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This Week in JAMA

This Week in JAMA Race, Site of Care, and Hospital Readmission Rates Reducing hospital readmissions represents an opportunity to improve quality and decrease costs. In an analysis of 2006-2008 national Medicare data for patients hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia, Joynt and colleagues Article examined whether racial disparity exists in hospital readmissions and, if so, whether the disparity is related to where black patients receive care. The authors found that compared with white patients, black patients had higher 30-day readmission rates that were related, in part, to worse outcomes among hospitals that disproportionately care for black patients. In an editorial, Hernandez and Curtis Article discuss the need for equitable and evidence-based strategies to reduce hospital readmissions and racial disparities in health care. Recurrent Readmissions to Children's Hospitals Children with complex chronic health conditions may experience recurrent readmissions to a hospital. In a retrospective analysis of hospitalization data from 317 643 patients who were admitted to 37 tertiary care pediatric hospitals in 2003 and followed up through 2008, Berry and colleagues found that 2.9% of patients experienced 4 or more readmissions—often for the same organ-system problem—within a 365-day period. These patients accounted for 18.8% of all admissions and 23.2% of total inpatient charges during the follow-up period. Factors associated with recurrent readmissions included the presence of a complex chronic condition and the use of assistive medical technology. Article Serum Bilirubin, Respiratory Disease, and Mortality Some data suggest that bilirubin has cytoprotective properties, including evidence from animal models that elevated bilirubin levels protect against respiratory injury from environmental stressors. Horsfall and colleagues examined the relationship between normal range serum bilirubin levels and the risk of respiratory disease and all-cause mortality in a longitudinal analysis of data from 504 206 adults. The authors report that moderately higher—but within normal range—bilirubin levels were associated with a reduced risk of lung cancer, chronic obstructive pulmonary disease, and all-cause mortality. Article CLINICIAN'S CORNER Financial Capacity and Cognitive Impairment Care of the Aging Patient Mr L is a 76-year-old man who has a 2-year history of Alzheimer-type dementia. He lives alone, has a paid daytime caregiver, and is dependent for most instrumental activities of daily living but still signs checks. He has a durable power of attorney for health care but not for financial matters. His daughter is concerned about Mr L's increasing irritability with respect to money and some questionable bank transactions. Widera and colleagues Article discuss the role of the primary clinician when financial incapacity affects older patients with cognitive impairment. Readers may submit comments for online posting at www.jama.com. A commentary by Sabatino Article discusses steps that can be taken in policy and practice to respond to financial capacity issues. A Piece of My Mind “[W]hen Andrea was moved upstairs, tucked into bed in a new room that was full of light and space and the easier kindness of a staff not overwhelmed by their census, ‘She was so comfortable that she cried.’” From “The Pavilion.” Article Medical News & Perspectives Studies identifying the important role that oxytocin plays in social interactions have led scientists to investigate whether the hormone might aid in disorders such as autism or schizophrenia. Article Commentaries Sudden acceleration of diabetes quality measures Article Me-too drugs: how many is too many? Article RCT innovation and leadership Article Comparative Effectiveness Research Call for Papers Authors are invited to submit manuscripts for an upcoming JAMA theme issue. Article Readers Respond How would you manage a 27-year-old woman who is in her second trimester of pregnancy, is addicted to heroin, and receives a 1-year jail sentence? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is February 27. JAMA Patient Page For your patients: Information about deep brain stimulation. Article http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

This Week in JAMA

JAMA , Volume 305 (7) – Feb 16, 2011

This Week in JAMA

Abstract

Race, Site of Care, and Hospital Readmission Rates Reducing hospital readmissions represents an opportunity to improve quality and decrease costs. In an analysis of 2006-2008 national Medicare data for patients hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia, Joynt and colleagues Article examined whether racial disparity exists in hospital readmissions and, if so, whether the disparity is related to where black patients receive care. The authors found that...
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2011.144
Publisher site
See Article on Publisher Site

Abstract

Race, Site of Care, and Hospital Readmission Rates Reducing hospital readmissions represents an opportunity to improve quality and decrease costs. In an analysis of 2006-2008 national Medicare data for patients hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia, Joynt and colleagues Article examined whether racial disparity exists in hospital readmissions and, if so, whether the disparity is related to where black patients receive care. The authors found that compared with white patients, black patients had higher 30-day readmission rates that were related, in part, to worse outcomes among hospitals that disproportionately care for black patients. In an editorial, Hernandez and Curtis Article discuss the need for equitable and evidence-based strategies to reduce hospital readmissions and racial disparities in health care. Recurrent Readmissions to Children's Hospitals Children with complex chronic health conditions may experience recurrent readmissions to a hospital. In a retrospective analysis of hospitalization data from 317 643 patients who were admitted to 37 tertiary care pediatric hospitals in 2003 and followed up through 2008, Berry and colleagues found that 2.9% of patients experienced 4 or more readmissions—often for the same organ-system problem—within a 365-day period. These patients accounted for 18.8% of all admissions and 23.2% of total inpatient charges during the follow-up period. Factors associated with recurrent readmissions included the presence of a complex chronic condition and the use of assistive medical technology. Article Serum Bilirubin, Respiratory Disease, and Mortality Some data suggest that bilirubin has cytoprotective properties, including evidence from animal models that elevated bilirubin levels protect against respiratory injury from environmental stressors. Horsfall and colleagues examined the relationship between normal range serum bilirubin levels and the risk of respiratory disease and all-cause mortality in a longitudinal analysis of data from 504 206 adults. The authors report that moderately higher—but within normal range—bilirubin levels were associated with a reduced risk of lung cancer, chronic obstructive pulmonary disease, and all-cause mortality. Article CLINICIAN'S CORNER Financial Capacity and Cognitive Impairment Care of the Aging Patient Mr L is a 76-year-old man who has a 2-year history of Alzheimer-type dementia. He lives alone, has a paid daytime caregiver, and is dependent for most instrumental activities of daily living but still signs checks. He has a durable power of attorney for health care but not for financial matters. His daughter is concerned about Mr L's increasing irritability with respect to money and some questionable bank transactions. Widera and colleagues Article discuss the role of the primary clinician when financial incapacity affects older patients with cognitive impairment. Readers may submit comments for online posting at www.jama.com. A commentary by Sabatino Article discusses steps that can be taken in policy and practice to respond to financial capacity issues. A Piece of My Mind “[W]hen Andrea was moved upstairs, tucked into bed in a new room that was full of light and space and the easier kindness of a staff not overwhelmed by their census, ‘She was so comfortable that she cried.’” From “The Pavilion.” Article Medical News & Perspectives Studies identifying the important role that oxytocin plays in social interactions have led scientists to investigate whether the hormone might aid in disorders such as autism or schizophrenia. Article Commentaries Sudden acceleration of diabetes quality measures Article Me-too drugs: how many is too many? Article RCT innovation and leadership Article Comparative Effectiveness Research Call for Papers Authors are invited to submit manuscripts for an upcoming JAMA theme issue. Article Readers Respond How would you manage a 27-year-old woman who is in her second trimester of pregnancy, is addicted to heroin, and receives a 1-year jail sentence? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is February 27. JAMA Patient Page For your patients: Information about deep brain stimulation. Article

Journal

JAMAAmerican Medical Association

Published: Feb 16, 2011

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