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1.
Amelia Barwise Carolina Jaramillo Paul Novotny Mark L. Wieland Charat Thongprayoon Ognjen Gajic Michael E. Wilson 《Mayo Clinic proceedings. Mayo Clinic》2018,93(9):1271-1281
Objective
To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English.Patients and Methods
We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014.Results
Of the 27,523 patients admitted to the ICU, 779 (2.8%) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95% CI, 0.46-0.82; P<.001) and took 3.8 days (95% CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95% CI, 0.16-0.91; P=.03) and took 19.1 days (95% CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95% CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95% CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95% CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results.Conclusion
There are important differences in end-of-life care and decision making for patients with LEP. 相似文献2.
Diana L. Vork Terry D. Schneekloth Adam C. Bartley Lisa E. Vaughan Maria I. Lapid Sheila G. Jowsey-Gregoire Ziad M. El-Zoghby Sandra M. Herrmann Cheryl L. Tran Robert C. Albright LaTonya J. Hickson 《Mayo Clinic proceedings. Mayo Clinic》2018,93(3):321-332
Objective
To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.Patients and Methods
Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year.Results
Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups.Conclusion
Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals. 相似文献3.
Fahad Alqahtani Sami Aljohani Ali Hama Amin Mohammed Al-Hijji Oluseun O. Ali David R. Holmes Mohamad Alkhouli 《Mayo Clinic proceedings. Mayo Clinic》2018,93(5):607-617
Objective
To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR).Patients and Methods
Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs).Results
Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001).Conclusions
African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites. 相似文献4.
Objective
To determine if there was a change in the number of outpatient physical therapy (PT) and occupational therapy (OT) visits for Medicare beneficiaries, and in the number of beneficiaries receiving extended courses of >12 therapy visits, after the Jimmo vs Sebelius settlement.Design
Cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) comparing calendar years 2011-2012 to 2014-2015.Setting
Community in-home survey.Participants
Medicare Part-B recipients who received outpatient PT/OT (N=1183, median age 70.8) during pre–Jimmo settlement (2011-2012) and post–Jimmo settlement (2014-2015) time periods.Intervention
Not applicable.Main Outcome Measures
Number of therapy visits/patient/year and number of subjects who received >12 therapy visits/year estimated by linear and logistic regressions controlling for potential confounders (age, body mass index [BMI], and geographic region).Results
The unadjusted median number of therapy visits/year increased from 7 to 8 after the settlement. Linear regression estimated a 1.02 increase in the number of therapy visits after the settlement (95% confidence interval [CI] 0.23, 1.80; P=.01). The odds of having >12 therapy visits/year increased (odds ratio=1.41; 95% CI 1.02,1.96; P=.04). We observed a significant interaction between race and the effect of the settlement on the odds of having >12 therapy visits (OR 3.64; 95% CI 1.58, 8.39). Non-Hispanic white subjects saw an increase in utilization while a combined group of black, Hispanic and Asian subjects’ utilization declined.Conclusion
Utilization of outpatient PT/OT changed after the 2013 Jimmo settlement. Further research is needed to determine the effect on patient outcomes and cost. 相似文献5.
Meena Kalluri Francisca Claveria Emily Ainsley Maged Haggag Susan Armijo-Olivo Janice Richman-Eisenstat 《Journal of pain and symptom management》2018,55(2):420-426
Context
Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but are rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in interstitial lung disease and palliative respiratory care, respectively), nurse, respiratory therapist, physiotherapist, and a dietitian. We adopted an early integrated palliative approach with a focus on early symptom management and advance care planning starting at the first clinic visit. We designed a Multidisciplinary collaborative (MDC) care model with emphasis on community-based care to manage patients in their homes and support caregivers.Objectives
Exploratory analysis of this model's association with acute care utilization in the last year of life and location of death was undertaken.Methods
Data from deceased IPF patients before and after 2012 (non-MDC and MDC care model, respectively) were collected, and statistical analysis was performed.Results
Patients in MDC care were 24.2 times less likely to have respiratory-related emergency room visits (95% CI: 3.12–187.44, P = 0.002), 2.32 times less likely to have respiratory-related hospitalizations (95% CI: 0.95–5.6, P = 0.064). The odds of achieving a home or hospice death in MDC care were 9.2 times compared to non-MDC care, who die mostly in the hospital (95% CI: 1.14–75, P = 0.037).Conclusions
MDC care model for IPF was associated with reduced health care use in the last year of life and more home deaths. 相似文献6.
