MedPAC ’s Proposed “Reforms” Should Be Tested Before They’re Implemented: CMS’s Hospital Readmissions Reduction Program Is Exhibit A | Part II
Conclusions reached by Gupta et al. and MedPAC In November of 2017 Ankur Gupta and 10 other experts in cardiovascular medicine published an article in JAMA Cardiology entitled, “Association of the Hospital Readmissions Reduction Program implementation with readmission and mortality outcomes in heart failure.” The authors were affiliated with well-known universities, and three of them were also editors of JAMA Cardiology . Their research was financed by grants from the NIH and Get With the Guidelines-Heart Failure (GWTG-HF), a “voluntary quality improvement program” sponsored by the American Heart Association. Gupta et al. examined data on 30-day CHF readmission and mortality rates for the years 2006 to 2014 . They divided this period into three segments – a pre-HRRP implementation phase (January 1, 2006 to March 31, 2010), the implementation phase (April 1, 2010 to September 30, 2012), and the HRRP penalty phase (October 1, 2012 to December 31, 2014). They found that 30-day readmissions fell during the penalty phase, while mortality rose slightly during the implementation phase and substantially during the penalty phase. The 30-day risk-adjusted mortality rate rose from 7.2 percent before HRRP implementation to 8.6 percent after. In an interview, co-author Gregg Fonarow stated, “If we were to extrapolate this to all Medicare beneficiaries hospitalized with heart failure, we are talking about maybe 10,000 patients a year...
Conclusion: Surgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.
Conclusion: Hyperuricemia and its accompanying dyslipidemia can be considered as the risk factor for acute ischemic stroke. PMID: 31325266 [PubMed - in process]
This study was conducted to find a correlation between thyroid profile and sepsis and associate it with the acute physiology and chronic health evaluation II (APACHE II) score. Background: :A cross-sectional study was conducted from January 2015 to December 2015 at the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. A total of 100 patients aged 18 years or more fulfilling the sepsis criteria were included in the study. Patients were subjected to clinical examination followed by systemic examination. The clinical severity as well as the prediction of outcome was assessed b...
Conclusions: In healthy Indians ≥50 years, ZOSTAVAX was well tolerated and resulted in expected VZV-specific antibody titer levels at 6 weeks post-vaccination. PMID: 31325263 [PubMed - in process]
Conclusion: Septic CVT prognosis had better than non septic CVT. Hence, CVT presents with wide range of presentations and anticoagulation is the treatment. Septic CVT if intervened timely with proper antibiotics have better prognosis. Antibiotics are the mainstay of therapy for septic CVT. PMID: 31325261 [PubMed - in process]
Conclusion: In patients of ischemic stroke platelet indices may be used for predicting severity of motor deficit. Although larger sample size and multivariate analysis is required before this can be used regularly in clinical practice. PMID: 31325260 [PubMed - in process]
Conclusion: Most common etiology of PRS is ANCA positive vasculitis in India. With high degree of suspicion for DAH in patients presenting with haemoptysis, breathlessness and alveolar opacities in chest x-ray and carefully investigating by simple urine examination for evidence of GN, timely diagnosis of PRS can be made. With timely appropriate treatment survival is 68%. Patients with PRS due to leptospirosis or dengue have features suggestive of underlying disease (like icterus with raised bilirubin but
Authors: Patil P, Darshan A, Ao S, Kothiwale VA Abstract Objective: To study the association of MPV (mean platelet volume) and acute ischemic stroke in patients of type 2 diabetes mellitus (DM). Material: This was a 1-year cross-sectional hospital-based study involving 79 patients presented with acute ischemic stroke. Among them, 25 were diabetic and 54 were nondiabetic. Demographic data and history of the patients were recorded. Investigations such as haemoglobin estimation, platelet count, MPV, HbA1c, imaging studies were conducted and evaluated for acute ischemic brain stroke. All the patients underwent neur...
Conclusion: Coronary Angiography remains the near gold standard in diagnosing ischemic heart disease but is associated with serious complications like stroke, arrhythmias, acute renal failure, infection, etc. Though Myocardial perfusion imaging cannot replace coronary angiogram, it can be used as a reliable and sensitive non-invasive alternate investigation to diagnose stable ischemic heart disease in high risk individuals who are unwilling for angiogram. PMID: 31324083 [PubMed - in process]
In July, Alaska Governor Michael Dunleavy slashed approximately 41 percent or $130 million from the University of Alaska system budget, a move that will have long-lasting and significant impacts on research and education throughout the state and potentially the United States. Governor Dunleavy used his line item veto authority to gut the budget of the University of Alaska system, which will likely result in the termination of research and education programs. “A preliminary rough estimate is that we would need to reduce 1,300 faculty and staff across the university system,” said Jim Johnson, President of the U...
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