Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience

Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015

The number of clinicians specializing in nursing home care increased by 33.7% from 2012 to 2015, although nursing home specialists made up only 21% of nursing home clinicians in 2015. Most of these specialists were advanced practitioners (physician assistants and nurse practitioners) delivering post-acute care. The change in number of nursing home specialists varied significantly by geographic region

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities

In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF admission than patients who had an initial visit

Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations

Nursing homes’ publicly reported star ratings increased substantially since Centers for Medicare & Medicaid Services’s Nursing Home Compare adopted a 5-star rating system. Our objective was to test whether the improvements in nursing home 5-star ratings were correlated with reductions in rates of hospitalization. We hypothesized that increased attention to 5-star star ratings motivated nursing homes to make changes that improved their star ratings but did not affect their hospitalization rate, resulting in a weakened association between ratings and hospitalizations. We used 2007-2010 Medicare hospital claims and nursing home clinical assessment data to compare the correlation between nursing home 5-star ratings and hospitalization rates before versus after 5-star ratings were publicly released. The correlation between the rate of hospitalization and a nursing home’s 5-star rating weakened slightly after the ratings became publicly available. This decrease in correlation was concentrated among patients receiving post-acute care, who experienced relatively more hospitalizations from best-rated nursing homes. The improvements in nursing home star ratings after the release of Medicare’s 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients. Although this dissociation may be due to better matching of sicker patients to higher-quality nursing homes or superficial improvements by nursing homes to increase their ratings without substantial investments in quality improvement, the 5-star ratings nonetheless became less meaningful as an indicator of nursing home quality for post-acute care patients

Asthma-related exacerbations, therapy switching, and therapy discontinuation: a comparison of 3 commonly used controller regimens

Background: Asthma control is the goal of therapeutic interventions. In observational studies, the use of short-acting beta-agonises (SABAs) is a surrogate for symptoms and emergency department or hospital events for exacerbations. Objective: To compare asthma exacerbations, medication switch, and use of SABAS among 3 treatment cohorts: fluticasone propionate and salmeterol as a single inhaler (FSC), fluticasone and salmeterol as separate inhalers (FP + SAL), and fluticasone propionate alone (FP). Methods: Administrative claims data from approximately 10 million individuals from April 2000 to December 2002 were examined. Patients 15 years or older with claims for asthma, SABAs, and study medications were included in the study. Asthma-related medical and pharmacy claims were evaluated. Multivariate regression techniques were used to model the outcomes of interest, controlling for patient characteristics. Results: The odds of a hospitalization or emergency department event were significantly lower for the patients receiving FSC (n = 1,013) compared with those receiving FP (n = 1,130) (odds ratio, 0.75; 95% confidence interval, 0.61-0.93) and those receiving FP + SAL (n = 271) (odds ratio, 0.69; 95% confidence interval, 0.51-0.95). Patients receiving FSC also had a significantly lower risk of switch or discontinuation of index medication and lower rates of postindex SABA use. Conclusion: In this analysis, patients receiving FSC had lower rates of asthma-related symptoms and exacerbations as measured by SABA refills and hospitalization, respectively, when compared with patients receiving either FP or FP + SAL. This observational examination of medical and pharmacy claims data adds to the clinical reports that demonstrate the increased effectiveness of FSC when compared with FP or FP + SAL