T. Rinda Soong Julianna J. Jung Gabor D. Kelen Richard E. Rothman Avanthi Burah Judy B. Shahan Yu-Hsiang Hsieh 《The American journal of emergency medicine》2012
Background
There is a lack of data on the effect(s) of suboptimal human immunodeficiency virus (HIV) care on subsequent health care utilization among emergency department (ED) patients with HIV. Findings on their ED and inpatient care utilization patterns will provide information on service provision for those who have suboptimal access to HIV-related care.Methods
A pilot prospective study was conducted on HIV-positive patients in an ED. At enrollment, participants were interviewed regarding health care utilization. Participants were followed up for 1 year, during which time data on ED visits and hospitalizations were obtained from their patient records. Inadequate HIV care (IHC) was defined according to Infectious Diseases Society of America recommendations as less than 3 scheduled clinic visits for HIV care in the year before enrollment. Cox regression models were used to evaluate whether IHC was associated with increased hazard of health care utilization.Results
Of 107 subjects, 36% were found to have IHC. Inadequate HIV care did not predict more frequent ED visits but was significantly associated with fewer hospitalizations (adjusted incidence rate ratio, 0.61 [95% CI: 0.43-0.86]). Inadequate HIV care did not significantly increase the hazard for earlier ED visit or hospitalization. However, further stratification analysis found that IHC increased the hazard of hospitalization for subjects without comorbid diseases (adjusted hazard ratio, 2.50 [95% CI: 1.10-5.68]).Conclusions
In our setting, IHC does not appear to be associated with earlier or more frequent ED visits but may lead to earlier hospitalization, particularly among those without other chronic diseases. 相似文献7.
Diana Dorstyn Rachel Roberts Gregory Murphy Ian Kneebone Ashley Craig Christine Migliorini 《Archives of physical medicine and rehabilitation》2018,99(2):272-280
Objective
To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS).Design
Randomized controlled design.Setting
Community-dwelling cohort.Participants
Adults (N = 95) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-five accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment.Main Outcome Measures
Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test – Revised), and mood (Patient Health Questionnaire-9).Results
Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI], .14–.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range, .42–.47; P range, .023–.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, –.23 to .57; P=.409). Completer data revealed larger, significant effect estimates (g range, .52–.64; P range, .009–.035).Conclusions
Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance. 相似文献8.
Venkat Bhat Mahmood Tazari Kymberly D. Watt Mamatha Bhat 《Mayo Clinic proceedings. Mayo Clinic》2018,93(12):1794-1802
Objective
To identify key predictors and survival outcomes of new-onset diabetes after transplant (NODAT) in liver transplant (LT) recipients by using the Scientific Registry of Transplant Recipients.Patients and Methods
Data of all adult LT recipients between October 1, 1987, and March 31, 2016, were analyzed using various machine learning methods. These data were divided into training (70%) and validation (30%) data sets to robustly determine predictors of NODAT. The long-term survival of patients with NODAT relative to transplant recipients with preexisting diabetes and those without diabetes was assessed.Results
Increasing age (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P≤.001), male sex (OR, 1.09; 95% CI, 1.05-1.13; P=.03), and obesity (OR, 1.13; 95% CI, 1.08-1.18; P<.001) were significantly associated with NODAT. Sirolimus as a primary immunosuppressant carried a 33% higher risk of NODAT than did tacrolimus (OR, 1.33; 95% CI, 1.22-1.45; P<.001) at 1 year after LT. Patients with NODAT had significantly decreased 10-year survival than did those without diabetes (63.0% vs 74.9%; P<.001), similar to survival in patients with diabetes before LT (58.9%).Conclusion
Using a machine learning approach, we found that older, male, and obese recipients are at especially higher risk of NODAT. Donor features do not affect risk. In addition, sirolimus-based immunosuppression is associated with a significantly higher risk of NODAT than other immunosuppressants. Most importantly, NODAT adversely affects long-term survival after LT in a manner similar to preexisting diabetes, indicating the need for more aggressive care and closer follow-up. 相似文献9.
