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Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia
Conclusions: Among Medicare beneficiaries hospitalized with pneumonia who received mechanical ventilation, noninvasive ventilation use was not associated with a real-world mortality benefit. Given the wide CIs, however, substantial harm associated with noninvasive ventilation could not be excluded. The use of noninvasive ventilation for patients with pneumonia should be cautioned, but targeted enrollment of marginal patients with pneumonia could enrich future randomized trials.
Source: Critical Care Medicine - February 18, 2017 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
Sepsis-Associated 30-Day Risk-Standardized Readmissions: Analysis of a Nationwide Medicare Sample*
We examined the relationship between risk-standardized readmission rates and hospital-level composite measures of quality and mortality. From 633,407 hospitalizations among 3,315 hospitals from 2008 to 2011, median risk-standardized readmission rates was 28.7% (interquartile range, 26.1–31.9). There were differences in risk-standardized readmission rates by region (Northeast, 30.4%; South, 29.6%; Midwest, 28.8%; and West, 27.7%; p
Source: Critical Care Medicine - June 17, 2017 Category: Emergency Medicine Tags: Feature Articles Source Type: research
Performance of a Modern Glucose Meter in ICU and General Hospital Inpatients: 3 Years of Real-World Paired Meter and Central Laboratory Results
Objective: Due to accuracy concerns, the Food and Drug Administration issued guidances to manufacturers that resulted in Center for Medicare and Medicaid Services stating that the use of meters in critically ill patients is “off-label” and constitutes “high complexity” testing. This is causing significant workflow problems in ICUs nationally. We wished to determine whether real-world accuracy of modern glucose meters is worse in ICU patients compared with non-ICU inpatients.
Design: We reviewed glucose results over the preceding 3 years, comparing results from paired glucose meter and central laboratory tests perf...
Source: Critical Care Medicine - August 17, 2017 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Practicing Medicine While Black (Part II)
By KIP SULLIVAN
Managed care advocates see quality problems everywhere and resource shortages nowhere. If the Leapfrog Group, the Medicare Payment Advisory Commission, or some other managed care advocate were in charge of explaining why a high school football team lost to the New England Patriots, their explanation would be “poor quality.”
If a man armed with a knife lost a fight to a man with a gun, ditto: “Poor quality.” And their solution would be more measurement of the “quality,” followed by punishment of the losers for getting low grades on the “quality” report card and rewards for the winners. The ob...
Source: The Health Care Blog - November 27, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized CMS Kip Sullivan value-based care Source Type: blogs
Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock*
Objectives:
To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013–2014.
Design:
A retrospective cohort design.
Setting:
Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014.
Patients:
Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock.
Interventions:
None.
Me...
Source: Critical Care Medicine - October 13, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
The impact of inpatient palliative care on end-of-life care among older trauma patients who die after hospital discharge
CONCLUSION
Inpatient PC is associated with lower-intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underused among those who die within 6 months after discharge.
LEVEL OF EVIDENCE
Therapeutic/Care management, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - October 26, 2018 Category: Orthopaedics Tags: 2018 WTA PODIUM PAPER Source Type: research
An analysis of homeless patients in the United States requiring ICU admission
ConclusionsCritically ill homeless patients with sepsis had longer hospital LOS but similar ICU LOS and mortality risk compared to non-homeless patients. Homelessness was not associated with increased LOS in the diabetes or alcohol and drug related groups.
Source: Journal of Critical Care - October 30, 2018 Category: Gastroenterology Source Type: research
A lack of understanding for what physicians really do
I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care. The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Source: Kevin, M.D. - Medical Weblog - June 25, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/robert-j-wagner" rel="tag" > Robert J. Wagner, MD < /a > < /span > Tags: Physician Cardiology Critical Care Source Type: blogs
National Performance on the Medicare SEP-1 Sepsis Quality Measure
We examined the hospital factors associated with reporting SEP-1 data, the hospital factors associated with performance on the SEP-1 measure, and the relationship between SEP-1 performance and performance on other quality measures related to time-sensitive medical conditions. A total of 3,283 hospitals were eligible for the analysis, of which 2,851 (86.8%) reported SEP-1 performance data. SEP-1 reporting was more common in larger, nonprofit hospitals. The most common reason for nonreporting was an inadequate case volume. Among hospitals reporting SEP-1 performance data, overall bundle compliance was generally low, but it v...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System*
Conclusions and Relevance:
Our health system’s program designed to adhere to the sepsis bundle metrics led to decreased mortality and length of stay in a cost-effective manner in a much larger catchment than just the cohort meeting the Centers for Medicare and Medicaid Services measures. Our single-center model of interventions may serve as a practice-based benchmark for hospitalized patients with suspected infection.
Source: Critical Care Medicine - September 18, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Effect of IV Push Antibiotic Administration on Antibiotic Therapy Delays in Sepsis
Conclusions:
Use of an IV push strategy may safely facilitate more rapid administration of β-lactam antibiotics and may allow for better compliance with sepsis management guidelines.
Source: Critical Care Medicine - July 30, 2020 Category: Emergency Medicine Tags: Brief Report Source Type: research
Obstacles to Value-Based Care Can Be Overcome
By KEN TERRY
(This is the seventh in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Even in a healthcare system dedicated to value-based care, there would be a few major barriers to the kinds of waste reduction described in this book. First, there’s the ethical challenge: Physicians might be tempted to skimp on care when they have financial incentives to cut costs. Second, there’s a practical obstacle: Clinical guidelines are not infallible, and large parts of medicine have never be...
Source: The Health Care Blog - September 30, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Value-Based Care healthcare reform Ken Terry Source Type: blogs
Comparison of Sepsis Definitions as Automated Criteria
CONCLUSIONS:
The application of commonly used sepsis definitions on a single population produced sepsis cohorts with low agreement, significantly different baseline demographics, and clinical outcomes.
Source: Critical Care Medicine - March 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
Celebrating the 12th Anniversary of the Affordable Care Act in a Pandemic: Where Would We Be Without It?
BY ROSEMARIE DAY
When the Affordable Care Act (ACA) was signed into law twelve years ago today, Joe Biden called it “a big f-ing deal.” Little did he, or anyone else at that time, realize how big of a deal it was. Just ten years later, America was engulfed in a global pandemic, the magnitude of which hadn’t been seen in a century. Two years after that, the numbers are chilling: over 79 million people were infected, at least 878,613 were hospitalized, and 971,968 have died.
As bad as these numbers are, things would have been much worse if the ACA hadn’t come to pass. The ACA created an essential safety net t...
Source: The Health Care Blog - March 23, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Obamacare Affordable Care Act covid19 Life In the Affordable Care Act Medicaid Pandemic rosemarie day Source Type: blogs
Starting from scratch: Creating an antibiotic stewardship program in a Pediatric skilled nursing facility
In October 2016, the Centers for Medicare and Medicaid Services (CMS) published the Reform of Requirements for Long-Term Care (LTC) Facilities final rule. This rule was a long overdue revision of the requirements that LTC facilities had to meet to participate in CMS programs and had not been comprehensively reviewed and updated since 1991. (Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities, 2016). As part of this rule, LTC facilities were required to develop an Infection Prevention and Control Program (IPCP) that included an antibiotic stewardship program (ASP) and employ at least one inf...
Source: Journal of Pediatric Nursing - July 1, 2023 Category: Nursing Authors: Rochelle Beard Tags: Society of Pediatric Nurses Department Source Type: research
