the Role of Oral Nutritional Supplements in the Management of Malnutrition: An Overview of Systematic Reviews and Meta-Analyses

2020 ◽  
Author(s):  
Christine Baldwin ◽  
Rosemary Smith ◽  
Michelle Gibbs ◽  
C Elizabeth Weekes ◽  
Peter W Emery
Keyword(s):  
At Risk ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Hospital Readmissions ◽  
Nutritional Supplement ◽  
Measurement Tool ◽  
High Quality ◽  
Oral Nutritional Supplements ◽  
Meta Analyses

ABSTRACT There is considerable heterogeneity across the findings of systematic reviews of oral nutritional supplement (ONS) interventions, presenting difficulties for healthcare decision-makers and patients alike. It is not known whether heterogeneity arises from differences in patient populations or relates to methodological rigor. This overview aimed to collate and compare findings from systematic reviews of ONSs compared with routine care in adult patients who were malnourished or at risk of malnutrition with any clinical condition and to examine their methodological quality. Three electronic databases were searched to July 2019, supplemented with hand-searching. Data on all outcomes were extracted and review methodological quality assessed using A MeaSurement Tool for Assessment of systematic Reviews (AMSTAR). Twenty-two reviews were included, 11 in groups from mixed clinical backgrounds and 11 in specific clinical conditions. Ninety-one meta-analyses were identified for 12 different outcomes but there was discordance between results. Significant benefits of ONSs were reported in 4 of 4 analyses of energy intake, 7 of 11 analyses of body weight, 7 of 22 analyses of mortality, 10 of 17 analyses of complications (total and infectious), 1 of 3 analyses of muscle strength, 4 of 9 analyses of body composition/nutritional status, 2 of 14 analyses of length of stay, and 2 of 5 analyses of hospital readmissions. Ten reviews were high quality (AMSTAR scores 8–11), 9 moderate (AMSTAR scores 3–8), and 3 poor (AMSTAR scores 0–3). Methodological deficiencies were limitations to searches, poor reporting of heterogeneity, and failure to incorporate quality of evidence into any recommendations. Discordance between reviews was not markedly reduced when only high-quality reviews were considered. Evidence for the effects of ONS in malnourished patients or those who are at risk of malnutrition is uncertain, and discordance in results can arise from differences in clinical background of patients or the etiological basis of malnutrition.

The Colectomy Improvement Project: Do Evidence-Based Guidelines Improve Institutional Colectomy Outcomes?

2016 ◽  
Vol 82 (9) ◽  
pp. 830-834 ◽  
Author(s):  
Danny Mammo ◽  
Claire Peeples ◽  
Marc Grodsky ◽  
Drew Honaker ◽  
Harry Wasvary
Keyword(s):  
Patient Outcomes ◽  
Educational Intervention ◽  
Best Practice ◽  
Improvement Project ◽  
Best Practice Guidelines ◽  
Improved Outcomes ◽  
Practice Parameters ◽  
Surgical Infections ◽  
Specific Practice ◽  
Evidence Based Guidelines

This study evaluates whether increased adherence to eight specific practice parameters leads to improved outcomes in patients undergoing elective colorectal resections. In addition, we analyzed whether physicians with better compliance achieved better patient outcomes. Compliance to practice parameters and subsequent outcomes were compared between two groups relative to an educational intervention promoting the eight best practice guidelines selected. A total of 485 patients were identified over a 4-year period and were separated into a pre- (n = 273) and post-education (n = 212) group. After the educational intervention, there was increased compliance in five of the eight practice parameters ( P < 0.05). When outcomes where examined, the readmission rate (2.4% vs 8.4%; P = 0.005) and the incidence of deep surgical infections (0% vs 1.8%; P = 0.01) were significantly decreased when comparing the posteducational group to that of the group before intervention. A lower rate of anastomotic leaks were identified in the posteducation group, but this did not reach significance (1.9% vs 5.1%; P = .09). When analyzed individually, the most compliant physicians achieved better patient outcomes than their peers. Education of the operative team improved adherence to practice parameters and this may have contributed to improving patient outcomes.

Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients

2018 ◽  
Vol 29 (6) ◽  
pp. 674-679 ◽  
Author(s):  
Scott M Eskildsen ◽  
Ganesh V Kamath ◽  
Daniel J Del Gaizo
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
National Database ◽  
Medicare Patient ◽  
Entire Study ◽  
Total Hip ◽  
Significant Difference ◽  
Medicare Patients

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

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