Sanders Chang Peter May Nathan E. Goldstein Juan Wisnivesky Doran Ricks David Fuld Melissa Aldridge Kenneth Rosenzweig Rolfe Sean Morrison Kavita V. Dharmarajan 《Journal of pain and symptom management》2018,55(6):1452-1458
Context
Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT.Objectives
Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment. Secondarily, we evaluated drivers of cost savings including hospital length of stay, utilization of specialty-care palliative services, and PRT schedules.Methods
Patients were included in our observational cohort study if they received PRT for bone metastases at a single tertiary care hospital from 2010 to 2016. We compared total costs and length of stay using propensity score-adjusted analyses. Palliative care utilization and PRT schedules were compared by χ2 and Mann-Whitney U tests.Results
We identified 181 inpatients, 76 treated before and 105 treated after PROC. Median total hospitalization cost was $76,792 (range $6380–$346,296) for patients treated before PROC and $50,582 (range $7585–$620,943) for patients treated after PROC. This amounted to an average savings of $20,719 in total hospitalization costs (95% CI [$3687, $37,750]). In addition, PROC was associated with shorter PRT schedules, increased palliative care utilization, and an 8.5 days reduction in hospital stay (95% CI [3.2,14]).Conclusion
The PROC service, a radiation oncology model integrating palliative care practice, was associated with cost-savings, shorter treatment courses and hospitalizations, and increased palliative care. 相似文献10.
Andrew J. Jager Michael A. Tutty Audiey C. Kao 《Mayo Clinic proceedings. Mayo Clinic》2017,92(3):415-422
Objective
To evaluate the association between degree of professional burnout and physicians’ sense of calling.Participants and Methods
US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one’s life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions.Results
A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001).Conclusion
Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care. 相似文献11.
Briana L. Moreland Laura L. Durbin Judith D. Kasper Thelma J. Mielenz 《Archives of physical medicine and rehabilitation》2018,99(8):1568-1575
Objective
To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation.Design
Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design.Setting
In-person interviews of a nationally representative sample of community-dwelling older adults.Participants
Medicare beneficiaries from NHATS (N=7062).Interventions
Not applicable.Main Outcomes Measures
Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation.Results
Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52–5.77; recurrent falls: OR=14.21; 95% CI, 7.45–27.10), fear of falling (OR=3.11; 95% CI, 1.90–5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31–13.24; score 1–4: OR=4.65; 95% CI, 2.23–9.68), and hip fracture (OR=3.24; 95% CI, 1.46–7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11–.40) and Hispanic ethnicity (OR=.37; 95% CI, .15–.87) were associated with not receiving fall-related rehabilitation.Conclusions
Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year. 相似文献12.
