Urgent Care Centers: Lower-Cost Than Emergency Departments, but They Increase Spending
The rapid expansion of Urgent Care Centers (UCC) over the past decade has raised the tantalizing possibility that UCCs could be a cost-effective alternative for visits that do not need the full capabilities of an emergency department (ED). On the surface, this seems to make sense. In our new study in Health Affairs, the average UCC visit cost only $171 compared to the staggering $1,646 for an ED visit.
Hospital Revenue Loss from Delayed Elective Surgeries
Hospitals lost more than $20 billion in revenue when the pandemic led to an unprecedented nationwide shutdown in elective surgical procedures from March to May 2020. In a new Annals of Surgery study, we quantified this impact and analyzed the potential implications of a widespread interruption in elective surgeries for patients, health disparities, and the financial health of hospitals.
Delayed Emergencies in COVID
COVID-19 changed every aspect of our lives, from shopping for groceries to visiting doctors. Early public health messages encouraged people who thought they could put off emergency care to avoid the emergency department (ED), to save capacity for an anticipated surge of COVID cases.
Prioritization of Pediatric Palliative Care Field-Advancement Activities in the United States: Results of a National Survey
Chris Feudtner, Jennifer A. Faerber, Abby R. Rosenberg, Kathie Kobler, Justin N. Baker, Brynn A. Bowman, Joanne Wolfe, Sarah Friebert
Abstract [from journal]
Background: The field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified eleven potential "next step" actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their "actionable importance."
Methods: Invitations to the survey were distributed in October 2019 to interdisciplinary
...Reducing Rehospitalizations Among Post-Acute Care Patients
After hospital discharge, about 40% of Medicare beneficiaries receive post-acute care (PAC) services, such as home health care (HHC), skilled nursing, or inpatient rehabilitation. But do they get the right care at the right time?
A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED
Carmelle Wallace, Yvette Schein, Gina Carabelli, Heta Patel, Needhi Mehta, Nadia Dowshen, Nancy Kassam-Adams, Kenneth Ginsburg and Cynthia Mollen
Abstract [from journal]
Objectives: Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients.
Methods: We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the
...Variation in U.S. Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic
David A. Asch, Natalie E. Sheils, Md Nazmul Islam, Yong Chen, Rachel M. Werner, John Buresh, Jalpa A. Doshi
Abstract [from journal]
Importance: It is unknown how much the mortality of patients with coronavirus disease 2019 (COVID-19) depends on the hospital that cares for them, and whether COVID-19 hospital mortality rates are improving.
Objective: To identify variation in COVID-19 mortality rates and how those rates have changed over the first months of the pandemic.
Design, setting, and participants: This cohort study assessed 38 517 adults who were admitted with COVID-19 to 955 US hospitals from
...Hospital Outcomes for Children With Severe Sepsis in the USA by Race or Ethnicity and Insurance Status: A Population-Based, Retrospective Cohort Study
Hannah K. Mitchell, Anireddy Reddy, Diana Montoya-Williams, Michael Harhay, Jessica C. Fowler, Nadir Yehya
Abstract [from journal]
Background: Disparities in outcomes of adult sepsis are well described by insurance status and race and ethnicity. There is a paucity of data looking at disparities in sepsis outcomes in children. We aimed to determine whether hospital outcomes in childhood severe sepsis were influenced by race or ethnicity and insurance status, a proxy for socioeconomic position.
Methods: This population-based, retrospective cohort study used data from the 2016 database release from the Healthcare Cost and
...Hospitalizations Among Adults With Chronic Kidney Disease in the United States: A Cohort Study
Sarah J. Schrauben, Hsiang-Yu Chen, Eugene Lin, Christopher Jepson, Wei Yang, Julia J. Scialla, Michael J. Fischer, James P. Lash, Jeffrey C. Fink, L. Lee Hamm, Radhika Kanthety, Mahboob Rahman, Harold I. Feldman, Amanda H. Anderson, CRIC Study Investigators
Abstract [from journal]
Background: Adults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known.
Methods and findings: Data from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization
Evaluation of Hospital Nurse-to-Patient Staffing Ratios and Sepsis Bundles on Patient Outcomes
Karen B. Lasater, Douglas M. Sloane, Matthew D. McHugh, Jeannie P. Cimiotti, Kathryn A. Riman, Brendan Martin, Maryann Alexander, Linda H. Aiken
Abstract [from journal]
Background: Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis.
Methods: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/...
Toward More Optimal Birth Outcomes
Women want to have a good birth, in which both they and the baby are healthy and happy at the end. For most women, the optimal birth outcome is a spontaneous vaginal birth (SVB), one without forceps or a vacuum. Some women may be surprised to learn that the hospital where they give birth has a significant effect on the kind of birth they will have.
Trends in Surgical Volume and In-Hospital Mortality Among United States Cirrhosis Hospitalizations
Kristen M. Tessiatore, Nadim Mahmud
Abstract [from journal]
Background: In the aging population of patients with cirrhosis in the United States, there is a potentially increased need for surgical procedures. However, individuals with cirrhosis have increased perioperative risk relative to patients without cirrhosis. We sought to quantify temporal trends in cirrhosis surgical procedures and in-hospital mortality in relation to surgical procedure type, elective admission status and compensated vs. decompensated status.
Methods: We performed a
...Spontaneous Vaginal Birth Varies Significantly Across U.S. Hospitals
Rebecca R. S. Clark and Eileen Lake
Abstract [from journal]
Background: Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital‐level variation in SVB overall and among low‐risk women in a four‐state sample representing 25% of births in the United States in 2016.
Hospital Safety-Net Status and Performance on Publicly Reported Episode Spending Measures
Amol S. Navathe, Lingmei Zhou, Joshua M. Liao
Abstract [from journal]
Objectives: As part of its strategy to improve health care value and contain hospital costs, Medicare trialed public reporting for episode-based spending via 6 novel Clinical Episode-Based Payment (CEBP) measures for cellulitis, kidney/urinary tract infection, gastrointestinal hemorrhage, spinal fusion, cholecystectomy, and aortic aneurysm. Because safety-net hospitals may fare more poorly than other hospitals under value-based reforms, we evaluated the relationship between safety-net status and