Victor Figueiredo Leite João Eduardo Daud Amadera Anna Maria Buehler 《Archives of physical medicine and rehabilitation》2018,99(3):574-583.e1
Objective
To assess the efficacy of viscosupplementation (hyaluronic acid [HA]) on the pain and disability caused by hip osteoarthritis, and to determine the occurrence of adverse events.Data Sources
PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov database, and specific journals up to March 2017.Study Selection
Randomized controlled trials (RCTs) comparing HA with any other intra-articular injection.Data Extraction
Performed according to Cochrane/Grades of Recommendation, Assessment, Development, and Evaluation criteria. Two authors extracted data and assessed the risk of bias and quality of evidence. A random-effects meta-analysis was conducted.Data Synthesis
Eight RCTs were retrieved (n=807): 4 comparing HA to placebo; 3 to platelet-rich plasma (PRP); 3 to methylprednisolone; and 1 to mepivacaine. Some RCTs had 3 arms. There is very low evidence that HA is not superior to placebo for pain at 3 months (standardized mean difference [SMD]=?.06; 95% CI, ?.38 to .25; P=.69), and high evidence that it is not superior in adverse events (risk ratio [RR]=1.21; 95% CI, .79–1.86; P=.38). There is low evidence that HA is not superior to PRP for pain at 1 month. There is very low evidence that HA is not superior to PRP for pain at 6 and 12 months (mean difference in visual analog scale [in cm]: ?.05 [95% CI, ?.81 to .71], 1.0 [95% CI, ?1.5 to 3.50], and .81 [95% CI, ?1.11 to 2.73], respectively). There is high evidence that HA is no different from methylprednisolone for pain at 1 month (SMD=.02; 95% CI, ?.18 to .22; P=.85). There is low evidence that HA is no different from methylprednisolone for Outcome Measures in Rheumatoid Arthritis Clinical Trials–Osteoarthritis Research Society International Responders Index at 1 month (RR=.44; 95% CI, .10–1.95; P=.28). There is high evidence that HA is no different from methylprednisolone for adverse events (RR=1.21; 95% CI, .79–1.87; P=.38).Conclusions
We do not recommend viscosupplementation for hip osteoarthritis. Compared with placebo, data show scarce evidence of its efficacy up to 3 months, and suggest no difference at 6 months. However, future RCTs could present HA as an alternative to methylprednisolone for short-term symptom relief. 相似文献13.
14.
Daniel Dominguez Ferraz Karen Valadares Trippo Gabriel Pereira Duarte Mansueto Gomes Neto Kionna Oliveira Bernardes Santos Jamary Oliveira Filho 《Archives of physical medicine and rehabilitation》2018,99(5):826-833
Objectives
To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD).Design
A pilot randomized, controlled, single-blinded trial.Setting
A state reference health care center for elderly, a public reference outpatient clinic for the elderly.Participants
Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank.Intervention
The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20).Main Outcome Measures
The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale.Results
All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups.Conclusions
Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants. 相似文献15.
Dawn B. Simpson Monique Breslin Toby Cumming Sam de Zoete Seana L. Gall Matthew Schmidt Coralie English Michele L. Callisaya 《Archives of physical medicine and rehabilitation》2018,99(11):2216-2221.e1
Objective
To examine whether change in rehabilitation environment (hospital or home) and other factors influence time spent sitting upright and walking after stroke.Design
Observational study.Setting
Two inpatient rehabilitation units and community residences following discharge.Participants
Participants (N=34) with stroke were recruited.Main Outcome Measure
An activity monitor was worn continuously for 7 days during the final week in the hospital and the first week at home. Other covariates included mood, fatigue, physical function, pain, and cognition. Linear mixed models were performed to examine the associations between the environment (exposure) and physical activity levels (outcome) in the hospital and at home. Interaction terms between the exposure and other covariates were added to the model to determine whether they modified activity with change in environment.Results
The mean age of participants was 68±13 years and 53% were male. At home, participants spent 45 fewer minutes sitting (95% CI -84.8, -6.1; P=.02), 45 more minutes upright (95% CI 6.1, 84.8; P=.02), and 12 more minutes walking (95% CI 5, 19; P=.001), and completed 724 additional steps (95% CI 199, 1250; P=.01) each day compared to in the hospital. Depression at discharge predicted greater sitting time and less upright time (P=.03 respectively) at home.Conclusions
Environmental change from hospital to home was associated with reduced sitting time and increased the time spent physically active, though depression modified this change. The rehabilitation environment may be a target to reduce sitting and promote physical activity. 相似文献16.
Megan M. Chock Jane C. Lin Vidush P. Athyal J. Michael Bostwick 《Mayo Clinic proceedings. Mayo Clinic》2019,94(10):1983-1993
ObjectiveTo compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population.Patients and MethodsCases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls.ResultsIn the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls.ConclusionCompared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits. 相似文献
17.
Tetsuro Tsujimoto Hiroshi Kajio Martin F. Shapiro Takehiro Sugiyama 《Mayo Clinic proceedings. Mayo Clinic》2018,93(4):409-418
Objective
To assess the relationship between use of β-blockers and all-cause mortality in patients with and without diabetes.Patients and Methods
Using data from the US National Health and Nutrition Examination Survey 1999-2010, we conducted a prospective cohort study. The study participants were followed-up from the survey participation date until December 31, 2011. We used a Cox proportional hazards model for all-cause mortality analysis. The multivariate-adjusted hazard ratios (HRs) of the participants taking β-blockers were compared with those of the participants not taking β-blockers.Results
This study included 2840 diabetic participants and 14,684 nondiabetic participants. Compared with diabetic participants not taking a β-blocker, all-cause mortality was significantly higher in diabetic participants taking any β-blocker (HR, 1.49; 95% CI, 1.09-2.04; P=.01), taking a β1-selective β-blocker (HR, 1.60; 95% CI, 1.13-2.24; P=.007), or taking a specific β-blocker (bisoprolol, metoprolol, and carvedilol) (HR, 1.55; 95% CI, 1.09-2.21; P=.01). In addition, all-cause mortality in diabetic participants with coronary heart disease (CHD) was significantly higher in those taking beta-blockers, compared with those not taking beta-blockers (HR, 1.64; 95% CI, 1.08-2.48; P=.02), whereas that in non-diabetic participants with CHD was significantly lower in those taking beta-blockers (HR, 0.68; 95% CI, 0.50-0.94; P=.02). A propensity score–matched Cox proportional hazards model yielded similar results.Conclusion
Use of β-blockers may be associated with an increased risk of mortality for patients with diabetes and among the subset who have CHD. 相似文献18.
Matteo Fabbri Kathleen Yost Lila J. Finney Rutten Sheila M. Manemann Cynthia M. Boyd Daniel Jensen Susan A. Weston Ruoxiang Jiang Véronique L. Roger 《Mayo Clinic proceedings. Mayo Clinic》2018,93(1):9-15
Objective
To examine the impact of health literacy on hospitalizations and death in a population of patients with heart failure (HF).Patients and Methods
Residents from the 11-county region in southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code 150 (n=5121) from January 1, 2013, through December 31, 2015, were identified and prospectively surveyed to measure health literacy using established screening questions. A total of 2647 patients returned the survey (response rate, 52%); 2487 patients with complete health literacy data were retained for analysis. Health literacy, measured as a composite score on three 5-point scales, was categorized as adequate (≥8) or low (<8). Cox proportional hazards regression and Andersen-Gill models were used to examine the association of health literacy with mortality and hospitalization.Results
Of 2487 patients (mean age, 73.5 years; 53.6% male [n=1333]), 10.5% (n= 261) had low health literacy. After mean ± SD follow-up of 15.5±7.2 months, 250 deaths and 1584 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations. After adjusting for age, sex, comorbidity, education, and marital status, the hazard ratios for death and hospitalizations in patients with low health literacy were 1.91 (95% CI, 1.38-2.65; P<.001) and 1.30 (95% CI, 1.02-1.66; P=.03), respectively, compared with patients with adequate health literacy.Conclusion
Low health literacy is associated with increased risks of hospitalization and death in patients with HF. The clinical evaluation of health literacy could help design interventions individualized for patients with low health literacy. 相似文献19.
Tracy M. Mroz Ann Meadow Elizabeth Colantuoni Bruce Leff Jennifer L. Wolff 《Archives of physical medicine and rehabilitation》2018,99(6):1090-1098.e4
Objective
To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.Design
Retrospective analysis.Setting
Home health agencies.Participants
Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.Interventions
Not applicable.Main Outcome Measures
Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.Results
Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).Conclusions
As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. 相似文献20.
Lin Liu Qiang-Min Huang Qing-Guang Liu Nguyen Thitham Li-Hui Li Yan-Tao Ma Jia-Min Zhao 《Archives of physical medicine and rehabilitation》2018,99(1):144-152.e2